Vibeke Brocks

Acardiac twins: pathophysiology, diagnosis, outcome and treatment. Six cases and review of the literature.

Twin gestation is often a hazardous pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Among the serious complications with twins, the twin-twin transfusion syndrome complicates 5–35% of monozygotic twin pregnancies with monochorionic placentation. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. In the following paper we review the literature on the subject and report 6 cases, 5 twins and 1 triplet, that were diagnosed at our department during the period of 1993–1997 and treated conservatively. Only 1 child survived.

Perinatal outcome after in vitro fertilisation

A prospective series of 90 consecutive pregnancies (70 singleton, 16 twin and 4 triplet pregnancies) resulting in births of 114 infants after in vitro fertilisation (IVF) at Rigshospitalet were compared to a control group of pregnancies and deliveries in 70 non‐IVF infertility patients with singleton pregnancies and 20 women with normal fertility with twin (n=16) or triplet (n=4) pregnancies. No differences in the incidence of third trimester pregnancy complications, abnormal fetal karyotypes or malformations were found. The number of women with spontaneous onset of labor and the gestational age at delivery were similar in the IVF and control groups. In singleton deliveries, the birth weight was lower (p<0.025) in the IVF group (median 3145 g, range 8904300 g) than in the control group (3399 g, 2592–4850 g), whereas in multiple gestation similar birth weights were found in the IVF and control groups. We conclude that the birth weight in singleton deliveries after IVF is lower than the birth weight in infertility patients treated differently. The cause of this difference remains obscure.

Plasma Fibronectin Concentration in Normal Pregnancy and Pre-Eclampsia

Plasma fibronectin concentration was determined by electrommuno assay in 111 normal pregnant women and in 23 pregnant with evidence of pre‐eclampsia. The plasma fibronectin concentration during the period of normal pregnancy showed a significant increase. In mild or severe pre‐eclampsia patients, the plasma fibronectin concentration was significantly higher than that measured at normal 38–41 weeks of gestation. The present findings suggest that measurement of plasma fibronectin might be of diagnostic value in pre‐eclampsia.

Routine Examination by Ultrasound for the Detection of Fetal Malformations in a Low Risk Population

A low risk population was offered screening for malformations in the second and third trimesters of pregnancy. Of 16,763 scans of pregnancies in the second trimester, 61 malformations were identified (0.36%). In the third trimester, scanning of 10,752 pregnancies revealed 24 malformations (0.22%): in all, in a low risk population 0.58% major malformations were found. The sensitivity for noncardiac malformations of the second trimester scanning was 54.3 with a specificity of 99.9%. The malformations overlooked was a more benign spectrum than the cases diagnosed. The sensitivity for cardiac malformations was less than 20%.

Circulating AMH Reflects Ovarian Morphology by Magnetic Resonance Imaging and 3D Ultrasound in 121 Healthy Girls

CONTEXT In adult women, Anti-Müllerian hormone (AMH) is produced by small growing follicles, and circulating levels of AMH reflect the number of antral follicles as well as primordial follicles. Whether AMH reflects follicle numbers in healthy girls remains to be elucidated. OBJECTIVE This study aimed to evaluate whether serum levels of AMH reflects ovarian morphology in healthy girls. DESIGN AND SETTING This was a population-based cohort study involving the general community. PARTICIPANTS Included in the study were 121 healthy girls 9.8-14.7 years of age. MAIN OUTCOME MEASURES Clinical examination, including pubertal breast stage (Tanners classification B1-5), ovarian volume, as well as the number and size of antral follicles were assessed by two independent modalities: magnetic resonance imaging (MRI), Ellipsoid volume, follicles ≥2 mm; and Transabdominal ultrasound, Ellipsoid and 3D volume, follicles ≥1 mm. Circulating levels of AMH, inhibin B, estradiol, FSH, and LH were assessed by immunoassays; T and androstenedione were assessed by liquid chromatography-tandem mass spectrometry. RESULTS AMH reflected the number of small (MRI 2-3 mm) and medium (4-6 mm) follicles (Pearsons Rho [r] = 0.531 and r = 0.512, P < .001) but not large follicles (≥7 mm) (r = 0.109, P = .323). In multiple regression analysis, small and medium follicles (MRI ≤ 6 mm) remained the main contributors to circulating AMH (β, 0.501; P < .001) whereas the correlation between AMH and estradiol was negative (β, -0.318; P = .005). In early puberty (B1-B3), the number of AMH-producing follicles (2-6 mm) correlated positively with pubertal stages (r = 0.453, P = .001), whereas AMH levels were unaffected (-0.183, P = .118). CONCLUSIONS Similarly to adult women, small and medium antral follicles (≤6 mm) were the main contributors to circulating levels of AMH in girls.

Uterine volume and endometrial thickness in healthy girls evaluated by ultrasound (3-dimensional) and magnetic resonance imaging

OBJECTIVE To report normative data on uterine volume and endometrial thickness in girls, according to pubertal stages; to evaluate factors that affect uterine volume; and to compare transabdominal ultrasound (TAUS) and magnetic resonance imaging (MRI). DESIGN Cross-sectional study of a nested cohort of girls participating in The Copenhagen Mother-Child Cohort. SETTING General community. PATIENT(S) One hundred twenty-one healthy girls, aged 9.8-14.7 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical examination, including pubertal breast stage (Tanner classification: B1-B5). Uterine volume: ellipsoid TAUS (n = 112) and 3-dimensional TAUS (n = 111); ellipsoid MRI (n = 61). Endometrial thickness: TAUS (n = 110) and MRI (n = 60). RESULT(S) Uterine volume and endometrial thickness were positively correlated with pubertal stages; e.g., ellipsoid TAUS: r = 0.753, and endometrium TAUS: 0.648. In multiple regression analyses, uterine volume was associated with the number of large follicles (TAUS >5 mm) (Beta 0.270); estradiol (E2) (Beta 0.504); and height (Beta 0.341). Volumes from ellipsoid vs. 3-dimensional TAUS were strongly correlated (r = 0.931), as were TAUS and MRI: ellipsoid volume (r = 0.891) and endometrial thickness (r = 0.540). Uterine volume was larger in TAUS compared with MRI; mean difference across the measured range: 7.7 (5.2-10.2) cm(3). Agreement was best for small uteri. CONCLUSION(S) Uterine volume and endometrial thickness increased as puberty progressed. Circulating E2 from large follicles was the main contributor to uterine and endometrial growth. The TAUS and MRI assessments of uterus and endometrium were strongly correlated.