Long-term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of age.

OBJECTIVES: To perform a neurophysiological follow-up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age. METHODS: In this study, Danish participants of the PREDICT study, including 989 surviving children from 498 twin pregnancies, were followed-up. PREDICT was a placebo-controlled randomized clinical trial examining the effect of progesterone for prevention of preterm delivery in unselected twin pregnancies. Medical histories of the children were reviewed and neurophysiological development was evaluated by the parent-completed Ages and Stages Questionnaire (ASQ) at either 48 or 60 months after the estimated date of delivery. We used the method of generalized estimating equation to account for the correlation within twins. RESULTS: A total of 492 children had been exposed prenatally to progesterone and 497 to placebo. There was no difference in the number of admissions to or length of stay in hospital between the treatment groups, and we found no overall difference in the rates of diagnoses made. However, the odds ratios (ORs) for a diagnosis concerning the heart was 1.66 (95% CI, 0.81-3.37), favoring placebo, among all children, 2.38 (95% CI, 1.07-5.30) in dichorionic twins and 8.19 (95% CI, 1.02-65.6) in all children when excluding diagnoses made at outpatient clinic visits. ASQ scores were available for 437 children (progesterone, n = 225; placebo, n = 212). Mean ASQ score was slightly higher in the progesterone group compared with the placebo group (P = 0.03). In dichorionic twins, the risk of having a low ASQ score (< 10(th) centile) was decreased in the progesterone group (OR, 0.34 (95% CI, 0.14-0.86)). CONCLUSION: Second- and third-trimester exposure of the fetus to progesterone does not seem to have long-term harmful effects during childhood, but future studies should focus on cardiac disease in the child. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Physical activity during pregnancy in normal-weight and obese women: compliance using pedometer assessment.

The objectives of this prospective study were to compare physical activity in 70 normal-weight women with a body mass index (BMI) 20-25 kg/m(2), and 70 obese with a BMI ≥ 30 kg/m(2), before and during pregnancy, and to compare compliance using the pedometer. Physical activity before pregnancy was assessed by questionnaires and during pregnancy by a pedometer worn on 7 consecutive days every 4th week. Obese women were less physically active than normal-weight women both before (p <0.05) and during pregnancy (p <0.0012). Both the compliance and the physical activity gradually declined during gestation. The change in physical activity could be described by a significant interaction between BMI group, gestational age (p <0.007) and the day of the week (p <0.001) when using ANOVA and interaction analysis. Maternal weight gain was larger in the normal-weight than in the obese women, but lower in the non-compliant obese women compared with the compliant (p <0.05).

[Sterilization of women in Denmark in 1990]. / Sterilisation af kvinder i Danmark i 1990.

Investigation of the techniques employed in sterilization of women in Denmark in 1990 was undertaken and compared to an equivalent investigation done in 1985. A questionnaire was sent to all hospitals in Denmark, Greenland and the Faroe Islands. Among the departments returning the questionnaire and carrying out sterilization of women in 1990, 29 departments were specialized gynaecological departments, 31 were non-subspecialized surgical departments and five were medical/surgical departments. Laparoscopic sterilization was used in every specialized gynaecological department. The percentage of surgical departments using this method has increased from 41.3 in 1985 to 87.0 in 1990. In 1990, bipolar electrocoagulation and clip-technique were the most frequently employed laparoscopic methods. In 1985 it was bipolar electrocoagulation. Five departments are still using unipolar electrocoagulation. In 1990, hysteroscopy mainly took place in the western part of Denmark.

PIP: An investigation of female sterilization techniques in Denmark was undertaken in 1992 and compared to an equivalent investigation done in 1985. A questionnaire was sent to all hospitals in Denmark, Greenland and the Faeroe Islands. 74 questionnaires out of 76 were answered. Two surgical departments did not answer the questionnaire. In 1990, no sterilizations were performed at 1 gynecological special department, 4 surgical departments and 3 mixed medical-surgical departments. One surgical department was converted into a medical department. Sterilizations were performed in 65 departments in 1990. Among the departments that returned the questionnaire and and that had carried out female sterilizations in 1990, 29 departments were specialized gynecological departments, 31 were nonsubspecialized surgical departments, and 5 were medical-surgical departments. Laparoscopic sterilization was used in every specialized gynecological department; the percentage of surgical departments using this method had increased from 41.3 in 1985 to 87.0 in 1990. In 1990, bipolar electrocoagulation and clip technique were the most frequently employed laparoscopic methods. In 1985 it was bipolar electrocoagulation. Five departments are still using unipolar electrocoagulation: 2 surgical departments and 3 gynecological wards. The average duration of use of uni- and bipolar electrocoagulation as well as the ring technique was 8 years, end-to-end coagulation and the clips technique averaged duration of use of 4-6 years. In east Denmark there were 23 departments (with 1914 operations), in west Denmark 39 (2934 operations), and in Greenland and the Faeroes 3 (84 operations) that carried out sterilizations totalling 65 departments (4932 operations). Refertilization operations were performed at 11 (57 operations) departments in east Denmark, 24 (127 operations) in west Denmark, and 2 (6 operations) in Greenland and the Faeroes, totaling 37 departments (190 operations). Hysteroscopy was carried out in 4 departments (61 operations) in east Denmark, and 13 (387 operations) in west Denmark, totaling 17 departments (448 operations).

[Clinical usefulness of the ROMCheck Membrane Immunoassay--a new method for the demonstration of the rupture of fetal membranes]. / Den kliniske anvendelighed af ROMCheck Membrane Immunoassay--en ny metode til påvisning of fostervandsafgang.

An investigation of the clinical usefulness of ROMCheck Membrane Immunoassay, a new method for the detection of amniotic fluid in the vagina, was undertaken. The ROMCheck-test is a monoclonal antibody test against fetal fibronectin in amniotic fluid. It was compared to commonly used methods as ferning, Nile blue staining of fetal cells and Nitrazine paper. We examined twenty pregnant women with suspected rupture of membranes and twenty women with apparently intact membranes receiving routine prenatal care. We found that clinical detection of amniotic fluid in the vagina resulted in a positive ROMCheck-test. When the ROMCheck-test was negative there was no indication of rupture of membranes. When the ROMCheck-test was positive and the other tests were negative, we could not exclude the possibility of the presence of amniotic fluid in the vagina at the time of examination. The test is a useful tool in identifying the presence or absence of amniotic fluid in the vagina.