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.

Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial.

OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes. DESIGN: Randomised controlled multicentre open-label trial. SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011. POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section. METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days). MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events. RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups. CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

Contraceptive attitudes and contraceptive failure among women requesting induced abortion in Denmark.

BACKGROUND: To elucidate how contraceptive attitudes among Danish-born and immigrant women influence the request of induced abortion. METHODS: A case-control study, the case group comprising 1095 Danish-born women and 233 immigrant women requesting abortion, in comparison with a control group of 1295 pregnant women intending to give birth. The analysis used hospital-based questionnaire interviews. RESULTS: Lack of contraceptive knowledge and experience of contraceptive problems were associated with the choice of abortion. This association was most pronounced among immigrant women, where women lacking knowledge had a 6-fold increased odds ratio (OR) and women having experienced problems a 5-fold increased OR for requesting abortion. Further, in this group of women, a partner's negative attitude towards contraception was associated with an 8-fold increased OR for requesting abortion. Contraceptive failure was prevalent; 21% of the women who did not plan to become pregnant but intended to give birth had experienced contraceptive failure. The same applied, respectively, for 45% of the Danish-born women and 36% of immigrant women, who requested abortion. Women who had experienced contraceptive failure were significantly more likely to request abortion. CONCLUSIONS: Immigrant women seem to have more difficulties in using contraception than Danish-born women. To address this problem, there is a need for culturally sensitive information campaigns targeting this heterogonous group of women.

Ovarian volume in gynecologically healthy women using no contraception, or using IUD or oral contraception.

OBJECTIVE: The aim of this study was to determine the ovarian volume by transvaginal ultrasonography in a gynecologically healthy population of women using no contraception, using intrauterine contraceptive device, or using oral contraceptive. MATERIALS AND METHOD: The study had a cross-sectional design. The ovaries of 428 women aged 1445 who contacted the family planning clinic in the county of Funen were examined. Most of the statistical analyses were carried out using standard techniques. However polynominal regression analysis was used to model ovarian volumes as a function of the day of cycle. RESULTS: No differences between the volumes of the right and the left ovary were found in any of the groups. Significant differences were found between the ovarian volumes of the three groups. The ovarian volumes were found to be largest in women using intrauterine contraceptive device, lesser in women using no contraception and smallest in women using oral contraception. A significant difference was found of the ovarian volumes throughout the menstrual cycle in women who were not using oral contraception. The ovarian volumes did not change throughout the menstrual cycle in women using oral contraception. In women not using oral contraception the largest ovary increased in volume from the start of the cycle to day 19, thereafter the volume declined. No evidence of any change of volume over the menstrual cycle was found in the smallest ovary and, for women using oral contraception, both ovaries. There was no correlation between age, height, weight, parity, and ovarian volume in any of the groups. CONCLUSION: The ovarian volumes, in gynecologically healthy women using intrauterine contraceptive device, are larger than in women using no contraception. It appears that oral contraception reduces the volumes of both ovaries in all phases of the menstrual cycle to equal levels.

PIP: The aim of this cross-sectional study was to determine the ovarian volume by transvaginal ultrasonography in a gynecologically healthy population of women using no contraception, using IUDs, or using oral contraceptives (OCs). The ovaries of 428 women aged 14-45 who contacted the family planning clinic in the county of Funen were examined. Most of the statistical analyses were carried out using standard techniques. However, polynominal regression analysis was used to model ovarian volumes as a function of the day of cycle. No differences between the volumes of the right and the left ovary were found in any of the groups. Significant differences were found between the ovarian volumes of the three groups. The ovarian volumes were found to be largest in women using IUDs, lesser in women using no contraception, and smallest in women using OCs. A significant difference was found of the ovarian volumes throughout the menstrual cycle in women who were not using OCs. The ovarian volumes did not change throughout the menstrual cycle in women using OCs. In women not using OCs the largest ovary increased in volume from the start of the cycle to day 19; thereafter the volume declined. No evidence of any change of volume over the menstrual cycle was found in the smallest ovary and, for women using OCs, in both ovaries. There was no correlation between age, height, weight, parity, and ovarian volume in any of the groups. The ovarian volumes in gynecologically healthy women using IUDs are larger than in women using no contraception. It appears that OC use reduces the volumes of both ovaries in all phases of the menstrual cycle to equal levels.

[Transvaginal ultrasonography. Clinical applications]. / Transvaginal ultralydskanning. Kliniske anvendelsesområder.

Transvaginal ultrasonography has an excellent patient acceptability and generally gives a more detailed picture of pelvic structures compared to what can be achieved by the transabdominal route, mainly because of the higher sound-frequency of the probes (5-7.5 MHz). On the basis of recent literature, a review is given concerning major clinical applications. The method has a firmly established role in diagnosing complications during early pregnancy as well as in modern infertility treatment. Recent advances have been obtained in several other fields of obstetrics and gynaecology, but further studies are still needed. Color Doppler mapping and characterization of flow by Doppler spectral analysis show great potentials in the hands of the gynaecological oncologist.

The inner ear of the common rhea (Rhea americana L.).

The morphology of the inner ear in rheas was examined by light and electron microscopy. The shape is typically bird-like with very long semicircular canals. The anterior and posterior cristae have small septa cruciata. The vestibular sensory epithelia contain two main types of hair cell innervation; bouton-innervated hair cells and calyceal hair cells characterized by a surrounding nerve calyx. The utricular macula has a single zone of calyceal hair cells, while all other previously examined birds, except the mute swan, have 2 zones. The height of the tallest sensory hairs of the cristae is 20-30 microns. In the utricular and lagenar macula, the hairs are 5-7 microns in the striola and 10-20 microns in the main parts of the sense organs. Along the edges of the maculae the longest hairs may reach 20-30 microns. The number of stereovilli on mature vestibular hair cells is 40-60. The sensory hairs of the hearing organ, the basilar papilla, are generally shorter but more numerous than the vestibular sensory hairs. In the proximal end, the tallest of the 175-200 stereovilli are 2.8-3.7 microns; in the distal end of the papilla, the number of stereovilli decrease to 65-100, and their height increases gradually to 7.3-8.7 microns. The neural sensory hairs are generally taller than those of the abneural side.

The chronic compartment syndrome and response to diuretic treatment.

In five middle-aged men with calf pain during jogging or fast walking, chronic compartment syndrome of the calf or anterior tibial muscles was revealed by circulatory studies which included measurement of compartment tissue pressure. After two to three weeks of diuretic medication the men were re-examined. Initially elevated compartment tissue pressures at rest and after exercise were significantly decreased following diuretic treatment. The study indicates that calf pain similar to that of arterial insufficiency may be caused by compartment syndrome even in elderly persons and may be relieved with diuretic medication.