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.

Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies.

OBJECTIVE: To assess outcome in twin pregnancies according to chorionicity. METHODS: A cohort was retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between weeks 11 and 14 in the period 1 January 2004 to 31 December 2006. Outcome data were retrieved from the National Board of Health. RESULTS: Among 2038 twin pregnancies, 1757 (86.2%) were dichorionic (DC) and 281 (13.8%) were monochorionic diamniotic (MC). In MC pregnancies, the rate of spontaneous fetal loss in both second and third trimesters was more than threefold higher than the comparable rate in DC pregnancies: 6.0% vs. 1.9% for at least one fetus in the second trimester (P < 0.001) and 2.1% vs. 0.7% in the third trimester (P = 0.03). In 98.4% of DC pregnancies and in 91.1% of MC pregnancies, at least one infant was liveborn. Amongst pregnancies with two live fetuses at 24 weeks, the proportion with two live infants at 28 days after delivery was 97.5% and 95.1%, respectively. CONCLUSIONS: The increased incidence of fetal loss in MC pregnancies compared with DC pregnancies predominantly occurs before 24 weeks' gestation. After this stage, although the risk of intrauterine fetal death is still higher in MC than in DC pregnancies, if both fetuses are alive at 24 weeks, the chance of a woman having two live infants 1 month after delivery is similar in MC and DC pregnancies.

A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis.

A 7-month outbreak of 15 cases of postpartum sepsis with group A haemolytic Streptococci (GAS) was stopped when a carrier was identified. Comparing delivery dates with duty rotas revealed that the carrier had been present during delivery in 13 of the 15 cases. The epidemic GAS type, T3-13-B3264, was found in a carbuncle in her groin and in atopic dermatitis lesions behind her ears and on her eyelids. Thus, it was not the microbiological screening of staff that helped detect the carrier. The outbreak went unnoticed for 6 months, as no 2 cases were diagnosed by the same physician and 5 cases were diagnosed by different general practitioners. The main risk factors for infection were presence of the carrier relative risk (relative risk RR 47.8, 95% confidence interval (CI) 10.9-209.5) and suturing of episiotomy (RR 11.0; 95% CI 2.6-47.9). We recommend that a thorough epidemiological investigation should be carried out in every single case of GAS postpartum infection. Despite initial intravenous treatment with penicillin, 8 patients experienced > 15 recurring postpartum GAS infections, such as endometritis, wound infection, tonsillitis, erysipelas and Brodie's abscess. Eradication of GAS should be confirmed after completion of treatment.

[Perinatal audit in the county of Viborg 1994-1996]. / Perinatal audit i Viborg Amt 1994-1996.

The purpose of this article is to present the results of the perinatal audit in Viborg County during the years 1994-1996. The perinatal deaths in Viborg County were classified according to commonly used classifications in perinatal audit evaluations, and mortality rates were calculated according to international definitions and compared with data from the Danish National Birth Register, 1995. During 1994-1996 the perinatal mortality rate decreased from 9.4/1000 deliveries to 6.5/1000 deliveries and the neonatal mortality rate decreased from 3.2/1000 deliveries to 2.4/1000 deliveries. The reductions were not statistically significant. No significant difference in mortality rates between Viborg County and overall national mortality rates in 1995 was shown.

Prenatal diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency in a family with a previous fatal case of sudden unexpected death in childhood.

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is a potentially fatal inherited disease with a carrier frequency of approximately 1:100 in most Caucasian populations. The disease is implicated in sudden unexpected death in childhood. A prevalent disease-causing point mutation (A985G) in the MCAD gene has been characterized, thus rendering diagnosis easy in the majority of cases. Since the clinical spectrum of MCAD deficiency ranges from death in the first days of life to an asymptomatic life, there are probably other genetic factors--in addition to MCAD mutations--involved in the expression of the disease. Thus, families who have experienced the death of a child from MCAD deficiency might have an increased risk of a seriously affected subsequent child. In such a family we have therefore performed a prenatal diagnosis on a chorionic villus sample by a highly specific and sensitive polymerase chain reaction (PCR) assay for the G985 mutation. The analysis was positive and resulted in abortion. We verified the diagnosis by direct analysis on blood spots and other tissue material from the aborted fetus and from family members.

Cord blood IgE. I. IgE screening in 2814 newborn children.

Screening of total IgE in 2814 cord blood samples was analysed by Phadebas IgE PRIST in 2 1-year birth cohorts (1983-1984 and 1985-1986) in Denmark (n = 1189 + 1625). 48.6% of the sera contained less IgE than the detection limit 0.1 kU/l. Cord blood IgE values greater than or equal to 0.5 kU/l were regarded as elevated. 13.2% of the sera contained at least 0.5 kU/l of IgE, with a significant preponderance in boys. Geometric mean cord blood IgE was 0.13 kU/l and 0.12 kU/l, respectively. Geometric mean cord blood IgE was significantly higher in boys. A significant seasonal variation with lowest IgE values in the autumn was found. No correlation between cord blood IgE and birth weight or gestational age was demonstrated. Only few newborns had cord blood IgA values greater than 0.014 g/l, calculated as geometric mean cord blood IgA + 2 SD among children with no detectable cord blood IgE, indicating infrequent contamination with maternal blood.

Cord blood IgE. II. Prediction of atopic disease. A follow-up at the age of 18 months.

Screening of total IgE in 2814 cord blood samples was analysed by Phadebas IgE PRIST in 2 1-year birth cohorts (1983-1984 and 1985-1986) in Denmark (n = 1189 + 1625). For follow-up we chose all infants with cord blood IgE greater than or equal to 0.5 kU/l and a randomly chosen group of the same size with cord blood IgE less than 0.5 kU/l. A total of 762 infants were clinically evaluated at 18 months of age. A diagnosis of definite atopy, probable atopy or no atopy, including both IgE and non-IgE mediated disease was established. Applying different cord blood IgE cut-off values (0.3, 0.5, 0.8, 1.1) we did not find an excess of atopic infants among those with elevated cord blood IgE irrespective of the chosen cut-off value. Atopic predisposition or family history of atopic disease was defined as at least one parent or older sibling with atopic disease. Significantly more infants with a family history developed atopy at 18 months. In the 2 series the positive predictive values of cord blood IgE greater than or equal to 0.5 were 43% and 46% and the sensitivities were 17% and 15%. The predictive values of having a family history were 48% and 44% and the sensitivities were 55% and 58%.

Cord blood IgE. III. Prediction of IgE high-response and allergy. A follow-up at the age of 18 months.

Screening of total IgE in 2814 cord blood samples was analysed by Phadebas IgE PRIST in 2 1-year birth cohorts (1983-1984 and 1985-1986) in Denmark (n = 1189 + 1625). For follow-up we chose all infants with cord blood IgE greater than or equal to 0.5 kU/l and a randomly chosen group of the same size with cord blood IgE less than 0.5 kU/l. A total group of 762 infants were clinically evaluated at 18 months of age, and in 688 of these we evaluated total and specific IgE. A diagnosis of definite atopy, probable atopy or no atopy was established. In the present study we defined allergic disease as atopic disease combined with elevated total IgE. We found a statistically significant correlation between cord blood IgE and IgE at 18 months of age. Significantly more infants with elevated cord blood IgE had developed allergic disease at 18 months. A cut-off value of 0.3 kU/l for cord blood IgE was superior to the originally suggested 0.5 kU/l. Significantly more infants with elevated cord blood IgE had developed specific IgE antibodies at 18 months. The most frequent specific IgE antibody was towards cow's milk. Specific IgE antibodies were very rarely found when total IgE was not elevated. A total IgE at the age of 18 months greater than 26 kU/l could be regarded as elevated. With regard to allergic disease the positive predictive values of cord blood IgE greater than or equal to 0.3 kU/l in the 2 series were 21% and the corresponding sensitivities 67% and 46%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of prenatal death in the community of Viborg, Denmark.

In order to lower the perinatal mortality rate, it is necessary to acquire a specific fetal diagnosis in all late abortions and stillbirths. A uniform classification for the maternal/fetal diagnosis is needed for comparison of progress in maternity care program between the different countries. We have studied 86 consecutive cases of late abortion and stillbirth at Viborg Hospital, Denmark, and made a comparison with the modified Aberdeen classification of fetal death.

Cimetidine as pre-anesthetic agent for cesarean section: perinatal effects on the infant, the placental transfer of cimetidine and its elimination in the infants.

In a prospective randomized study of 39 consecutive cesarean sections, 20 patients received cimetidine 400 mg intramuscularly as a pre-anesthetic, an 19 control patients were given NaCl. No perinatal effects on the infants were observed by cardiotocography before delivery, and K, Na, pH, PCO2, HCO-3 and glucose values in capillary blood were nearly identical in the two groups 2 hours after birth, the difference being non-significant (p greater than 0.05). No respiratory effects or arrhythmias were observed. In another study comprising 8 elective cesarean sections in patients with uncomplicated pregnancies, cimetidine was found to cross the placenta at a maternal/cord blood ratio of 3:1. The drug could not be detected in any of the infants 2 hours after delivery.

Conization of the cervix uteri. Complications in connection with plain catgut or silk suturing.

During a retrospective study on postoperative complications in 213 patients who had undergone conization, a (non-significant) reduction in the bleeding rate from 27.9% to 18.6% was found when using silk sutures (102 patients) instead of plain catgut (111 patients) for adaption of the edges of the wound (0.1 less than p less than 0.2). The reduction was most pronounced and significant in cases where bleeding had occurred during the first 4 days after surgery, the usual period for hospital stay under normal conditions. After discharge the bleeding rates were more comparable, 12.6% in the catgut group and 16.6% in the silk group. On the other hand, more cases of stenosis of the cervical canal were observed, i.e., 25.5% in the silk group and 8.1% in the catgut group (p less than 0.001). The period of hospitalization was reduced on an average by 2 days when using silk (p less than 0.001).