Prenatal detection of trisomy 21 by second-trimester ultrasound examination and maternal age in a non-selected population of 49 314 births in Norway.

OBJECTIVES: To assess the contribution of the second-trimester routine ultrasound examination and maternal age (>or= 38 years) to the prenatal detection of trisomy 21 in a large non-selected population in which no other screening methods were carried out. METHODS: A prospective follow-up study was carried out in a non-selected Norwegian population from 1987 to 2004, including a total of 49 314 births. Data from all cases of trisomy 21, detected prenatally by karyotyping following amniocentesis performed for abnormal ultrasound findings or because of maternal age >or= 38 years, or postnatally after delivery, were registered. The study period was divided into three 6-year periods. RESULTS: Eighty-eight cases of trisomy 21 were registered. The prenatal detection rate was 43% (38/88). No significant change in the detection rate was observed over the 18 years. Fourteen percent (12/88) of cases were detected as a result of advanced maternal age and 30% (26/88) by prenatal ultrasound examination. Of all women with a trisomy 21 fetus, 72% (63/88) were under 38 years of age. The percentage of women >or= 38 years opting for karyotyping during the three time periods decreased significantly from 51% to 50% and 36%, respectively. The termination rate of trisomy 21 fetuses was 84%, with no significant change over time. CONCLUSIONS: Our data can be considered as a reference standard for population screening for trisomy 21 based solely on maternal age and second-trimester ultrasound imaging. The prenatal detection rate of trisomy 21 cases was poor and remained unchanged throughout the 18-year study period. If improvement in detection rates is desired, additional programs are necessary.

Prenatal ultrasound detection of facial clefts: a prospective study of 49,314 deliveries in a non-selected population in Norway.

OBJECTIVES: To evaluate prenatal detection of facial clefts by ultrasound examination in a large non-selected population, and to study trends in detection rates over 18 years, as well as the prevalence of isolated cases and those with associated anomalies. METHODS: This prospective follow-up study from January 1987 to December 2004 was divided into two 9-year periods. The study included all registered cases of prenatally or postnatally diagnosed facial clefts in a non-selected population in Norway. RESULTS: A total of 101 fetuses or newborns with facial clefts in a population of 49 314 deliveries were registered. The distribution of clefts was: 25 (25%) cleft lip, 52 (51%) cleft lip and palate, and 24 (24%) cleft palate (CP). No CP was detected prenatally. Cleft lip with or without cleft palate (CL(P)) was detected prenatally in 35/77 (45%) cases, with a significant increase in the detection rate from 34% to 58% between the two 9-year periods (P = 0.03). Over the whole study period CL(P) was detected at a median of 19 + 2 gestational weeks, with no change over time; altogether 24/35 (69%) cases were detected at the routine second-trimester ultrasound examination. Thirty-three of 77 (43%) cases of CL(P) and 14/24 (58%) cases of CP had associated anomalies; 12/101 (12%) had chromosomal aberrations. In 18/101 (18%) the clefts were part of a syndrome or sequence. CONCLUSIONS: The detection rate for CL(P) improved significantly over time. Detection of CL(P) is important because nearly half the cases have associated anomalies.

Prenatal ultrasound detection of talipes equinovarus in a non-selected population of 49 314 deliveries in Norway.

OBJECTIVES: To evaluate prenatal ultrasound detection of talipes equinovarus (TEV) in a large non-selected population and to study trends in detection rates over time, as well as the prevalence and outcome of isolated TEV and TEV with associated anomalies. METHODS: All cases of pre- or postnatally diagnosed TEV between 1987 and 2004 within a non-selected population of 49 314 deliveries were investigated. The study period was divided into three 6-year periods to shed light on changes in detection rates and other aspects of the anomaly over time. RESULTS: A total of 113 cases of TEV were registered during the 18-year period, of which 49% had isolated TEV and 51% had associated anomalies. During the three 6-year periods, there was a significant improvement (P = 0.006) in the overall detection of TEV from 43% to 67% and 77%, respectively. The detection rate for isolated TEV increased over time. Isolated bilateral TEV cases were detected more than twice as often as isolated unilateral TEV. The three largest groups of associated anomalies were syndromes/sequences (26%), chromosome aberrations (26%), and musculoskeletal disorders (24%). Pregnancies were terminated in 23% of the cases, all with severe additional anomalies. Treatment of TEV included surgery in 86% of the cases. CONCLUSION: The overall detection rate of TEV improved significantly over time. Prenatal detection was higher when TEV was bilateral and when other associated anomalies were present. Parents should be informed that, in suspected isolated TEV, associated anomalies might remain undetected prenatally.

Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study.

BACKGROUND: Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims. METHODS: We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's chi(2) test. FINDINGS: The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit. INTERPRETATION: Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

The morphology of the inferior epigastric artery has implications on its use as a conduit for myocardial revascularization.

The inferior epigastric artery (IEA) is a new arterial graft for myocardial revascularization. We examined the inferior epigastric artery, the internal thoracic artery (ITA) and representative sections of the coronary arteries in 45 postmortem examinations, for microscopic signs of atherosclerosis. In addition, a morphometric evaluation of the intima and media of both conduits was performed. The intima of the ITA is significantly thicker, but atherosclerosis is absent. There are fewer fenestrations/mm in the internal elastic lamina (IEL) (4.00 +/- 1.60 versus 4.62 +/- 1.46) of the IEA and the combined thickness of media and intima is lower (0.20 +/- 0.04 mm versus 0.30 +/- 0.06 mm). However, 24% of IEAs showed medial calcification of variable degrees. We conclude that the IEA should not be used routinely for myocardial revascularization until the long-term patency of this graft has been explored.