Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial.

OBJECTIVE: To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications. DESIGN: Randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark. POPULATION: Women with singleton pregnancy in the vertex position undergoing labour induction or augmentation. METHODS: Two hundred women were randomised when cervical dilation was ≤4 cm to either continue or discontinue oxytocin infusion when cervical dilation reached 5 cm. MAIN OUTCOME MEASURES: The primary outcome was duration of the active phase of labour, defined as the time period from 5 cm of cervical dilation until delivery. Secondary outcomes were mode of delivery, uterine tachysystole, hyperstimulation, abnormalities in fetal heart rate, postpartum haemorrhage rate, perineal tears, and neonatal outcomes. RESULTS: The active phase of labour was longer by 41 minutes (95% confidence interval 11-75 minutes) in the discontinued group (median 125 minutes in 85 women who had reached the active phase and delivered vaginally) versus the continued group (median 88 minutes in 78 women). The incidence of fetal heart rate abnormalities (51 versus 20%) and uterine hyperstimulation (12 versus 2%) was significantly greater in the continued than the discontinued oxytocin group. The incidence of tachysystole, caesarean deliveries, postpartum haemorrhage, third degree perineal tears and adverse neonatal outcomes was higher in the continued group, but did not reach significance. CONCLUSIONS: Discontinuation of oxytocin infusion in the active phase of labour may improve some labour outcomes but has the disadvantage of increasing the duration of the active phase of labour. TWEETABLE ABSTRACT: Stopping oxytocin in the active phase seems to make labour less complicated but lengthens duration.

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.

Increased nuchal translucency, normal karyotype and infant development.

OBJECTIVE: To investigate whether chromosomally normal fetuses with a nuchal translucency (NT) ≥ 99th percentile(3.5 mm) in the first trimester have an increased risk of delayed development at 2 years of age. METHODS: The study included children of women from 10 Danish hospitals who had fetal NT either ≥ 99th percentile (Group 1) or <95th percentile (Group 2) in the first trimester. The groups were matched by gender,gestational age at birth and maternal age. There were twice as many children in Group 2 as in Group 1. Follow-up was conducted at 2 years of age, infant development being assessed by the 'Ages and Stages Questionnaire'. The cutoff value for delayed development was defined as the 5th percentile from the first 100 questionnaires from Group 2. RESULTS: In a 1-year period 202 of 33 266 fetuses (0.6%)had NT ≥ 3.5 mm. Of these, 99 (49.0%) were liveborn with normal karyotype and normal ultrasound findings during pregnancy. The response rate to the ASQ was 83.3% in Group 1 and 71.4% in Group 2. A low ASQ score was found in 1.3% (1/80) and 4.4% (6/137)in Groups 1 and 2, respectively (P = 0.265), but no difference was found in the mean ASQ score between the two groups (P = 0.160). CONCLUSION: Fetuses with NT ≥ 99th percentile, normal karyotype and normal ultrasound findings during pregnancy had no increased risk of developmental delay at 2 years of age compared with fetuses with normal NT(<95th percentile).

[Management of prolonged pregnancy in Denmark. A questionnaire study]. / Behandling af overbåren graviditet i Danmark. En spørgeskemaundersøgelse.

In order to describe how post-term pregnancy was managed in Denmark, a questionnaire was sent to all 50 maternity departments with a 100% response rate. Thirty-nine departments managed post-term pregnancy; twenty-one departments conservatively (i.e.expectantly) and 18 departments with induction of labour. Cardiotocography in the surveillance of the foetus was routine in 35 departments; 21 departments monitored with ultrasound and 18 used human placental lactogen. Gestational age was confirmed by ultrasound before 20th week of gestation in nine of ten departments with > 2000 births per year, in four of 19 departments with 1000-2000 births per year, and in five of ten departments with < 1000 births per year. Ten departments which managed post-term pregnancy by induction did not routinely confirm gestational age by ultrasound. Danish obstetricians differ in their management of post term pregnancy. Cumulative data from prospective, randomized studies can be interpreted as showing an active policy of induction to be advantageous. A large multicentre study is difficult, but desirable in order out to discuss for and against induction or expectant management.

A phase II trial of ifosfamide, 5-fluorouracil, and leucovorin in recurrent uterine cervical cancer.

Thirty patients with recurrent squamous cell carcinoma of cervix uteri no longer amenable to control with surgery and/or radiotherapy were treated with a combination of ifosfamide, 5-fluorouracil, and Leucovorin every 4 weeks. The response rate was 53% (complete response, 33%; partial response, 20%). Response rates outside and inside irradiated area were 68 and 27%, respectively. The median progression-free interval was 7 months, and the median overall survival was 12 months. Adverse effects included primarily leukopenia, and dose reduction was necessary in 18 patients (60%). The present combination is active in the treatment of recurrent cervical cancer with a high response rate. The long-term survival is however still unsatisfactory.

Renal malignancy in von Hippel-Lindau's disease. Case reports.

We present our experience with 4 patients with von Hippel-Lindau's disease. They all had asymptomatic renal malignancy, and three patients had bilateral tumors. None of the patients had metastases from their renal tumors, but two patients had developed new tumors which demanded surgery. Abdominal computerized tomography was first choice in the initial evaluation, eventually supplemented by renal angiography. The treatment should be conservative, but bilateral nephrectomy and hemodialysis may be required. Screening of at-risk family members and close and lifelong follow-up is emphasized.

Chemotherapy in perineal leiomyosarcoma.

A case report of a woman with perineal leiomyosarcoma who was cured by combination chemotherapy is presented, and the literature on chemotherapy of soft tissue is reviewed.

A comparison of Lamicel tents and gemeprost (Cervagem) pessaries prior to first trimester abortion.

In an open, randomized study 108 women were treated with either a Lamicel tent or a 1 mg gemeprost pessary (Cervagem) 4 h before first trimester abortion. Both treatments were effective in producing cervical dilatation, however further dilatation was significantly easier after Cervagem. Preoperative abdominal pain and gastrointestinal side-effects were significantly more frequent in the Cervagem group. The incidence of postoperative pain and blood loss were similar in the two groups. Advantages and disadvantages of the two treatments are mentioned.

[Fertility after extrauterine pregnancy. A 16-year retrospective study]. / Fertilitet efter ekstrauterin graviditet. En 16 års retrospektiv opgørelse.

A retrospective investigation of fertility following extrauterine pregnancy during a period of 16 years in a central hospital was carried out. Out of 283 women with extrauterine pregnancy, if proved possible to investigate the postoperative fertility in 181 women. It was found that 71.8% of the patients conceived and 49.2% were delivered of living infants while 16% developed renewed extrauterine pregnancies. No significant differences were found in the frequencies of renewed extrauterine pregnancy and the number of liveborn infants between women who had been submitted to radical operation and women in whom conservative operative methods were employed. On the basis of this investigation and review of the literature, the present authors consider, that conservative operation should be employed where this is technically possible.