Danish National IVF Registry 1994 and 1995. Treatment, pregnancy outcome and complications during pregnancy.

SUBJECT: Data from the compulsory Danish National IVF Registry from 1994 and 1995 regarding treatments, abortions and complications following assisted reproductive technologies. METHODS: Data were generated through registries and compared to pregnancies in Denmark in 1995. Those pregnancies that resulted in a delivery were compared to a matched control group. RESULTS: In 1994 and 1995 5219 women were treated in 9471 initiated cycles. The numbers increased over the period. The overall delivery rate per initiated cycle was 19%, egg donation 24%, IVF 20%, ICSI 16% and frozen egg replacement 10%. The rates increased over the period. The rate of spontaneous abortions was highest for ICSI (25%) and egg donation (27%). For IVF and ICSI the birth rates per transfer of 1 embryo was 13, 1%, 2 embryos 25, 4%, 3 embryos 25, 8% and 4 or more 3, 8%. Transfer of 2 embryos resulted in 75% singleton, 25% twin and 0.2% triplet deliveries. After transfer of 3 embryos the corresponding rates were 68%, 29% and 4%. No quadruplet deliveries occurred. Totally, 1.4% reported complications to the treatment, the most frequent being ovarian hyperstimulation syndrome. In the study group 5.8% of the women who gave birth were diagnosed with imminent abortion vs. 3.0% in the control group (OR 1.98, CI 1.41-2.78). CONCLUSIONS: Transfer of three embryos did not result in higher pregnancy rates as compared to transfer of two embryos. The first data from the Danish IVF Registry support data from other registries regarding treatment, pregnancy outcome and complications during pregnancy.

Danish National In-Vitro Fertilization Registry 1994 and 1995: a controlled study of births, malformations and cytogenetic findings.

This paper reports data from the Danish in-vitro fertilization (IVF) registry from 1994 to 1995 including data on treatments and the results of these (perinatal outcome, cytogenetic findings and fetal malformations) in comparison with a control group matched for maternal age, parity, multiplicity and year of birth. There were 1756 deliveries of 2245 children (24.3% twins, 1.8% triplets). The rate of prematurity among IVF children was 23.8% (NS) [singletons 7. 3% (P < 0.05), twins 41.2% and triplets 93.5%], 23.6% weighed <2500 g [singletons 7% (P < 0.05), twins 42.2% and triplets 87.1%]. The perinatal mortality rate was 21.8 in the study group compared to 17. 4 in the control group (NS). In total, 13.2% of all clinical pregnancies and 15.4% of the pregnancies that resulted in a delivery had a prenatal genetic examination. Of all examined, 3.5% had an abnormal karyotype. In total, 107 (4.8%) children in the study group and 103 (4.6%) in the control group were born with malformations (NS), compared to 2.8% in the background population. Our results indicate that it is the characteristics of the patients and multiplicity of pregnancy, rather than the assisted reproductive technology that determines the fetal risks of IVF pregnancies compared to the background population.

[Catheter-directed thrombolytic therapy--a current alternative to proximal deep venous thrombosis]. / Kateterbasert trombolytisk behandling--aktuelt alternativ ved proksimal dyp venetrombose.

Deep venous thrombosis extending into the iliac veins is associated with significant acute and late morbidity despite adequate conventional treatment with heparin and oral anticoagulants. The purpose of this paper is to focus on a multidisciplinary, aggressive approach with catheter-directed thrombolysis, in which a catheter with many side-holes is placed within the thrombus and thrombolytics infused. The aim is to eliminate the thrombus, to provide unobstructed venous drainage from the affected limb, and to prevent recurrent thrombosis. Total recanalisation of the iliofemoral segment was achieved in three of four treated patients, while partial lysis was obtained in one patient with symptoms for four weeks. Two weeks after discharge, two patients had no symptoms, while two had a moderate leg oedema. All of the three women used oral contraceptives at the time of thrombus formation; two had hereditary thrombophilia. Most probably, successful catheter-directed thrombolysis will reduce the incidence of post-thrombotic syndrome, but there are no long-term follow-up studies after such treatment.

Multicentre randomised study of computerised anticoagulant dosage. European Concerted Action on Anticoagulation.

BACKGROUND: The demand for anticoagulant treatment is increasing. We compared the benefits of computer-generated anticoagulant dosing with traditional dosing decided by experienced medical staff in achieving target international normalised ratios (INRs). METHODS: In five European centres we randomly assigned 285 patients in the stabilisation period and stabilised patients to the computer-generated-dose group (n=137) or traditional-dose group (n=148). Centres had a specialist interest in oral anticoagulation but no previous experience with computer-generated dosing. The computer program calculated doses and times to next visit. Our main endpoint was time spent in target INR range (Rosendaal method). FINDINGS: For all patients combined, computer-generated dosing was significantly beneficial overall in achieving target INR (p=0.004). The mean time within target INR range for all patients and all ranges was 63.3% (SD 28.0) of days in the computer-generated-dose group compared with 53.2% (27.7) in the traditional-dose group. For the stabilisation patients alone, computer-generated doses led to a non-significant benefit in all INR ranges (p=0.06), whereas in the stable patients the benefit was significant (p=0.02). INTERPRETATION: The computer program gave better INR control than the experienced medical staff and at least similar standards to the specialised centres should be generally available. Clinical outcome and cost effectiveness remain to be assessed.

[Venous thromboembolism--incidence and risk factors in Oslo]. / Venøs tromboembolisme--insidens og risikofaktorer i Oslo.

Over a period of three years, 378 patients with objectively verified venous thromboembolism were treated at Aker University Hospital. Below the age of 60, men and women had about the same incidence of venous thromboembolism, but that age the incidence was significantly higher among men than among women. Incidence increased exponentially with age, from about 1:10,000 at age 20 to about 1:1,000 at age 50. The incidence found here is lower than in earlier Nordic studies. The great majority of the patients (93%) had deep venous thrombosis in the lower extremities, 11% had symptomatic and verified pulmonary embolism, and 1% had their thrombus in an inner organ vein. 23% of patients were previously treated for venous thromboembolism, and 22% had cancer. Seven women were on oral contraception, and 22 used postmenopausal hormone substitution. An obvious temporary precipitating factor was present in 42% of the patients, while 36% had a spontaneous venous thromboembolism. Hereditary thrombophilic disorder was found in 32% of patients below the age of 60.

[The trend in induced abortions in Denmark until 1995. Illustrated by the relation to other data sources, preventive campaigns during the last years and the stage of pregnancy]. / Udviklingen i provokerede aborter i Danmark frem til 1995. Belyst i relation til aendrede datakilder, de senere års forstaerkede forebyggelsesindsats og svangerskabslaengden.

This study presents a review of the trend in the Danish abortion rate, with a view to prevention campaigns and introduction of electronic registration of abortions through the National Patient Registry. The number of induced abortions has been decreasing steadily since 1975; abortion on demand up to the end of 12th gestational week has been permitted by law in Denmark since 1973. The lowest number ever was registered in 1994 and 1995, corresponding to a rate of 13.7 per 1,000 women aged 15-49 years. The number per 1,000 liveborn decreased from 277 in 1993 to 253 in 1994. The relative number of abortions was highest among women aged 20-29 years, and in the capital area. Since 1993 the health authorities have strengthened campaigns to reduce the number of unplanned pregnancies, primarily focusing on younger women and with special programs in the capital area. The reduction for these groups could point to a success of the prevention campaigns, although the rates of terminated pregnancies might be influenced by many other factors.

PIP: A review was conducted of the trend in the abortion rate against the backdrop of prevention campaigns starting in 1993 and against the introduction of electronic registration of abortions through the National Patient Registry in Denmark. In 1994, there were 17,598 abortions reported by forms to the Abortion Registry, the lowest figure since 1973. Data indicated about 18,114 abortions in the Registry in 1994 and 17,720 in 1995. The number of induced abortions had been decreasing since 1975. Abortion on demand up to the 12th gestational week has been permitted since 1973 in Denmark. The lowest figures were registered in 1994 and 1995, corresponding to a rate of 13.7/1000 women 15-49 years old. Abortions per 1000 live-born children decreased from 277 in 1993 to 253 in 1994. The relative number of abortions was the highest among women 20-29 years old and in the capital area; these groups experienced the highest drop from 1993 to 1995. The rate increased slightly for women 30-39 years old, but stagnated for women over 39 years of age. Despite a drop in the total abortion rate from 1993 to 1995, there were increases in 9 counties, which could be explained by the lower rate of coverage through data reporting. The total figure of abortions dropped from 840 in 1990 to 670 in 1995 in Copenhagen county. The proportion of abortions after the 12th week of pregnancy since 1990 increased from 2.2% to 2.9%; the number of abortions after the 21st week rose from 0.1% (16 cases) in 1990 to 0.2% (28 cases) in 1995. Abortions performed due to the risk of hereditary disease increased from 82 in 1990 to 174 in 1995, while abortions performed for social indication increased from 137 to 154 during this period.

[Reporting of induced abortions in 1994. A comparison between the data in the Registry of Legally Induced Abortions and the National Patient Registry]. / Indberetning af provokerede aborter i 1994. En sammenligning mellem data i Registeret over Legalt Provokerede Aborter og Landspatientregistere]

Up to 31st December 1994 all cases of legally induced abortions were notified by the physician responsible for the operation to the National Board of Health and recorded in the Register of Induced Abortions. Following this data, abortion statistics will rely on data concerning induced abortions in the Danish National Patient Register, which includes information based upon the unique personal number of all patients admitted to hospitals. The completeness of the Register of Induced Abortions and the National Patient Register as to induced abortions in 1994 was assessed to evaluate the impact of the change in method of monitoring on trends in the national and regional abortion rate. The complete number of induced abortions was estimated to be the sum of the number recorded in both registers, cases recorded only in the Register of Induced Abortions, cases recorded only in the National Patient Register, and the missing number of registration of induced abortions calculated by capture-recapture methods. Of these 18,429 abortions 96.4% were registered in the National Patient Register and 93.5% in the Register of Induced Abortions. There were some regional variations. In some counties more abortions were registered in the Register of Induced Abortions and in others in the National Patient Register. Considering the change from 1995 in sources of the statistics of induced abortions, analyses of trends in the abortion rate in the early 1990s in Denmark must be evaluated with prudence.

[Chylothorax after pressure pneumothorax]. / Kylothorax etter trykkpneumothorax.

Chylothorax is a pleural effusion caused by leakage of chyle into the pleural cavity. The commonest causes of pleural effusion are trauma to the ductus thoracicus or neoplasms in the mediastinum. The trauma can be iatrogenic or accidental. Chylothorax caused by tension pneumothorax has not previously been reported. We describe a case where this etiology is the most likely explanation of the chylous effusion in our patient.

Change in social status and risk of low birth weight in Denmark: population based cohort study.

OBJECTIVE: To estimate the risk of having a low birthweight infant associated with changes in social, environmental, and genetic factors. DESIGN: Population based, historical cohort study using the Danish medical birth registry and Statistic Denmark's fertility database. SUBJECTS: All women who had a low birthweight infant (< 2500 g) (index birth) and a subsequent liveborn infant (outcome birth) in Denmark between 1980 and 1992 (exposed cohort, n = 11,069) and a random sample of the population who gave birth to an infant weighing > or = 2500 g and to a subsequent liveborn infant (unexposed cohort, n = 10,211). MAIN OUTCOME MEASURES: Risk of having a low birthweight infant in the outcome birth as a function of changes in male partner, area of residence, type of job, and social status between the two births. RESULTS: Women in the exposed cohort showed a high risk (18.5%) of having a subsequent low birthweight infant while women in the unexposed cohort had a risk of 2.8%. After adjustment for initial social status, a decline in social status increased the absolute risk of having a low birthweight infant by about 5% in both cohorts, though this was significant only in the unexposed cohort. Change of male partner did not modify the risk of low birth weight in either cohort. CONCLUSION: Having had a low birthweight infant and a decline in social status are strong risk factors for having a low birthweight infant subsequently.

[The pattern of attendance at a psychiatric clinic]. / Henvendelsesmønsteret i psykiatrisk skadestue.

Over a three month investigation period, 1199 patients attended a psychiatric emergency-room. The sex ratio was 55.5% male/44.5% female, and the average age of the patients was 43.5 years. One-third of the patients had problems of alcohol abuse, one-third were psychotic and one-eighth were in a period of crisis. One-third of the visits resulted in an overnight stay in the emergency-room, and one-third were admitted to psychiatric hospital ward. Only 17% of the alcoholics were admitted to the psychiatric ward. Sixty-one percent of the long-term psychiatric patients were admitted, and only 13% left the emergency-room without any follow-up plan.

[Migraine aura as the cause of apoplexy in young adults]. / Migraeneaura som årsag til apopleksi hos yngre.

In the five year period 1972-1977, 27 patients aged 15-45 years were admitted to a neurological department in the Copenhagen area because of acute focal neurological deficits, lasting more than 24 hours and of presumably vascular origin i.e. stroke. In seven cases, the neurological deficits were of thromboembolic origin and in further seven cases the deficits occurred in relation to migraine with aura. Two cases were classified as migraine-equivalents. In the remaining eleven cases it was not possible to decide whether the persisting neurological deficits were of migrainous or thromboembolic origin. Nine of these 11 patients were women. Nine had headache and six had nausea/vomiting or photo/phonofobia. Cerebral angiography was performed in five of these 11 patients and in all the angiograms were normal. Migraine-aura was most probably the cause of the persisting deficits in some of these 11 patients. It is concluded, that migraine-aura is relatively often the cause of stroke in young adults.

[Migraine with aura (classical migraine) in patients examined for cerebrovascular disease]. / Migraene med aura (klassisk migraene) hos patienter undersøgt for cerebrovaskulaer sygdom.

Four patients were investigated for cerebrovascular origin of focal neurologic deficits. Three of the patients had persistent deficits. However, during cerebral angiography and subsequent regional cerebral blood flow (rCBF) investigation all patients developed attacks of migraine with aura. During the rCBF study focal reduction of the blood flow, typical for migraine with aura, developed in the posterior brain regions. It is concluded that vasospasm of migrainous origin might be the cause of the neurological deficits in the four patients.