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Sagberg K, Eskild A, Sommerfelt S, Halle TK, Hillestad V, Haavaldsen C. Two-dimensional (2D) placental ultrasound measurements - The correlation with placental volume measured by magnetic resonance imaging (MRI). Placenta 2024; 149:7-12. [PMID: 38452718 DOI: 10.1016/j.placenta.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Information about placental size in ongoing pregnancies may aid the identification of pregnancies with increased risk of adverse outcome. Placental volume can be measured using magnetic resonance imaging (MRI). However, this method is not universally available in antenatal care. Ultrasound is the diagnostic tool of choice in pregnancy. Therefore, we studied whether simple two-dimensional (2D) ultrasound placental measurements were correlated with placental volume measured by MRI. METHODS We examined a convenience sample of 104 ongoing pregnancies at gestational week 27, using both ultrasound and MRI. The ultrasound measurements included placental length, width and thickness. Placental volume was measured using MRI. The correlation between each 2D placental ultrasound measurement and placental volume was estimated by applying Pearson's correlation coefficient (r). RESULTS Mean placental length was 17.2 cm (SD 2.1 cm), mean width was 14.7 cm (SD 2.1 cm), and mean thickness was 3.2 cm (SD 0.6 cm). Mean placental volume was 536 cm3 (SD 137 cm3). The 2D ultrasound measurements showed poor correlation with placental volume (placental length; r = 0.27, width; r = 0.37, and thickness r = 0.13). DISCUSSION Simple 2D ultrasound measurements of the placenta were poorly correlated with placental volume and cannot be used as proximate measures of placental volume. Our finding may be explained by the large variation between pregnancies in intrauterine placental shape.
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Affiliation(s)
- Karianne Sagberg
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318, Oslo, Norway.
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318, Oslo, Norway
| | - Silje Sommerfelt
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318, Oslo, Norway
| | - Tuva K Halle
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318, Oslo, Norway
| | - Vigdis Hillestad
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway; Department of Diagnostic Imaging, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway
| | - Camilla Haavaldsen
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway
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Mikaelsen I, Johansen AN, Tappert C, Eggebø TM. Induction of labor in twin pregnancies - A retrospective cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100724. [PMID: 35436694 DOI: 10.1016/j.srhc.2022.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. METHODS This retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. RESULTS Among the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40-1.04) after adjusting for maternal age and parity. Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94-7.43) vs. 7.32 (7.16-7.42), and 7.27 (6.90-7.48) vs. 7.29 (7.08-7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. CONCLUSION Our results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.
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Affiliation(s)
- Ingrid Mikaelsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anine Nikoline Johansen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Christian Tappert
- Departement of Obstetrics, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway
| | - Torbjørn Moe Eggebø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Center for Fetal Medicine, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway; Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
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3
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Percentiles of intrauterine placental volume and placental volume relative to fetal volume: A prospective magnetic resonance imaging study. Placenta 2022; 121:40-45. [DOI: 10.1016/j.placenta.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
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Haftorn KL, Lee Y, Denault WRP, Page CM, Nustad HE, Lyle R, Gjessing HK, Malmberg A, Magnus MC, Næss Ø, Czamara D, Räikkönen K, Lahti J, Magnus P, Håberg SE, Jugessur A, Bohlin J. An EPIC predictor of gestational age and its application to newborns conceived by assisted reproductive technologies. Clin Epigenetics 2021; 13:82. [PMID: 33875015 PMCID: PMC8056641 DOI: 10.1186/s13148-021-01055-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/11/2021] [Indexed: 01/11/2023] Open
Abstract
Background Gestational age is a useful proxy for assessing developmental maturity, but correct estimation of gestational age is difficult using clinical measures. DNA methylation at birth has proven to be an accurate predictor of gestational age. Previous predictors of epigenetic gestational age were based on DNA methylation data from the Illumina HumanMethylation 27 K or 450 K array, which have subsequently been replaced by the Illumina MethylationEPIC 850 K array (EPIC). Our aims here were to build an epigenetic gestational age clock specific for the EPIC array and to evaluate its precision and accuracy using the embryo transfer date of newborns from the largest EPIC-derived dataset to date on assisted reproductive technologies (ART). Methods We built an epigenetic gestational age clock using Lasso regression trained on 755 randomly selected non-ART newborns from the Norwegian Study of Assisted Reproductive Technologies (START)—a substudy of the Norwegian Mother, Father, and Child Cohort Study (MoBa). For the ART-conceived newborns, the START dataset had detailed information on the embryo transfer date and the specific ART procedure used for conception. The predicted gestational age was compared to clinically estimated gestational age in 200 non-ART and 838 ART newborns using MM-type robust regression. The performance of the clock was compared to previously published gestational age clocks in an independent replication sample of 148 newborns from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restrictions (PREDO) study—a prospective pregnancy cohort of Finnish women. Results Our new epigenetic gestational age clock showed higher precision and accuracy in predicting gestational age than previous gestational age clocks (R2 = 0.724, median absolute deviation (MAD) = 3.14 days). Restricting the analysis to CpGs shared between 450 K and EPIC did not reduce the precision of the clock. Furthermore, validating the clock on ART newborns with known embryo transfer date confirmed that DNA methylation is an accurate predictor of gestational age (R2 = 0.767, MAD = 3.7 days). Conclusions We present the first EPIC-based predictor of gestational age and demonstrate its robustness and precision in ART and non-ART newborns. As more datasets are being generated on the EPIC platform, this clock will be valuable in studies using gestational age to assess neonatal development. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01055-z.
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Affiliation(s)
- Kristine L Haftorn
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway. .,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway. .,Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Yunsung Lee
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - William R P Denault
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Mathematics, University of Oslo, Oslo, Norway
| | - Haakon E Nustad
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Deepinsight, Karl Johans Gate 8, Oslo, Norway
| | - Robert Lyle
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Håkon K Gjessing
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anni Malmberg
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School, Population Health Sciences, Bristol, UK
| | - Øyvind Næss
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Astanand Jugessur
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jon Bohlin
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Division for Infection Control and Environmental Health, Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
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Sagberg K, Eskild A, Sommerfelt S, Gjesdal KI, Higgins LE, Borthne A, Hillestad V. Placental volume in gestational week 27 measured by three-dimensional ultrasound and magnetic resonance imaging. Acta Obstet Gynecol Scand 2021; 100:1412-1418. [PMID: 33556213 DOI: 10.1111/aogs.14115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ultrasound is the diagnostic tool of choice in pregnancy. We lack valid ultrasound methods for placental size measurements. Our aim was therefore to compare three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for measurements of placental volume. MATERIAL AND METHODS We measured placental volume by 3D ultrasound and MRI in 100 unselected pregnancies at 27 weeks of gestation (25+4 -28+4 weeks). The 3D ultrasound acquisitions were analyzed offline, and the placental outline was manually traced using the virtual organ computer-aided analysis (VOCAL) 30° rotational technique. The MRI examinations included a T2-weighted gradient echo sequence in the sagittal plane, with 5-mm slices through the entire uterus. The placental outline was manually traced in each slice. The correlation between 3D ultrasound and MRI placental volumes was estimated by intraclass correlation coefficients. Bland-Altman analysis was applied to visualize systematic bias and limits of agreement, in which the ratio MRI placental volume/3D ultrasound placental volume was plotted against the average of the two methods. RESULTS The intraclass correlation coefficient between 3D ultrasound and MRI measurements was 0.49 (95% confidence interval 0.33-0.63). In general, 3D ultrasound measured smaller placental volumes (median 373 cm3 , interquartile range 309-434 cm3 ) than MRI (median 507 cm3 , interquartile range 429-595 cm3 ) and the systematic bias was 1.44. The 95% limits of agreement between the two methods were wide (0.68-2.21). CONCLUSIONS We found poor to moderate correlation between 3D ultrasound and MRI placental volume measurements. Generally, 3D ultrasound measured smaller placental volumes than MRI, suggesting that 3D ultrasound failed to visualize the entire placenta. Our findings may hopefully contribute to the improvement of ultrasound methods for placental measurements.
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Affiliation(s)
- Karianne Sagberg
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Sommerfelt
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell I Gjesdal
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
| | - Lucy E Higgins
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, UK.,Saint Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Arne Borthne
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
| | - Vigdis Hillestad
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
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Mynarek M, Bjellmo S, Lydersen S, Strand KM, Afset JE, Andersen GL, Vik T. Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study. BMC Pregnancy Childbirth 2020; 20:67. [PMID: 32005186 PMCID: PMC6995227 DOI: 10.1186/s12884-020-2751-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guidelines regarding management of prelabor rupture of membranes (PROM) at term vary between immediate induction and expectant management. A long interval between PROM and delivery increases the risk for perinatal infections. Severe perinatal infections are associated with excess risk for cerebral palsy (CP) and perinatal death. We investigated if increasing intervals between PROM and delivery were associated with perinatal death or CP. METHODS Eligible to participate in this population-based cohort-study were term born singletons without congenital malformations born in Norway during 1999-2009. Data was retrieved from the Medical Birth Registry of Norway (MBRN) and the Cerebral Palsy Register of Norway. In line with the registration in the MBRN, intervals between PROM and delivery of more than 24 h was defined as 'prolonged' and intervals between 12 and 24 h as 'intermediate'. Outcomes were stillbirth, death during delivery, neonatal mortality and CP. Logistic regression was used to calculate odds ratio (OR) with 95% confidence intervals (CI) for adverse outcomes in children born after prolonged and intermediate intervals, compared with a reference group comprising all children born less than 12 h after PROM or without PROM. RESULTS Among 559,972 births, 34,759 children were born after intermediate and 30,332 were born after prolonged intervals. There was no association between increasing intervals and death during delivery or in the neonatal period, while the prevalence of stillbirths decreased with increasing intervals. Among children born after intermediate intervals 38 (0.11%) had CP, while among those born after prolonged intervals 46 (0.15%) had CP. Compared with the reference group, the OR for CP was 1.16 (CI; 0.83 to 1.61) after intermediate and 1.61 (CI; 1.19 to 2.18) after prolonged intervals. Adjusting for antenatal factors did not affect these associations. Among children with CP the proportion with diffuse cortical injury and basal ganglia pathology on cerebral MRI, consistent with hypoxic-ischemic injuries, increased with increasing intervals. CONCLUSION Intervals between PROM and delivery of more than 24 h were associated with CP, but not with neonatal mortality or death during delivery. The inverse association with stillbirth is probably due to reverse causality.
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Affiliation(s)
- Maren Mynarek
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, PO Box 8905, NO-7491, Trondheim, Norway.
| | - Solveig Bjellmo
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, PO Box 8905, NO-7491, Trondheim, Norway.,Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Health and Child Welfare, PB 8905, MTFS, 7491, Trondheim, Norway
| | - Kristin Melheim Strand
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan Egil Afset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, PO Box 8905, NO-7491, Trondheim, Norway.,Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Guro L Andersen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, PO Box 8905, NO-7491, Trondheim, Norway.,Vestfold Hospital Trust, The Cerebral Palsy Register of Norway, PB 2168, 3103, Tønsberg, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, PO Box 8905, NO-7491, Trondheim, Norway
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Incidence and risk factors for obstetric anal sphincter ruptures, OASIS, following the introduction of preventive interventions. A retrospective cohort study from a Norwegian hospital 2012-2017. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 22:100460. [PMID: 31491687 DOI: 10.1016/j.srhc.2019.100460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A decrease of obstetric anal sphincter injuries (OASIS) was observed after preventive interventions were implemented at a Norwegian university hospital. The aim was to investigate whether the improvement had sustained over the following years. MATERIALS AND METHODS We performed a retrospective cohort study of 18 258 singleton vaginal cephalic births, ≥37 + 0 weeks of gestation during 2012-2017, examining data from the hospital's birth journals and separate registration forms. Interventions to prevent OASIS were implemented in 2011, and training in practical skills was repeated each year. MAIN OUTCOME MEASURES The main outcome was OASIS (n = 377). RESULTS Frequency of OASIS overall decreased from 3.6% prior to 2011 to 2.1% after the intervention and sustained at that level throughout the study period. A trend of fewer OASIS among spontaneous deliveries, decreasing from 2.1% to 1.2% (p = 0.01) was observed, but no trend was seen for instrumental deliveries (p = 0.37), where the incidence fluctuated between 4.0% and 9.3% with an average of 6.5%. Primiparity, increased maternal age and increased fetal head circumference were associated with more OASIS in spontaneous deliveries. In instrumental deliveries, primiparity, occiput posterior position and increased fetal head circumference were associated with more OASIS, whilst episiotomy was associated with fewer OASIS. CONCLUSION The incidence of obstetric anal sphincter injuries maintained at a similar level of around 2.1% during the six following years after introducing preventive interventions. Regularly repetition and practical training seemed to be effective.
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Kessler J, Johnsen SL, Ebbing C, Karlsen HO, Rasmussen S, Kiserud T. Estimated date of delivery based on second trimester fetal head circumference: A population-based validation of 21 451 deliveries. Acta Obstet Gynecol Scand 2018; 98:101-105. [PMID: 30168856 DOI: 10.1111/aogs.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/26/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fetal biometry is used for determining gestational age and estimated date of delivery (EDD). However, the accuracy of the EDD depends on the assumed length of pregnancy included in the calculation. This study aimed at assessing the actual pregnancy length and accuracy of EDD prediction based on fetal head circumference measured at the second trimester. MATERIAL AND METHODS This was a population-based observational study with the following inclusion criteria: singleton pregnancy, head circumference dating in the second trimester, spontaneous onset or induction of delivery ≥ 294 days of gestation, live birth. The EDD was set anticipating a pregnancy length of 282 days. Bias in the prediction of EDD was defined as the difference between the actual date of birth and the EDD. RESULTS Head circumference measurements were available for 21 451 pregnancies. Ultrasound-dated pregnancies had a median pregnancy length of 283.03 days, corresponding to a method bias of 1.03 days (95% CI; 0.89-1.16). This bias was dependent on the head circumference at dating, ranging from -1.58 days (95% CI; -3.54 to 1.12) to 3.42 days (95% CI; 1.98-4.31). The median pregnancy length, based on the last menstrual period of women with a regular menstrual cycle (n = 12 985), was 283.15 days (95% CI; 282.91-283.31). A total of 5685 (22.9%, 95% CI; 22.4% to 23.4%) and 886 women (3.6%, 95% CI; 3.3%-3.8%) were still pregnant 7 and 14 days after the EDD, respectively. CONCLUSIONS Second trimester head circumference measurements can be safely used to predict EDD. A revision of the pregnancy length to 283 days will reduce the bias of EDD prediction to a level comparable with other methods.
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Affiliation(s)
- Jörg Kessler
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Synnøve Lian Johnsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | | | - Svein Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Torvid Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Reimers A, Helde G, Becser Andersen N, Aurlien D, Surlien Navjord E, Haggag K, Christensen J, Lillestølen KM, Nakken KO, Brodtkorb E. Zonisamide serum concentrations during pregnancy. Epilepsy Res 2018; 144:25-29. [DOI: 10.1016/j.eplepsyres.2018.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
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10
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Hjorth-Hansen A, Salvesen Ø, Engen Hanem LG, Eggebø T, Salvesen KÅ, Vanky E, Ødegård R. Fetal Growth and Birth Anthropometrics in Metformin-Exposed Offspring Born to Mothers With PCOS. J Clin Endocrinol Metab 2018; 103:740-747. [PMID: 29165598 DOI: 10.1210/jc.2017-01191] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/10/2017] [Indexed: 01/28/2023]
Abstract
CONTEXT Metformin is used in an attempt to reduce pregnancy complications associated with polycystic ovary syndrome (PCOS). Little is known about the effect of metformin on fetal development and growth. OBJECTIVES To compare the effect of metformin versus placebo on fetal growth and birth anthropometrics in PCOS offspring compared with a reference population in relation to maternal body mass index (BMI). DESIGN Post hoc analysis of a randomized controlled trial. SETTING Double-blind, placebo-controlled, multicenter study. PATIENTS 258 offspring born to mothers with PCOS. INTERVENTION 2000 mg metformin (n = 131) or placebo (n = 121) from first trimester to delivery. MAIN OUTCOME MEASURES Mean abdominal diameter and biparietal diameter (BPD) at gestational weeks 19 and 32. Head circumference (HC), birth length, and weight related to a reference population of healthy offspring, expressed as gestational age- and sex-adjusted z-scores. RESULTS Metformin- versus placebo-exposed offspring had larger heads at gestational week 32 (BPD, 86.1 mm versus 85.2 mm; P = 0.03) and at birth (HC, 35.6 cm versus 35.1 cm; P < 0.01). Analyses stratified by maternal prepregnancy BMI, larger heads were observed only among offspring of overweight/obese mothers. Among normal-weight mothers, the effect of metformin compared with placebo was reduced length (z-score = -0.96 versus -0.42, P = 0.04) and weight (z-score = -0.44 versus 0.02; P = 0.03). Compared with the reference population, offspring born to PCOS mothers (placebo group) had reduced length (z-score = -0.40; 95% confidence interval, -0.60 to -0.40), but similar birth weight and HC. CONCLUSIONS Metformin exposure resulted in larger head size in offspring of overweight mothers, traceable already in utero. Maternal prepregnancy BMI modified the effect of metformin on offspring anthropometrics. Anthropometrics of offspring born to PCOS mothers differed from those of the reference population.
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Affiliation(s)
| | - Øyvind Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Liv Guro Engen Hanem
- Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torbjørn Eggebø
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olav's University Hospital of Trondheim, Trondheim, Norway
| | - Kjell Å Salvesen
- Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olav's University Hospital of Trondheim, Trondheim, Norway
| | - Eszter Vanky
- Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olav's University Hospital of Trondheim, Trondheim, Norway
| | - Rønnaug Ødegård
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Obesity Research, St. Olav's University Hospital of Trondheim, Trondheim, Norway
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Midwives' and obstetricians' views on appropriate obstetric sonography in Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:1-5. [PMID: 29804752 DOI: 10.1016/j.srhc.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/19/2017] [Accepted: 12/31/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway. MATERIAL AND METHODS This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety. RESULTS The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication. CONCLUSION The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.
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Gjessing HK, Grøttum P, Økland I, Eik-Nes SH. Fetal size monitoring and birth-weight prediction: a new population-based approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:500-507. [PMID: 27130245 DOI: 10.1002/uog.15954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 04/04/2016] [Accepted: 04/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To develop a complete, population-based system for ultrasound-based fetal size monitoring and birth-weight prediction for use in the second and third trimesters of pregnancy. METHODS Using 31 516 ultrasound examinations from a population-based Norwegian clinical database, we constructed fetal size charts for biparietal diameter, femur length and abdominal circumference from 24 to 42 weeks' gestation. A reference curve of median birth weight for gestational age was estimated using 45 037 birth weights. We determined how individual deviations from the expected ultrasound measures predicted individual percentage deviations from expected birth weight. The predictive quality was assessed by explained variance of birth weight and receiver-operating characteristics curves for prediction of small-for-gestational age. A curve for intrauterine estimated fetal weight was constructed. Charts were smoothed using the gamlss non-linear regression method. RESULTS The population-based approach, using bias-free ultrasound gestational age, produces stable estimates of size-for-age and weight-for-age curves in the range 24-42 weeks' gestation. There is a close correspondence between percentage deviations and percentiles of birth weight by gestational age, making it easy to convert between the two. The variance of birth weight that can be 'explained' by ultrasound increases from 8% at 20 weeks up to 67% around term. Intrauterine estimated fetal weight is 0-106 g higher than median birth weight in the preterm period. CONCLUSIONS The new population-based birth-weight prediction model provides a simple summary measure, the 'percentage birth-weight deviation', to be used for fetal size monitoring throughout the third trimester. Predictive quality of the model can be measured directly from the population data. The model computes both median observed birth weight and intrauterine estimated fetal weight. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H K Gjessing
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - P Grøttum
- Section of Medical Informatics, University of Oslo, Oslo, Norway
| | - I Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - S H Eik-Nes
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olav's University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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13
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Wessel H, Nyberg T. Lower accuracy in prediction of delivery date in Stockholm County following introduction of new guidelines. Acta Obstet Gynecol Scand 2017; 96:223-232. [PMID: 27858960 DOI: 10.1111/aogs.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In Stockholm County, new guidelines for predicting the day of delivery were introduced in 2010. Recent clinical use has indicated that the predictive quality might be suboptimal. This study compares the accuracy of three equations applied during the first (crown-rump length or bi-parietal diameter) and second trimesters (bi-parietal diameter or bi-parietal diameter combined with femur length). MATERIAL AND METHODS The accuracy of estimated delivery date was compared in 14 239 ultrasound exams using median deviations from actual birth date, proportion of postterms, births within ±seven days of estimated delivery date, accuracy variations depending on fetal size, alternative fetal measurements obtained on the same occasion, and menstrual age. RESULTS The bi-parietal diameter and crown-rump length formulae overestimated pregnancy length by two and three days respectively, causing 7-8% of pregnancies to be labelled postterm. A combined bi-parietal diameter+femur length formula overestimated by one day, with 5.1% postterms. No significant difference was found in the proportion of births within ±seven days. Second trimester estimated delivery date assessment had larger median variations than did first trimester assessment and suffered from shifting deviations across fetal size. The comparison of different biometry formulae in the same individual demonstrated one day extra deviation for bi-parietal diameter and three days extra deviation for crown-rump length compared with the combined bi-parietal diameter+femur length formula. CONCLUSIONS The algorithms and dating occasions tested seem inappropriate for the present 280-day term definition. Alternative formulae ought to be sought, and the assumed duration of pregnancy reconsidered; 283 days corresponds to the observed pregnancy length calculated from last menstrual period, and would better fit the observed results for first trimester ultrasound scans.
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Affiliation(s)
- Hans Wessel
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Ultragyn i Stockholm AB, Stockholm, Sweden
| | - Tommy Nyberg
- Department of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden
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14
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Khan NH, Tegnander E, Dreier JM, Eik-Nes S, Torp H, Kiss G. Automatic Detection and Measurement of Fetal Biparietal Diameter and Femur Length —Feasibility on a Portable Ultrasound Device. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojog.2017.73035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Eggebø TM, Klefstad OA, Økland I, Lindtjørn E, Eik-Nes SH, Gjessing HK. Estimation of fetal weight in pregnancies past term. Acta Obstet Gynecol Scand 2016; 96:183-189. [PMID: 27743479 DOI: 10.1111/aogs.13044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/10/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the accuracy of estimating fetal weight with ultrasound in pregnancies past term, using the eSnurra algorithm. MATERIAL AND METHODS In all, 419 women with pregnancy length of 290 days, attending a specialist consultation at Stavanger University Hospital, Norway, were included in a prospective observational study. Fetal weight was estimated using biparietal diameter (BPD) and abdominal circumference (AC). The algorithm implemented in an electronic calculation (eSnurra) was used to compute estimated fetal weight (EFW). Results were compared with birthweight (BW). RESULTS The mean interval between the ultrasound examination and birth was 2 days (SD 1.4). The median difference between BW and EFW was -6 g (CI -40 to +25 g) and the median percentage error was -0.1% (95% CI -1.0 to 0.6%). The median absolute difference was 190 g (95% CI 170-207 g). The BW was within 10% of EFW in 83% (95% CI 79-87%) of cases and within 15% of EFW in 94% (95% CI 92-96%) of cases. Limits of agreement (95%) were from -553 g to +556 g. Using 5% false-positive rates, the sensitivity in detecting macrosomic and small for gestational age fetuses was 54% (95% CI 35-72%) and 49% (95% CI 35-63%), respectively. CONCLUSION The accuracy of fetal weight estimation was good. Clinicians should be aware of limitations related to prediction at the upper and lower end, and the importance of choosing appropriate cut-off levels.
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Affiliation(s)
- Torbjørn M Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,National Center for Fetal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav A Klefstad
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Elsa Lindtjørn
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Sturla H Eik-Nes
- National Center for Fetal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håkon K Gjessing
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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16
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Østborg TB, Romundstad PR, Eggebø TM. Duration of the active phase of labor in spontaneous and induced labors. Acta Obstet Gynecol Scand 2016; 96:120-127. [DOI: 10.1111/aogs.13039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/07/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Tilde B. Østborg
- Department of Obstetrics and Gynecology; Stavanger University Hospital; Stavanger Norway
| | | | - Torbjørn M. Eggebø
- Department of Obstetrics and Gynecology; Stavanger University Hospital; Stavanger Norway
- National Center for Fetal Medicine; Trondheim University Hospital (St. Olavs Hospital); Trondheim Norway
- Department of Laboratory Medicine; Children's and Women's Health; Norwegian University of Science and Technology; Trondheim
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17
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Bohlin J, Håberg SE, Magnus P, Reese SE, Gjessing HK, Magnus MC, Parr CL, Page CM, London SJ, Nystad W. Prediction of gestational age based on genome-wide differentially methylated regions. Genome Biol 2016; 17:207. [PMID: 27717397 PMCID: PMC5054559 DOI: 10.1186/s13059-016-1063-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/14/2016] [Indexed: 01/09/2023] Open
Abstract
Background We explored the association between gestational age and cord blood DNA methylation at birth and whether DNA methylation could be effective in predicting gestational age due to limitations with the presently used methods. We used data from the Norwegian Mother and Child Birth Cohort study (MoBa) with Illumina HumanMethylation450 data measured for 1753 newborns in two batches: MoBa 1, n = 1068; and MoBa 2, n = 685. Gestational age was computed using both ultrasound and the last menstrual period. We evaluated associations between DNA methylation and gestational age and developed a statistical model for predicting gestational age using MoBa 1 for training and MoBa 2 for predictions. The prediction model was additionally used to compare ultrasound and last menstrual period-based gestational age predictions. Furthermore, both CpGs and associated genes detected in the training models were compared to those detected in a published prediction model for chronological age. Results There were 5474 CpGs associated with ultrasound gestational age after adjustment for a set of covariates, including estimated cell type proportions, and Bonferroni-correction for multiple testing. Our model predicted ultrasound gestational age more accurately than it predicted last menstrual period gestational age. Conclusions DNA methylation at birth appears to be a good predictor of gestational age. Ultrasound gestational age is more strongly associated with methylation than last menstrual period gestational age. The CpGs linked with our gestational age prediction model, and their associated genes, differed substantially from the corresponding CpGs and genes associated with a chronological age prediction model. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1063-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Bohlin
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway.
| | - S E Håberg
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
| | - P Magnus
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
| | - S E Reese
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, PO Box 12233, MD A3-05, Research Triangle Park, Durham, NC, 27709, USA
| | - H K Gjessing
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
| | - M C Magnus
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
| | - C L Parr
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
| | - C M Page
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
| | - S J London
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, PO Box 12233, MD A3-05, Research Triangle Park, Durham, NC, 27709, USA
| | - W Nystad
- Norwegian Institute of Public Health, P.O. Box 4404, 0456, Oslo, Norway
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18
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Bratlid D. Estimating date of delivery and gestational age - technology, biology or both? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1332. [PMID: 27637046 DOI: 10.4045/tidsskr.16.0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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19
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Janbu T. One Norwegian national tool for estimating date of delivery and fetal age. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:790-1. [PMID: 27221177 DOI: 10.4045/tidsskr.15.1221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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20
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Rossen J, Østborg TB, Lindtjørn E, Schulz J, Eggebø TM. Judicious use of oxytocin augmentation for the management of prolonged labor. Acta Obstet Gynecol Scand 2015; 95:355-61. [DOI: 10.1111/aogs.12821] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/09/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Janne Rossen
- Department of Obstetrics and Gynecology; Sørlandet Hospital HF; Kristiansand Norway
- Department of Laboratory Medicine; Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
| | - Tilde B. Østborg
- Department of Obstetrics and Gynecology; Stavanger University Hospital; Stavanger Norway
| | - Elsa Lindtjørn
- Department of Obstetrics and Gynecology; Stavanger University Hospital; Stavanger Norway
| | - Jørn Schulz
- Department of Clinical Science; University of Stavanger; Stavanger Norway
| | - Torbjørn M. Eggebø
- Department of Obstetrics and Gynecology; Stavanger University Hospital; Stavanger Norway
- National Center for Fetal Medicine; St. Olavs Hospital - Trondheim University Hospital; Trondheim Norway
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21
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Pay A, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. Prediction of small-for-gestational-age status by symphysis-fundus height: a registry-based population cohort study. BJOG 2015; 123:1167-73. [PMID: 26644370 DOI: 10.1111/1471-0528.13727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a chart for risk of small-for-gestational-age (SGA) at birth depending on deviations in symphysis-fundus (SF) height values for gestational age during pregnancy weeks 24-42. DESIGN Registry-based population cohort study. SETTING Antenatal clinics, Västra Götaland County, Sweden, 2005-2010. POPULATION The study included 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital. Data (including 282 713 SF height measurements) were extracted from the hospital's computerised obstetric database. METHODS Linear and binary regression analyses were used to derive prediction models with deviations in birthweight (BW) and SF height by gestational age as dependent and independent variables, respectively. Receiver operating characteristic curves were generated to evaluate the predictive value of the model in detecting SGA. MAIN OUTCOME MEASURES Birthweight and small-for-gestational-age. RESULTS Symphysis-fundus height accounted for 3% of individual BW variance at 24 weeks, increasing gradually to 20% at 40 weeks. Maternal factors explained an additional 10 percentage points of BW variance. Receiver operating characteristic curves confirmed that SF height was a stronger SGA predictor in late than in early pregnancy. Using an SGA relative risk cut-off limit of ≥2-fold, the overall sensitivity was 50% and the overall specificity 80%. Only the most recent SF measurement was useful in predicting BW deviation; previous measurements added nothing to the predictive value. CONCLUSIONS The ability of SF measurements to detect SGA status at birth increases with gestational age. Only the most recent SF measurement has predictive value; a static or falling pattern of SF values did not increase SGA likelihood. TWEETABLE ABSTRACT New SF curves predict SGA best in late pregnancy; only the most recent SF measurement has predictive value.
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Affiliation(s)
- Asd Pay
- Departments of Obstetrics and Gynaecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway.,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J F Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - A C Staff
- Departments of Obstetrics and Gynaecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - B Jacobsson
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
| | - H K Gjessing
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Ebbing C, Johnsen SL, Kessler J, Kiserud T, Rasmussen S. Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:740-1. [PMID: 25947590 DOI: 10.4045/tidsskr.15.0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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23
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Fetal Growth, Cognitive Function, and Brain Volumes in Childhood and Adolescence. Obstet Gynecol 2015; 125:673-682. [DOI: 10.1097/aog.0000000000000694] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Skråstad RB, Hov GG, Blaas HGK, Romundstad PR, Salvesen KÅ. Risk assessment for preeclampsia in nulliparous women at 11-13 weeks gestational age: prospective evaluation of two algorithms. BJOG 2014; 122:1781-8. [PMID: 25471057 DOI: 10.1111/1471-0528.13194] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate two algorithms for prediction of preeclampsia in a population of nulliparous women in Norway. DESIGN Prospective screening study. SETTING National Centre for Fetal Medicine in Trondheim, Norway. POPULATION Five hundred and forty-one nulliparous women. METHODS The women were examined between 11(+0) and 13(+6) weeks with interviews for maternal characteristics and measurements of mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein A and placental growth factor. The First Trimester Screening Program version 2.8 by The Fetal Medicine Foundation (FMF) was compared with the Preeclampsia Predictor TM version 1 revision 2 by Perkin Elmer (PREDICTOR). MAIN OUTCOME MEASURES Prediction of preeclampsia requiring delivery before 37 weeks, before 42 weeks and late preeclampsia (delivery after 34 weeks). RESULTS The performance of the two algorithms was similar, but quite poor, for prediction of preeclampsia requiring delivery before 42 weeks with an area under the curve of 0.77 (0.67-0.87) and sensitivity 40% (95% CI 19.1-63.9) at a fixed 10% false positive rate for FMF and 0.74 (0.63-0.84) and sensitivity 30% (95% CI 11.9-54.3) at a fixed 10% false positive rate for PREDICTOR. The FMF algorithm for preeclampsia requiring delivery <37 weeks had an area under the curve of 0.94 (0.86-1.0) and sensitivity of 80% (95% CI 28.4-99.5) at a 10% fixed false positive rate. CONCLUSIONS Fetal Medicine Foundation and PREDICTOR algorithms had similar and only modest performance in predicting preeclampsia. The results indicate that the FMF algorithm is suitable for prediction of preterm preeclampsia.
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Affiliation(s)
- R B Skråstad
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, National Centre for Fetal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - G G Hov
- Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - H-G K Blaas
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, National Centre for Fetal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - P R Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Obstetrics and Gynaecology, National Centre for Fetal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Lund, Sweden
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25
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Skråstad RB, Hov GG, Blaas HGK, Romundstad PR, Salvesen KÅ. A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population. Acta Obstet Gynecol Scand 2014; 93:1238-47. [PMID: 25146367 DOI: 10.1111/aogs.12479] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy. DESIGN Prospective screening study. SETTING National Center for Fetal Medicine, Trondheim, Norway. POPULATION 579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. METHODS Women were examined between 11(+0) and 13(+6) weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves. MAIN OUTCOME MEASURES Prediction of preeclampsia, severe preeclampsia and gestational hypertension. RESULTS The best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate. CONCLUSIONS Maternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.
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Affiliation(s)
- Ragnhild B Skråstad
- Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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26
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Morken NH, Skjaerven R, Wilcox AJ. Ultrasound prediction of perinatal outcome: the unrecognised value of sibling data. BJOG 2014; 122:1674-81. [DOI: 10.1111/1471-0528.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- N-H Morken
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Department of Clinical Sciences; University of Bergen; Bergen Norway
| | - R Skjaerven
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Norwegian Institute of Public Health; Bergen Norway
| | - AJ Wilcox
- Epidemiology Branch; NIEHS/NIH; Durham NC USA
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27
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Eidem I, Vangen S, Henriksen T, Vollset SE, Hanssen KF, Joner G, Stene LC. Discrepancy in term calculation from second trimester ultrasound scan versus last menstrual period in women with type 1 diabetes. Acta Obstet Gynecol Scand 2014; 93:809-16. [PMID: 24807126 DOI: 10.1111/aogs.12422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 05/05/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To study differences in ultrasound-based compared to menstrual-based term estimation in women with type 1 diabetes. DESIGN Nationwide register study. SETTING Norway. POPULATION Deliveries in Norway 1999-2004 by women registered in the Norwegian Childhood Diabetes Registry (n = 342) and the background population (n = 307 248), with data on both ultrasound-based and menstrual-based gestational age notified in the Birth Registry of Norway. Births with major malformations were excluded. METHODS Linkage of two nationwide registries, the Medical Birth Registry of Norway and the Norwegian Childhood Diabetes Registry. MAIN OUTCOME MEASURES Estimated gestational age at delivery based on routine second trimester ultrasound measurements and last menstrual period. RESULTS In women with type 1 diabetes, the distribution of gestational age at delivery was shifted considerably towards a lower gestational age when using second trimester ultrasound data for estimation, compared with last menstrual period data. The difference between the two estimation methods was larger among women with type 1 diabetes, although also evident in the general population. One in four women with diabetes and a certain last menstrual period date had their ultrasound-calculated term postponed 1 week or more, while one in 10 had it postponed 2 weeks or more. Corresponding numbers in the background population were one in five and one in 20. CONCLUSIONS We found a systematic postponement of ultrasound-based compared with menstrual-based term estimation in women with type 1 diabetes. Relying solely on routine ultrasound-based term calculation for delivery decision may imply a risk of going beyond an optimal pregnancy length.
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Affiliation(s)
- Ingvild Eidem
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Rogne T, Jacobsen GW. Association between low blood glucose increase during glucose tolerance tests in pregnancy and impaired fetal growth. Acta Obstet Gynecol Scand 2014; 93:1160-9. [PMID: 24576054 DOI: 10.1111/aogs.12365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate how different levels of increase in maternal blood glucose from a fasting state to 2 h after an oral glucose challenge in late pregnancy are associated with fetal growth, with special emphasis on those with a low increase. DESIGN Prospective cohort study. SUBJECTS We followed 855 women, of whom 70% had an increased risk for carrying lighter babies. STUDY DESIGN AND METHODS Ultrasound was used to estimate fetal growth in gestational weeks 25, 33 and 37. In week 37 the women had a 75-g oral glucose tolerance test, and fasting and 2-h capillary glucose values were recorded with the difference between these two called delta (∆) glucose. Three groups were constructed from the ∆ glucose distribution: Low below the 10th centile; Medium between the 10th and 90th centiles; and High above the 90th centile. Missing data were imputed. Linear and Poisson regression models were applied. OUTCOME MEASURES Estimated fetal weight, percent deviation from expected fetal weight and anthropometric measures at birth. RESULTS The Low group carried the lightest fetuses and the High group the heaviest. The fetal growth in the Low group deviated increasingly more in a negative direction from week 25 to 37 than in the other groups. CONCLUSION In a high-risk population, a positive relation between ∆ glucose and fetal growth was found. The Low group demonstrated impaired growth. More attention should be paid to pregnant women with an insufficient increase in glucose after a glucose challenge. Future studies should challenge our findings in high-risk and low-risk populations.
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Affiliation(s)
- Tormod Rogne
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Winje BA, Røislien J, Saastad E, Eide J, Riley CF, Stray-Pedersen B, Frøen JF. Wavelet principal component analysis of fetal movement counting data preceding hospital examinations due to decreased fetal movement: a prospective cohort study. BMC Pregnancy Childbirth 2013; 13:172. [PMID: 24007565 PMCID: PMC3844562 DOI: 10.1186/1471-2393-13-172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/29/2013] [Indexed: 11/23/2022] Open
Abstract
Background Fetal movement (FM) counting is a simple and widely used method of assessing fetal well-being. However, little is known about what women perceive as decreased fetal movement (DFM) and how maternally perceived DFM is reflected in FM charts. Methods We analyzed FM counting data from 148 DFM events occurring in 137 pregnancies. The women counted FM daily from pregnancy week 24 until birth using a modified count-to-ten procedure. Common temporal patterns for the two weeks preceding hospital examination due to DFM were extracted from the FM charts using wavelet principal component analysis; a statistical methodology particularly developed for modeling temporal data with sudden changes, i.e. spikes that are frequently found in FM data. The association of the extracted temporal patterns with fetal complications was assessed by including the individuals’ scores on the wavelet principal components as explanatory variables in multivariable logistic regression analyses for two outcome measures: (i) complications identified during DFM-related consultations (n = 148) and (ii) fetal compromise at the time of consultation (including relevant information about birth outcome and placental pathology). The latter outcome variable was restricted to the DFM events occurring within 21 days before birth (n = 76). Results Analyzing the 148 and 76 DFM events, the first three main temporal FM counting patterns explained 87.2% and 87.4%, respectively, of all temporal variation in the FM charts. These three temporal patterns represented overall counting times, sudden spikes around the time of DFM events, and an inverted U-shaped pattern, explaining 75.3%, 8.6%, and 3.3% and 72.5%, 9.6%, and 5.3% of variation in the total cohort and subsample, respectively. Neither of the temporal patterns was significantly associated with the two outcome measures. Conclusions Acknowledging that sudden, large changes in fetal activity may be underreported in FM charts, our study showed that the temporal FM counting patterns in the two weeks preceding DFM-related consultation contributed little to identify clinically important changes in perceived FM. It thus provides insufficient information for giving detailed advice to women on when to contact health care providers. The importance of qualitative features of maternally perceived DFM should be further explored.
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Affiliation(s)
- Brita Askeland Winje
- Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
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Predicting date of birth and examining the best time to date a pregnancy. Int J Gynaecol Obstet 2013; 123:105-9. [PMID: 23932061 DOI: 10.1016/j.ijgo.2013.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/02/2013] [Accepted: 07/09/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the estimated date of birth (eDOB) from the last menstrual period (LMP) and ultrasound scans at varying gestations (<7(0), 7(0)-10(6), 11(0)-14(0), 14(1)-19(6), and 20(0)-27(6)weeks) with the actual date of birth (aDOB). METHODS In a retrospective study, data were analyzed from 18 708 women with spontaneous labor who delivered a single neonate without major anomalies in a local health district in Australia between 2007 and 2011. Data were sourced from a computerized population birth database. The study outcomes were duration of pregnancy expressed as total days, and the difference between aDOB and eDOB by dating method. RESULTS Only 5% of births occurred on the eDOB, regardless of the dating method or timing of the dating. Approximately 66% of births occurred within 7days of the eDOB, and there was little difference among the ultrasound examinations performed at varying gestational weeks. The ultrasound scans at 11(0)-14(0)weeks of gestation performed as well as ultrasound scans conducted at other gestational ages. CONCLUSION On a population basis, there were no meaningful differences in the prediction of date of birth by ultrasound scan date. An early dating scan (≤10weeks) is unnecessary if LMP is reliable.
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Løhaugen GCC, Østgård HF, Andreassen S, Jacobsen GW, Vik T, Brubakk AM, Skranes J, Martinussen M. Small for gestational age and intrauterine growth restriction decreases cognitive function in young adults. J Pediatr 2013; 163:447-53. [PMID: 23453550 DOI: 10.1016/j.jpeds.2013.01.060] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/05/2012] [Accepted: 01/28/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the effect on adult cognitive function of being born small for gestational age (SGA), and to evaluate whether cognitive function is related to intrauterine growth restriction (IUGR). STUDY DESIGN Fifty-nine SGA subjects (birth weight <10th percentile) and 81 controls (birth weight ≥10th percentile) born at term underwent cognitive assessment with the Wechsler Adult Intelligence Scale-Third Edition at age 19-20 years. Repeated ultrasound measures of fetal growth were available for weeks 25, 33, and 37 in a subgroup of 29 SGA subjects and 75 control subjects, and these were data used to dichotomize the 29 SGA subjects into those with IUGR and those without IUGR. IUGR was defined as growth deviating more than -2 SD from the mean value of the control group. The effect of maternal smoking during pregnancy was considered as well. Group differences were analyzed using a general linear model, controlling for sex and socioeconomic status. RESULTS The SGA group had lower full IQ scores than the control group (mean difference, -6.3; 95% CI, -2.8 to -9.7; P = .001), including lower scores on 6 of the Wechsler Adult Intelligence Scale-Third Edition subtests. In the SGA subgroup with repeated ultrasound measures, 6 of 29 subjects (21%) had IUGR, and these subjects also had a lower IQ compared with controls (mean difference, -14.0; 95% CI: -4.8 to -23.3; P = .003). Maternal smoking during pregnancy was related to lower IQ in the control group but not in the SGA group, independent of IUGR or non-IUGR status. CONCLUSION IQ scores were lower in young adults born SGA compared with controls. Our analysis suggest that this outcome is related to IUGR.
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Affiliation(s)
- Gro C C Løhaugen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Pay ASD, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. A new population-based reference curve for symphysis-fundus height. Acta Obstet Gynecol Scand 2013; 92:925-33. [PMID: 23611757 DOI: 10.1111/aogs.12157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 04/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present a new gestational-age-specific percentile curve for symphysis-fundus (SF) height and to determine the effects of maternal and fetal covariates. DESIGN A population-based register study. SETTING Antenatal clinics in Västra Götaland County, Sweden, between 2005 and 2010. POPULATION A total of 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital. MAIN OUTCOME MEASURES Measurement of SF height. METHODS A non-linear regression of SF height on day of pregnancy was used to construct a reference chart for the median and other percentiles of SF height. RESULTS The new reference curve for SF height showed almost linear growth until term. The median value was considerably larger at each gestational age compared with the curves for SF height used in Norway and Denmark. Compared with the curve currently used in Sweden, higher median values were observed only at gestational ages >34 weeks, accompanied by an upward shift in all percentiles. The only notably influential covariates were maternal pre-pregnancy weight and height. CONCLUSIONS The new reference curve for SF height shows a pattern that is different from the Scandinavian reference curves of older origin, reflecting changes in the pregnant population, as well as methodological differences. The new curve can be adjusted for maternal and fetal covariates to suit individual pregnancies.
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Affiliation(s)
- Aase Serine D Pay
- Women and Children's Division, Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
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Eikenes L, Martinussen MP, Lund LK, Løhaugen GC, Indredavik MS, Jacobsen GW, Skranes J, Brubakk AM, Håberg AK. Being born small for gestational age reduces white matter integrity in adulthood: a prospective cohort study. Pediatr Res 2012; 72:649-54. [PMID: 23007032 DOI: 10.1038/pr.2012.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Being born small for gestational age (SGA) (birth weight <10th percentile) is connected to decreased white matter (WM) integrity in newborns and increased prevalence of psychiatric symptoms in adulthood. The aims of this study were to investigate whether being born SGA at term affects WM integrity in young adulthood and to explore possible relationships between fractional anisotropy (FA) and pre- and perinatal factors and cognitive and psychiatric outcomes in adulthood in SGA and controls. METHODS Diffusion tensor imaging and tract-based spatial statistics were conducted to test for voxelwise differences in FA in SGAs (n = 46) and controls (n = 57) at 18-22 y. RESULTS As compared with controls SGAs had reduced FA in ventral association tracts and internal/external capsules. In the SGAs, no relationship was found between FA and intrauterine head growth in the third trimester, although total intelligence quotient was negatively correlated to FA. In controls, a positive correlation was found between FA and brain growth in the third trimester and maternal smoking. No relationship was found between FA and psychiatric measures in SGAs or controls. CONCLUSION These results demonstrate that being born SGA leads to reduced WM integrity in adulthood, and suggest that different factors modulate the development of WM in SGA and control groups.
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Affiliation(s)
- Live Eikenes
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Blaas HGK, Vogt C, Eik-Nes SH. Abnormal gyration of the temporal lobe and megalencephaly are typical features of thanatophoric dysplasia and can be visualized prenatally by ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:230-234. [PMID: 22374812 DOI: 10.1002/uog.11127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 05/31/2023]
Abstract
Autopsies of fetuses with thanatophoric dysplasia (TD) have shown abnormal gyration of the temporal lobes. In addition, the head is relatively large compared with the abdomen. We evaluated by ultrasound six consecutive cases of TD at 19 + 0 to 19 + 6 gestational weeks based on last menstrual period. We observed abnormal and deep transverse sulci in the temporal lobes in all cases; these features were confirmed at autopsy. We performed biometric assessment, including biparietal diameter (BPD) and mean abdominal diameter (MAD). For each MAD value in the TD fetuses, we computed mean and SD of the corresponding BPD values from a population-based registry in the relevant age range, and used them to calculate Z-scores for each BPD/MAD ratio. In the general population, the average BPD/MAD ratio was 1.05. In the TD fetuses, the mean BPD was 51.5 (range, 49-54) mm, the MAD was 45 (range, 41-47) mm and the BPD/MAD ratio was 1.15 (range, 1.09-1.20). The average Z-score of the ratios for TD fetuses was 2.44 (range, 1.05-3.39). The ratios for the TD fetuses were significantly higher than were the population ratios (P = 0.016). At autopsy, the mean brain-to-body weight ratio was 20.6% (range, 15.4-24.1%), which was greater than the corresponding mean ratio of 14.9% in normal fetuses. We conclude that abnormal and deep transverse gyration of the temporal lobes can be visualized by ultrasound in mid-second-trimester fetuses with TD. Due to megalencephaly, fetuses with TD have significantly different body proportions, with a larger BPD compared with normal fetuses.
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Affiliation(s)
- H-G K Blaas
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway.
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Placental pathology in pregnancies with maternally perceived decreased fetal movement--a population-based nested case-cohort study. PLoS One 2012; 7:e39259. [PMID: 22723978 PMCID: PMC3378526 DOI: 10.1371/journal.pone.0039259] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022] Open
Abstract
Background Decreased fetal movements (DFM) are associated with fetal growth restriction and stillbirth, presumably linked through an underlying placental dysfunction. Yet, the role of placental pathology has received limited attention in DFM studies. Our main objective was to explore whether maternal perceptions of DFM were associated with placental pathology in pregnancies recruited from a low-risk total population. Methods/Principal Findings Placentas from 129 DFM and 191 non-DFM pregnancies were examined according to standardized macro- and microscopic protocols. DFM was defined as any maternal complaint of DFM leading to a hospital examination. Morphological findings were timed and graded according to their estimated onset and clinical importance, and classified in line with a newly constructed Norwegian classification system for reporting placental pathology. With our population-based approach we were unable to link DFM to an overall measure of all forms of placental pathology (OR 1.3, 95% CI 0.8–2.2, p = 0.249). However, placental pathology leading to imminent delivery could be a competing risk for DFM, making separate subgroup analyses more appropriate. Our study suggests a link between DFM and macroscopic placental pathology related to maternal, uteroplacental vessels, i.e. infarctions, placental lesions (intraplacental hematomas) and abruptions. Although not statistically significant separately, a compound measure showed a significant association with DFM (OR 2.4, 95%CI 1.1–5.0, p = 0.023). This association was strengthened when we accounted for relevant temporal aspects. More subtle microscopic materno-placental ischemic changes outside the areas of localized pathology showed no association with DFM (OR 0.5, 95%CI 0.2–1.4, p = 0.203). There was a strong association between placental pathology and neonatal complications (OR 2.9, 95% CI 1.6–5.1, p<0.001). Conclusions In our population-based study we were generally unable to link maternally perceived DFM to placental pathology. Some associations were seen for subgroups.
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Økland I, Nakling J, Gjessing HK, Grøttum P, Eik-Nes SH. Advantages of the population-based approach to pregnancy dating: results from 23,020 ultrasound examinations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:563-568. [PMID: 21898635 DOI: 10.1002/uog.10081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To confirm the results from two previous evaluations of term prediction models, including two sample-based models and one population-based model, in a third population. METHODS In a study population of 23,020 second-trimester ultrasound examinations, data were prospectively collected and registered over the period 1988-2009. Three different models for ultrasonically estimated date of delivery were applied to the measurements of fetal biparietal diameter (BPD) and two models were applied to the femur length (FL) measurements; the resulting term estimations were compared with the actual time of delivery. The difference between the actual and the predicted dates of delivery (the median bias) was calculated for each of the models, for three BPD/FL-measurement subgroups and for the study population as a whole. RESULTS For the population-based model, the median bias was + 0.4 days for the BPD-based predictions and - 0.4 days for the FL-based predictions, and the biases were stable over the inclusion ranges. The biases of the two traditional models varied with the size of the fetus at examination; median biases were - 0.87 and + 2.2 days, respectively, with extremes - 4.2 and + 4.8 days for the BPD-based predictions, and the median bias was + 1.72 days with range - 0.8 to + 4.5 days for FL-based predictions. The disagreement between the two sample-based models was never less than 2 days for the BPD-based predictions. CONCLUSION This study confirms the results from previous studies; median biases were negligible with term predictions from the population-based model, while those from the traditional models varied substantially. The biases, which have clinical implications, seem inevitable with the sample-based models, which, even if overall biases were removed, will perform unsatisfactorily.
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Affiliation(s)
- I Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
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Saastad E, Winje BA, Stray Pedersen B, Frøen JF. Fetal movement counting improved identification of fetal growth restriction and perinatal outcomes--a multi-centre, randomized, controlled trial. PLoS One 2011; 6:e28482. [PMID: 22205952 PMCID: PMC3244397 DOI: 10.1371/journal.pone.0028482] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/09/2011] [Indexed: 12/02/2022] Open
Abstract
Background Fetal movement counting is a method used by the mother to quantify her baby's movements, and may prevent adverse pregnancy outcome by a timely evaluation of fetal health when the woman reports decreased fetal movements. We aimed to assess effects of fetal movement counting on identification of fetal pathology and pregnancy outcome. Methodology In a multicentre, randomized, controlled trial, 1076 pregnant women with singleton pregnancies from an unselected population were assigned to either perform fetal movement counting from gestational week 28, or to receive standard antenatal care not including fetal movement counting (controls). Women were recruited from nine Norwegian hospitals during September 2007 through November 2009. Main outcome was a compound measure of fetal pathology and adverse pregnancy outcomes. Analysis was performed by intention-to-treat. Principal Findings The frequency of the main outcome was equal in the groups; 63 of 433 (11.6%) in the intervention group, versus 53 of 532 (10.7%) in the control group [RR: 1.1 95% CI 0.7–1.5)]. The growth-restricted fetuses were more often identified prior to birth in the intervention group than in the control group; 20 of 23 fetuses (87.0%) versus 12 of 20 fetuses (60.0%), respectively, [RR: 1.5 (95% CI 1.0–2.1)]. In the intervention group two babies (0.4%) had Apgar scores <4 at 1 minute, versus 12 (2.3%) in the control group [RR: 0.2 (95% CI 0.04–0.7)]. The frequency of consultations for decreased fetal movement was 71 (13.1%) and 57 (10.7%) in the intervention and control groups, respectively [RR: 1.2 (95% CI 0.9–1.7)]. The frequency of interventions was similar in the groups. Conclusions Maternal ability to detect clinically important changes in fetal activity seemed to be improved by fetal movement counting; there was an increased identification of fetal growth restriction and improved perinatal outcome, without inducing more consultations or obstetric interventions. Trial Registration ClinicalTrials.govNCT00513942
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Affiliation(s)
- Eli Saastad
- Faculty of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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Økland I, Bjåstad TG, Johansen TF, Gjessing HK, Grøttum P, Eik-Nes SH. Narrowed beam width in newer ultrasound machines shortens measurements in the lateral direction: fetal measurement charts may be obsolete. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:82-87. [PMID: 21308840 DOI: 10.1002/uog.8954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Fetal ultrasound measurements are made in axial, lateral and oblique directions. Lateral resolution is influenced by the beam width of the ultrasound system. To improve lateral resolution and image quality, the beam width has been made narrower; consequently, measurements in the lateral direction are affected and apparently made shorter, approaching the true length. The aims of this study were to explore our database to reveal time-dependent shortening of ultrasound measurements made in the lateral direction, and to assess the extent of beam-width changes by comparing beam-width measurements made on old and new ultrasound machines. METHODS A total of 41,941 femur length measurements, collected during the time-period 1987-2005, were analyzed, with time as a covariate. Using three ultrasound machines from the 1990s and three newer machines from 2007, we performed 25 series of blinded beam-width measurements on a tissue-mimicking phantom, measuring at depths of 3-8 cm with a 5-MHz transducer. RESULTS Regression analysis showed time to be a significant covariate. At the same gestational age, femur length measurement was 1.15 (95% CI, 1.08-1.23) mm shorter in the time-period 1999-2005 than in the time-period 1987-1992. Overall, the beam width was 1.08 (95% CI, 0.50-1.65) mm narrower with the new machines than with the old machines. CONCLUSIONS Technical improvements in modern ultrasound machines that have reduced the beam width affect fetal measurements in the lateral direction. This has clinical implications and new measurement charts are needed.
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Affiliation(s)
- I Økland
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olavs University Hospital, Trondheim, Norway.
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Okland I, Gjessing HK, Grøttum P, Eggebø TM, Eik-Nes SH. A new population-based term prediction model vs. two traditional sample-based models: validation on 9046 ultrasound examinations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:207-213. [PMID: 20560133 DOI: 10.1002/uog.7728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To compare results of predictions of date of delivery from a new population-based model with those from two traditional regression models. METHODS We included 9046 fetal biparietal diameter (BPD) measurements and 8776 femur length (FL) measurements from the routine ultrasound examinations at Stavanger University Hospital between 2001 and 2007. The prediction models to be validated were applied to the data, and the resulting predictions were compared with the actual time of the subsequent deliveries. The primary measure was the median bias (the difference between the true and the predicted date of delivery), calculated for each method, for the study population as a whole and for three subgroups of BPD/FL measurements. We also assessed the proportion of births within ± 14 days of the predicted day, and rates of preterm and post-term deliveries, which were regarded as secondary measures. RESULTS For the population-based model, the median bias was -0.15 days (95% confidence interval (CI), -0.43 to 0.12) for the BPD-based, and -0.48 days (95% CI, -0.86 to -0.46) for the FL-based predictions, and both biases were stable over the inclusion ranges. The biases of the traditional regression models varied, depending on the fetal size at the time of the examination; the extremes were -3.2 and + 4.5 days for the BPD-based, and -1.0 and + 5.0 days for the FL-based predictions. CONCLUSIONS The overall biases, as well as the biases for the subgroups, were all smaller with the population-based model than with the traditional regression models, which exhibited substantial biases in some BPD and FL subcategories. For the population-based model, the FL-based predictions were in accordance with the BPD-based predictions.
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Affiliation(s)
- I Okland
- National Center for Fetal Medicine, Women and Children's Center, St Olavs University Hospital, Trondheim, Norway.
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Økland I, Gjessing HK, Grøttum P, Eik-Nes SH. Biases of traditional term prediction models: results from different sample-based models evaluated on 41 343 ultrasound examinations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:728-734. [PMID: 20533451 DOI: 10.1002/uog.7707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate two Norwegian traditional, sample-based term prediction models as applied to the data from a large population-based registry. The two models were also compared with an established German model. METHODS Our database included information from 41 343 non-selected ultrasound scans registered over the years 1987-2005. The prediction models were applied to measurements from the ultrasound examinations, and the resulting term predictions were compared with the actual times of the deliveries. The median bias (the difference between the true and the predicted date of delivery) was calculated for each model, both for the study population as a whole and for subgroups of measurements of biparietal diameter (BPD) and femur length (FL). Secondary measures, i.e. proportion of births within ± 14 days and the rates of preterm and post-term deliveries, were also assessed. RESULTS The analyses showed that the models had significant biases, predicting delivery date either too late or too early. For each model the size of the bias varied, depending on the fetal size at the time of the examination; the extremes were minus 4 and plus 4 days for the BPD-based predictions. There were similar results with the FL-based predictions. CONCLUSION Term predictions made with traditional sample-based models had significant biases that varied over each method's measurement range. These models have important shortcomings, probably because of strict selection criteria in the process of constructing the models, and because the methods primarily aim at estimating the last menstrual period-based day of conception, not the day of birth.
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Affiliation(s)
- I Økland
- National Center for Fetal Medicine, Women and Children's Center, St Olavs University Hospital, Trondheim, Norway.
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Salomon LJ, Pizzi C, Gasparrini A, Bernard JP, Ville Y. Prediction of the date of delivery based on first trimester ultrasound measurements: An independent method from estimated date of conception. J Matern Fetal Neonatal Med 2009; 23:1-9. [DOI: 10.3109/14767050903078672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kiserud T, Johnsen SL, Rasmussen S. Re: A direct method for ultrasound prediction of day of delivery: a new, population-based approach. Problems of accounting for a retrospective selection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:225-227. [PMID: 18254145 DOI: 10.1002/uog.5204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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