Maternal physical activity affects yolk sac size and growth in early pregnancy, but girls and boys use different strategies.

This longitudinal study investigated the impact of actigraphy-measured maternal physical activity on yolk sac size during early development. The yolk sac, a transient extraembryonic organ, plays a crucial role in embryonic development and is involved in metabolism, nutrition, growth, and hematopoiesis. Prospectively collected data from 190 healthy women indicated that their total daily physical activity, including both light and moderate-vigorous activity, was associated with yolk sac growth dynamics depending on embryonic sex and gestational age. Higher preconception maternal physical activity was linked to a larger yolk sac at 7 weeks (95% CI [0.02-0.13 mm]) and a smaller yolk sac at 10 weeks' gestation (95% CI [- 0.18 to - 0.00]) in male embryos; in female embryos, the yolk sac size was increased at 10 weeks' gestation (95% CI [0.06-0.26]) and was, on average, 24% larger than that in male embryos (95% CI [0.12-0.38]). Considering the pattern of other maternal effects on yolk sac size-e.g., body composition and sleep duration-we suggest that physiological yolk sac adaptations occur in short, sex-specific time windows and can be influenced by various maternal factors.

Gynaecological fistulae after surgery or radiotherapy. / Gynekologiske fistler etter kirurgi eller strålebehandling.

BACKGROUND: Gynaecological fistulae cause urinary and/or faecal incontinence. Haukeland University Hospital has systematically recorded treatments for gynaecological fistulae, since 2012 in its capacity as the Norwegian National Unit for Gynaecological Fistulae. This study describes characteristics of and therapeutic outcomes for gynaecological fistulae caused by surgery and/or radiotherapy. MATERIAL AND METHOD: We have conducted a retrospective cohort study of women who were treated at the Department of Gynaecology and Obstetrics, Haukeland University Hospital, in the period 1995-2019 for gynaecological fistulae due to surgery or radiotherapy. RESULTS: Surgery or radiotherapy was the cause of gynaecological fistulae in 182 of a total of 411 women. 163 of them consented to the study, 124/163 (76 %) with fistulae following surgery and 39/163 (24 %) with fistulae following radiotherapy. The post-surgical fistulae were mainly urogenital (91/124: 73 %) and most often caused by a hysterectomy (n = 71) or urinary incontinence procedure (n = 11). Post-radiotherapy fistulae were mainly enterogenital (34/39: 87 %), with rectal cancer (n = 22) and cervical cancer (n = 11) as the most frequent types of cancer. The main procedure was vaginal fistuloplasty, which was carried out on 100/124 (81 %) of women with post-surgical fistula and 7/39 (18 %) of those with post-radiotherapy fistula. Catheter drainage or stomy alone resulted in healing in 14/163 (9 %) of all patients. A total of 117/124 (94 %) of women with post-surgical fistula achieved healing, compared with 10/39 (26 %) with post-radiotherapy fistula. 28/39 (72 %) of the latter had a permanent urostomy or enterostomy. INTERPETATION: Gynaecological fistulae caused by surgery have a good healing rate, while post-radiotherapy fistulae are more often permanent.

Incidence of gynecological fistula and its surgical treatment: A national registry-based study.

INTRODUCTION: Gynecological fistula (affecting female genital organs) leads to involuntary loss of urine or feces. In industrialized societies, fistulas occur mostly as complications of surgery, radiation therapy or inflammatory bowel disease. We sought to determine the incidence of gynecological fistula and type of surgical treatment provided in Norway. MATERIAL AND METHODS: This was a retrospective national cohort study of women treated for gynecological fistula (International Classification of Disease-10 code N82) during 2008-2014, identified from the mandatory Norwegian Patient Registry. To compare groups, we utilized Chi-square or non-parametric tests. RESULTS: In all, 1627 women (.06% of the female Norwegian population) had 4475 hospital admissions with a diagnosis of gynecological fistula. In total, 1214/1627 (75%) had fistula as the main diagnosis: 346 (29%) a urogenital fistula, 672 (55%) an enterogenital, 38 (3%) a genitocutaneous and 22 (2%) both urinary and enteral fistula. Surgery for gynecological fistula was performed in 723 women, an incidence rate of 4.2 per 100 000 person-years (95% confidence interval [CI] 4.2-4.3); gynecological procedures (mostly vaginal/perineal) were performed in 163 women (23%), urological in 43 (6%), enteral in 267 (37%) and surgery involving multiple pelvic compartments in 250 (35%). Women undergoing fistula surgery had a median of three hospital contacts (95% CI 3-3), for 370 women (52%), the procedure was performed by a gynecologist, and 212 of these (29%) were also operated by urologists or gastroenterologists. CONCLUSIONS: Gynecological fistula is rare in Norway, with an overall incidence of 6/10 000 in the female population, whereas the incidence of surgically treated fistula is 4.2/100 000. However, the condition represents considerable morbidity for the individual patient.

Incidence of obstetric fistula in Norway: a population-based prospective cohort study.

INTRODUCTION: Obstetric fistula is a serious complication of childbirth prevalent in developing societies. Less is known about its occurrence in industrialized countries. We aimed to determine incidence and outcome of obstetric fistulas in Norway. MATERIAL AND METHODS: This was a population-based prospective cohort study. Patient characteristics were registered for all treated at the National Treatment Center for Gynecologic Fistulas, Haukeland University Hospital, Bergen. Women with obstetric fistula after delivering in Hordaland County were included when calculating the incidence based on number of deliveries in that county during 1995-2014. RESULTS: Of 280 fistulas, 40 were related to obstetrics (four urogenital and 36 enterogenital), 19 women were from Hordaland County. During this period, 116 389 deliveries were registered, giving an incidence of obstetric fistula of 16.3/100,000 deliveries (95% confidence interval 10.2-25.7/100,000). The urinary fistulas were due to cesarean section, cerclage, and uterine rupture, and all were repaired surgically. The 36 enteral fistulas were all related to vaginal deliveries; nine (25%) were instrumental and 19 (53%) had experienced a perineal tear of grade 3-4. These fistulas were small, with a median diameter of 2 mm. Four healed spontaneously or after enterostomy, and 30 were repaired transvaginally. In all, 37 of 40 obstetric fistulas were confirmed healed at follow up. Two women refrained from surgery, and one was lost to follow up. CONCLUSION: Obstetric fistula does occur in industrialized societies but with a low incidence; fistulas are due to obstetric trauma or surgery rather than prolonged obstructed labor. The outcome of treatment is excellent when women are treated at a competent center.

Reference Ranges for Head Circumference in Ethiopian Children 0-2 Years of Age.

BACKGROUND: Head circumference (HC) charts are important for early detection of hydrocephalus during childhood. In low-income countries where population-based HC charts are rarely available, hydrocephalus occurs more commonly than in developed countries, and is usually not diagnosed early enough to prevent severe brain damage. This applies to Ethiopia as well. The World Health Organization (WHO) has provided standard HC charts advocated for global use, but recent studies cast doubts whether these charts are equally applicable in various populations. The aim of the study was therefore to establish reference ranges for early childhood HC in Ethiopia. METHODS: In this prospective, observational cross-sectional study, measurements of HC were collected from healthy children of different ethnicities between birth and 24 months, in health centers situated in 5 Ethiopian cities. Reference ranges for HC were estimated using the LMS method and compared with those recommended by WHO. RESULTS: A total of 4019 children were included. Overall, 6.7% of boys and 7.1% of girls were above the +2 standard deviation (SD) of the WHO reference ranges, whereas the corresponding figures below -2 SD were 2.8% and 2.1%. Similarly, the +2 SD lines of the Ethiopian reference curves were considerably higher than those of the WHO growth standards, whereas the median and -2 SD lines were more comparable. CONCLUSIONS: Ethiopian HC reference ranges for children from birth to 24 months of age were found to differ significantly from those established by WHO and should correspondingly be considered as the first choice for screening for hydrocephalus in that population.

WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component.

BACKGROUND: In 2006 WHO presented the infant and child growth charts suggested for universal application. However, major determinants for perinatal outcomes and postnatal growth are laid down during antenatal development. Accordingly, monitoring fetal growth in utero by ultrasonography is important both for clinical and scientific reasons. The currently used fetal growth references are derived mainly from North American and European population and may be inappropriate for international use, given possible variances in the growth rates of fetuses from different ethnic population groups. WHO has, therefore, made it a high priority to establish charts of optimal fetal growth that can be recommended worldwide. METHODS: This is a multi-national study for the development of fetal growth standards for international application by assessing fetal growth in populations of different ethnic and geographic backgrounds. The study will select pregnant women of high-middle socioeconomic status with no obvious environmental constraints on growth (adequate nutritional status, non-smoking), and normal pregnancy history with no complications likely to affect fetal growth. The study will be conducted in centres from ten developing and industrialized countries: Argentina, Brazil, Democratic Republic of Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand. At each centre, 140 pregnant women will be recruited between 8 + 0 and 12 + 6 weeks of gestation. Subsequently, visits for fetal biometry will be scheduled at 14, 18, 24, 28, 32, 36, and 40 weeks (+/- 1 week) to be performed by trained ultrasonographers.The main outcome of the proposed study will be the development of fetal growth standards (either global or population specific) for international applications. DISCUSSION: The data from this study will be incorporated into obstetric practice and national health policies at country level in coordination with the activities presently conducted by WHO to implement the use of the Child Growth Standards.

Obstetric fistula in 14,928 Ethiopian women.

OBJECTIVES: Obstetric fistulas are severe sequelae of prolonged obstructed labor, a widespread but incompletely documented problem of low-income countries. Here, we characterize women with obstetric fistula, test the hypothesis that primi- and multipara represent different profiles and that fetal size is an important factor in developing fistula. DESIGN: Hospital registry statistics and questionnaire. POPULATION: A total of 14,928 Ethiopian women with obstetric fistula in 1974-2006 and 434 admitted in 2007-8. METHODS: Self-reported age, marital status, education, distance from home to health facility, parity, duration of labor, neonatal outcome and sex, lag time to treatment; measurement of weight, stature, extent of lesion and clinical assessment of continence before hospital discharge. OUTCOME MEASURES: Duration of labor, extent of pelvic injury and neonatal survival, cure rate. RESULTS: Primi- were more common than multiparous cases (56.8 vs. 43.2%). They were of similar age at marriage (17 years) and stature at hospital admission, but shorter than the population average (152.7 vs. 156.5 cm). Primipara had longer labor than multipara (50.5% > 3 days vs. 27%), larger uro-vaginal fistula, more stillbirths (95 vs. 88%), recto-vaginal fistula, vaginal scarring, persistent incontinence after repair and were more commonly divorced. Male fetuses were involved in 76.7% of obstructed deliveries but in only 44.6% of a previous uneventful delivery in multipara. Educational attainment positively influenced outcomes. CONCLUSIONS: Obstetric fistula is more commonly associated with primiparous than subsequent pregnancies. Primipara have a longer and more damaging labor. A causative role for cephalo-pelvic disproportion is supported by the observation that male fetuses are more commonly involved in obstructed labor.

[Uro- and enterovaginal fistulas]. / Gynekologiske fistler til urinveier og tarm.

BACKGROUND: Gynecological fistulas that cause faecal or urinary incontinence, represent a considerable global health problem that usually reflects inadequate help at birth. The problem has a different profile in the more industrialised countries. The aim of the present study was to characterise gynaecological fistulas in a Norwegian setting. MATERIAL AND METHODS: Data (medical history, type of fistula, treatment and outcome) were recorded from women assessed and treated for uro- and enterogenital fistulas in 1995-2005 at the Woman's clinic Haukeland University Hospital. RESULTS: Of 82 women, 21 were assessed for uro- and 61 for enterogenital fistula. The verified urogenital fistula (19/21) were mainly caused by surgery (16) and only one came after birth. 17 patients required operative closure. Birth (20) and surgical procedures (17) were the main causes of the 54/61 verified enterogenital fistulas. Cancer (9) and inflammatory bowel disease (14) were important contributing diseases. So far 40 patients have been cured, 38 by surgery. Median time from symptoms to diagnosis seven weeks (range 1 day to 10 years) for urogenital and 15 weeks (range 3 days to 3 years) for enterogenital fistulas. INTERPRETATION: Obstetrical fistulas represent 1/3 of the vaginal fistulas treated in our department, but in contrast to the developing world, these lesions are mainly enterovaginal. Surgery, cancer and inflammatory bowel diseases comprised the rest of the fistulas. Urovaginal fistulas comprised 1/4 of all fistulas and were almost exclusively caused by surgery. For many patients it took a long time before they received a diagnosis.

Longitudinal reference ranges for estimated fetal weight.

OBJECTIVE: The aims of the present study were to establish reference ranges for the growth of estimated fetal weight (EFW) between gestational weeks 20 and 42 and to determine the effect of fetal and maternal factors. METHODS: This prospective longitudinal study was based on 634 low-risk pregnancies and a total of 1799 examinations. Gestational age was computed from last menstrual period. Head circumference, abdominal circumference, and femur length were measured using ultrasound, and EFW was calculated using the formula of Combs et al. The statistical analysis was based on regression analysis and multilevel modeling. RESULTS: Intrauterine growth expressed by EFW showed a continuous pattern until term. Males were calculated to be 5% heavier than female fetuses at 20 gestational weeks and 3% at 40 weeks. Otherwise, the fetal and maternal effects on intrauterine growth correspond to a weight shift of 1.3% for breech/nonbreech, 2.5% for each increase in maternal height tertile, and -4% for smoking/nonsmoking. Maternal age higher than 34 years had a significant increased EFW of 4.5% compared with maternal age less than 24 years. Cephalic index in the third tertile had a 1.1% lower EFW compared with the first tertile. Maternal weight, body mass index, and parity did not influence the EFW. Terms for customization to individualize the growth patterns are presented. CONCLUSIONS: The present growth chart is recommended as robust reference ranges for assessing EFW and growth. Fetal and maternal variables can be added into the models to individualize the prediction of EFW.

Longitudinal reference charts for growth of the fetal head, abdomen and femur.

OBJECTIVES: The aims of the present study were to establish improved reference charts for growth of the fetal head, abdomen and femur, and to determine the effect of fetal and maternal factors. STUDY DESIGN: This prospective longitudinal study included 650 low-risk pregnancies. Outer-outer biparietal diameter (BPD), head circumference (HC), mean abdominal diameter (MAD), abdominal circumference (AC) and femur length (FL) were measured by ultrasound, and the statistical analysis was based on regression analysis and multilevel modeling. RESULTS: Reference percentiles for the growth of MAD, AC and FL showed continuous growth in gestational week 10-40, while BPD and HC showed a slightly blunted growth toward the end of pregnancy. FL was the only variable that was not influenced by gender. There was a significant negative association between breech presentation and all five biometrical variables, while maternal weight was positively associated with all five variables. Cephalic index significantly influenced BPD and HC. Maternal height had a positive effect on BPD, HC, AC and FL, and parity had a positive effect on MAD and AC, while smoking influenced negatively HC, MAD, and FL. Terms for calculating conditional reference values and customisation for individualised growth assessment are presented. CONCLUSIONS: New reference charts for the growth of fetal head, abdomen and femur are suggested for assessing fetal size and growth, and can be adjusted for maternal and fetal factors to suite individual pregnancies.

Fetal age assessment based on femur length at 10-25 weeks of gestation, and reference ranges for femur length to head circumference ratios.

BACKGROUND: The aim of the present study is to establish new reference charts for gestational age assessment based on fetal femur length (FL), and new reference ranges for FL to head ratios at gestational weeks 10-25, and to determine the effect of maternal and fetal factors on these charts. METHODS: Six hundred fifty low-risk women with regular menstrual periods and singleton pregnancies were recruited to a prospective cross-sectional study after obtaining written consent. FL, outer-outer biparietal diameter (BPD), and head circumference (HC) were measured at 10-25 weeks of gestation. We used regression analysis in order to construct mean curves and to assess the effect of maternal and fetal factors on age assessment. RESULTS: The new chart for age assessment by means of FL was based on 636 measurements. The 95% CI of the mean corresponded to <1 day. The variation between the mean and the 90th percentile was 5, 6, and 7 days at 13, 18, and 23 weeks, respectively, similar to the results when using BPD or HC. Maternal age modestly influenced gestational age assessment (1.3 days/10 years, P = 0.005), whereas smoking, height, body mass index, multiparity, fetal sex, cephalic index, and breech presentation had no impact. Reference charts for FL to head ratios have been presented. Maternal age, fetal sex, and cephalic index influenced the FL/BPD ratio, whereas only fetal sex influenced FL/HC. CONCLUSIONS: Fetal age assessment based on FL is an equally robust method as using HC. FL/HC is a more robust ratio to characterize fetal proportions than is FL/BPD.