Screening for pre-eclampsia with competing-risks model using placental growth factor measurement in blood samples collected before 11 weeks' gestation.

OBJECTIVES: To describe the distributional properties and assess the performance of placental growth factor (PlGF) measured in blood samples collected before 11 weeks' gestation in the prediction of pre-eclampsia (PE). METHODS: The study population consisted of pregnant women included in the Pre-eclampsia Screening in Denmark (PRESIDE) study with a PlGF measurement from the routine combined first-trimester screening (cFTS) blood sample collected at 8-14 weeks' gestation. PRESIDE was a prospective multicenter study investigating the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for PE in a Danish population. In the current study, serum concentration of PlGF in the cFTS blood samples was analyzed in batches between January and June 2021. RESULTS: A total of 8386 pregnant women were included. The incidence of PE was 0.7% at < 37 weeks' gestation and 3.0% at ≥ 37 weeks. In blood samples collected at 10 weeks' gestation, PlGF multiples of the median (MoM) were significantly lower in pregnancies with preterm PE < 37 weeks compared to unaffected pregnancies. However, PlGF MoM did not differ significantly between pregnancies with PE and unaffected pregnancies in samples collected before 10 weeks' gestation. CONCLUSIONS: The gestational-age range for PlGF sampling may be expanded from 11-14 to 10-14 weeks when assessing the risk for PE using the FMF first-trimester screening model. There is little evidence to support the use of PlGF in blood samples collected before 10 weeks' gestation. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Quadruplet pregnancy outcome with and without fetal reduction: Danish national cohort study (2008-2018) and comparison with dichorionic twins.

OBJECTIVES: To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with non-reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period. METHODS: This was a retrospective Danish national register-based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non-reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non-reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings. RESULTS: Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non-reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non-reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non-reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non-reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non-reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins. CONCLUSION: This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Pre-eclampsia screening in Denmark (PRESIDE): national validation study.

OBJECTIVES: To investigate the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for pre-eclampsia in a Danish population and compare screening performance with that of the current Danish strategy, which is based on maternal risk factors. METHODS: This was a prospective study of women with a singleton pregnancy attending for their first-trimester ultrasound scan and screening for aneuploidies at six Danish university hospitals between May 2019 and December 2020. Prenatal data on maternal characteristics and medical history were recorded, and measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and serum placental growth factor (PlGF) were collected without performing a risk assessment for pre-eclampsia. Information on acetylsalicylic acid use was recorded. After delivery, pregnancy outcome, including gestational age at delivery and pre-eclampsia diagnosis, was recorded. Pre-eclampsia risk assessment for each woman was calculated blinded to outcome using the FMF screening algorithm following adjustment to the Danish population. Detection rates (DRs) of the FMF algorithm were calculated for a fixed screen-positive rate (SPR) of 10% and for the SPR achieved in the current Danish screening. RESULTS: A total of 8783 pregnant women were included, with a median age of 30.8 (interquartile range (IQR), 28.1-33.9) years. The majority were white (95%), naturally conceiving (90%), non-smokers (97%) and had no family history of pre-eclampsia (96%). The median body mass index was 23.4 (IQR, 21.2-26.6) kg/m2 . A complete risk assessment including maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A was available for 8156 women (92.9%). In these women, UtA-PI was measured bilaterally with a median value of 1.58 (IQR, 1.27-1.94) and the median resting MAP of 80.5 (IQR, 76.1-85.4) mmHg in two consecutive measurements. Among these, 303 (3.7%) developed pre-eclampsia, including 55 (0.7%) cases of pre-eclampsia with delivery < 37 weeks of gestation and 16 (0.2%) cases of pre-eclampsia with delivery < 34 weeks. At a SPR of 10%, combined screening using the FMF algorithm based on maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A had a DR of 77.4% (95% CI, 57.6-97.2%) for pre-eclampsia with delivery < 34 weeks, 66.8% (95% CI, 54.4-79.1%) for pre-eclampsia with delivery < 37 weeks and 44.1% (95% CI, 38.5-49.7%) for pre-eclampsia with delivery at any gestational age. The current Danish screening strategy using maternal risk factors detected 25.0% of women with pre-eclampsia with delivery < 34 weeks and 19.6% of women with pre-eclampsia with delivery < 37 weeks at a SPR of 3.4%. When applying the FMF algorithm including maternal characteristics, MAP, UtA-PI and PlGF at the fixed SPR of 3.4%, the DRs were 60.5% (95% CI, 36.9-84.1%) for PE with delivery < 34 weeks and 45.2% (95% CI, 32.0-58.5%) for PE with delivery < 37 weeks. CONCLUSION: In this large Danish multicenter study, the FMF algorithm based on maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A predicted 77.4% of cases with pre-eclampsia with delivery < 34 weeks and 66.8% of cases with pre-eclampsia with delivery < 37 weeks of gestation at a SPR of 10%, suggesting that the performance of the algorithm in a Danish cohort matches that in other populations. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Late sequelae after laparoscopic sterilization in the pregnant and non-pregnant woman.

To determine the frequency of late sequelae after laparoscopic sterilization performed at the time of induced abortion, we compared data on 114 women who underwent induced first-trimester abortion and concurrent laparoscopic sterilization, with 288 women who had sterilization performed at least 3 months after induced abortion. The period of observation was 12-95 months, median 49 months. We found no statistical difference between the groups with respect to failures, low abdominal pain, dyspareunia, change in bleeding pattern, sexual life and regrets. The results of these findings, discussed here, support the practice of performing the combined procedure.

PIP: Data on 114 women who underwent induced 1st trimester abortion and concurrent laparoscopic sterilization were compared with data on 288 women who had sterilization performed at least 3 months after induced abortion. The study was done to determine the frequency of late sequelae after laparoscopic sterilization performed at the time of induced abortion. The observation period ranged from 12-95 months (median 49 months) for the post abortion group. Electrocoagulation was used in 85 patients and tubal ring application in 29 patients. For the interval group, the observation period ranged from 12-90 months (median 50 months). Electrocoagulation was used in 212 patients and tubal rings in 76 patients. There was no statistical difference between the 2 groups with respect to median age, age distribution, and number of children prior to sterilization. In the post-abortion group, 42.9% had undergone at least 1 previous legal abortion; in the interval group the figure was 26.4%. The difference was statistically significant. 10 women in the interval group and 5 women in the postabortion group became pregnant after the sterilization. 7.0% of the women in the postabortion group and 4.2% in the interval group reported dyspareunia as a consequence of the operation; the figures were 11.4% and 11.5%, respectively, for abdominal pain. Changes in bleeding pattern after the sterilization procedure were reported by 26.3% in the postabortion group and 37.7% in the interval group. The difference was not statistically significant. 213 women (52.9%) reported no changes in their sexual life. 42.8% reported an improvement and 4.3% a deterioration. 15 women (3.7%) regretted their decision to be sterilized. 12 of these women desired more children, 5 because of remarriage. The remaining women reported sexual frigidity, permanent distress due to changes in menstrual pattern, and a changed attitude to pregnancy as the reason for regret. In sum, except for a trend in the interval group towards fewer failures, there was no significant difference between the 2 groups, and nearly 96% of the women in both groups were satisfied with the operation, despite the fact that 35% of these had had at least 1 of the identified late sequelae.

Late sequelae following laparoscopic sterilization employing electrocoagulation and tubal ring techniques: a comparative study.

Data on 211 consecutive laparoscopic sterilized women were compared. Half the patients were sterilized using unipolar electrocoagulation and the rest had tubal rings. The period of observation was 21-50 months, median 36.5 months. Four failures were observed, median 15 months after the operation. Pregnancy rates were 0.32 per 100 woman years using electrocoagulation and 1.02 using tubal rings. A total of 11% had experienced low abdominal pain and 4% dyspareunia. Menstrual pattern changes were reported by 31% in the electrocoagulation group and 43% in the tubal ring group. The rates of late sequelae were statistically significant independent of the technique employed.

PIP: 2 groups of consecutive patients who were sterilized either by laparoscopic tubal diathermy or by laparoscopic application of tubal rings were reviewed. Particular reference was paid to the evaluation of late occurring problems such as safety, low abdominal pain, dyspareunia, and bleeding pattern changes. The total of 285 healthy women were sterilized over the 1978-82 period. All the operations were performed electively at the patient's request, and they were informed that the sterilization was an irreversible procedure. The laparoscopic sterilizations were performed in essentially the same manner in both groups, using a Benveniste uterine guide for better stabilization and manipulation of the uterus. The median observation time was 36.5 months (range 21-50 months). At the time of admission, 28% were pregnant, all in the 1st trimester. These women underwent sterilization immediately after induced abortion. The study patients were selected to receive different occlusion techniques with respect to the time period they were sterilized. In Group 1 (electrocoagulation), a total of 106 (50.2%) women sterilized consecutively from 1978-80 had both fallopian tubes unipolarly electrocoagulated twice without tubal division. In Group 2 (tubal ring), a total of 105 (49.8%) women sterilized consecutively from 1980-82 had both fallopian tubes ligated by means of silastic band application approximately 2 1/2 cm from the uterine corner. There was no statistically significant difference between the 2 groups of women in terms of median age, age-distribution, number and distribution of induced abortions, and number of children prior to sterilization. In the electrocoagulation group, 1 woman became pregnant after the sterilization. The pregnancy occurred 21 months after the operation. The reason for the failure was not established as the pregnancy was ectopic and had ruptured. In the tubal ring group, 3 women became pregnant after the sterilization. The failures occurred from 6-23 months after the operation. In 2 cases the tubal rings were found on the round ligaments or completely missing at 1 salpinx. In the 3rd case, both rings were situated in the correct position. 13.2% of the electrocoagulation group reported low abdominal pain and 6.6% dysparunia as new symptoms appearing after the sterilization. The corresponding rates in the tubal ring group were 8.6% and 1.9%. These differences were not statistically significant, and there also was no difference between the rates in the decades. Changes in bleeding pattern following the sterilization procedure were equally related to age and reported by 33 women in the electrocoagulation group and 45 in the tubal ring group. It is concluded that the rates of late sequelae following laparoscopic sterilization using unipolar electrocoagulation or ring application to the fallopian tubes are independent of the method used, but combining these data with the results of other studies, the ring method is found to be more suitable because of fewer ectopic pregnancies and a greater potential for reversal.