Unselected Pregnant Population Research Articles

Longitudinal maternal cardiac function in hypertensive disorders of pregnancy

Compared with gestational hypertension, preeclampsia has traditionally been considered the worse end of the spectrum of hypertensive disorders of pregnancy. It is associated with worse pregnancy outcomes and future cardiovascular morbidities. Both hypertensive disorders may be associated with cardiac maladaptation in pregnancy. However, previous studies were limited by small numbers and a paucity of longitudinal data and unaccounted for the contribution of maternal characteristics that can affect hemodynamics. This study aimed to assess, in an unselected population, the maternal cardiac adaptation in normotensive and hypertensive pregnancies after controlling for important maternal characteristics that affect maternal cardiac function and the interaction among these covariates. This was a prospective, multicenter longitudinal study of maternal hemodynamics, assessed by a noninvasive bioreactance technology, measured at 11 0/7 to 13 6/7, 19 0/7 to 24 0/7, 30 0/7 to 34 0/7, and 35 0/7 to 37 0/7 weeks of gestation in 3 groups of women. Group 1 was composed of women with preeclampsia (n=45), group 2 was composed of women with gestational hypertension (n=61), and group 3 was composed of normotensive women (n=1643). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal age, height, weight, weight gain, race, previous obstetrical history, and birthweight. After adjusting for confounders that significantly affect maternal hemodynamics, both group 1 and group 2, compared with group 3, had pathologic cardiac adaptation. Group 1, compared with group 3, demonstrated hyperdynamic circulation with significantly higher cardiac output driven by greater stroke volume in the first trimester of pregnancy. As the pregnancies progressed to after 20 0/7 weeks of gestation, this hyperdynamic state transitioned to hypodynamic state with low cardiac output and high peripheral vascular resistance. Group 2, compared with group 3, had no significant differences in cardiac output, stroke volume, and heart rate before 20 0/7 weeks of gestation but thereafter demonstrated a continuous decline in cardiac output and stroke volume, similar to group 1. Both groups 1 and 2, compared with group 3, had persistently elevated mean arterial pressure and uterine artery pulsatility index throughout pregnancy. After adjusting for confounders that affect maternal hemodynamics in an unselected pregnant population, women with preeclampsia and gestational hypertension, compared with normotensive women, demonstrated similar cardiac maladaptation. This pathologic profile was evident after 20 0/7 weeks of gestation and at least 10 weeks before the clinical manifestation of the disease.

Multifactorial study of the relationship between fear of childbirth and mode of delivery

Objective. This study investigated the relationship between fear of childbirth (FOC) and mode of delivery and proposed a cut-off value of FOC for an unselected Turkish pregnant population. Materials and Methods. This cross-sectional study was conducted between March 2019 and February 2020 at Kirsehir Ahi Evran University Obstetrics and Gynecology Polyclinic. The Wijma Delivery Expectancy (WDEQ-A) Scale and General Information Form were used for data collection. Results. Social-media effect, concern for disorder in baby, education level, and fear of vaginal bleeding were significant risk factors for the study groups. A new cut-off value of FOC was proposed based on the distribution of FOC scores as 69 (fourth quartile) for an unselected Turkish pregnant population. Conclusions. Training programs regarding delivery and pregnancy processes were recommended to be organized to reduce FOC. Moreover, the newly proposed cut-off value of FOC was recommended to be utilized in clinics.

Utilization of Uterine and Umbilical Artery Doppler in the Second and Third Trimesters to Predict Adverse Pregnancy Outcomes: A Nigerian Experience.

Objective: To assess the utility of uterine and umbilical artery Doppler in the second and third-trimester in predicting adverse pregnancy outcomes.Methodology: In a prospective longitudinal study, the demographic, clinical, Doppler ultrasound parameters of the uterine and umbilical arteries of 84 consecutive women attending the antenatal clinic at 22–24 weeks and 116 women at 30–34 weeks gestation and pregnancy outcomes were documented and analyzed.Results: Pregnant women with adverse pregnancy outcomes had significantly higher second-trimester mean uterine systolic/diastolic (S/D) ratio (p = 0.001), pulsatility index (PI; p = 0.003), umbilical artery S/D (p = 0.016), and resistivity index (RI; p = 0.041) as well as higher third-trimester uterine S/D and PI. While pregnancies with adverse fetal outcomes showed significantly higher uterine artery S/D and PI at the second trimester, third-trimester uterine showed higher S/D, RI, and PI and umbilical artery PI than in women with normal fetal outcomes. The combination of uterine PI and early diastolic notch were predictors of maternal outcomes and correctly predicted 73% (p < 0.001) in the second trimester. By the third trimester, the uterine PI alone was the best predictor and accurately predicted about 62% of maternal outcomes (p = 0.028). In addition, the second-trimester uterine S/D and early diastolic notch and uterine PI in the third trimester correctly predicted 79% and 78% of fetal outcomes, respectively.Conclusion: Among unselected pregnant women population, the second-trimester Doppler parameters are better predictors of maternal adverse pregnancy outcomes, while adverse fetal outcome prediction by uterine and umbilical Doppler at the second- and the third-trimester parameters are comparable.

A prospective population-based multicentre study on the impact of maternal body mass index on adverse pregnancy outcomes: Focus on normal weight.

Maternal body mass index (BMI) below or above the reference interval (18.5-24.9 kg/m2) is associated with adverse pregnancy outcomes. Whether BMI exerts an effect within the reference interval is unclear. Therefore, we assessed the association between adverse pregnancy outcomes and BMI, in particular within the reference interval, in a general unselected pregnant population. Data was extracted from a prospective population-based multicentre cohort (Risk Estimation for PrEgnancy Complications to provide Tailored care (RESPECT) study) conducted between December 2012 to January 2014. BMI was studied in categories (I: <18.5, II: 18.5-19.9, III: 20.0-22.9, IV: 23.0-24.9, V: 25.0-27.4, VI: 27.5-29.9, VII: >30.0 kg/m2) and as a continuous variable within the reference interval. Adverse pregnancy outcomes were defined as composite endpoints for maternal, neonatal or any pregnancy complication, and for adverse pregnancy outcomes individually. Linear trends were assessed using linear-by-linear association analysis and (adjusted) relative risks by regression analysis. The median BMI of the 3671 included women was 23.2 kg/m2 (IQR 21.1-26.2). Adverse pregnancy outcomes were reported in 1256 (34.2%). Linear associations were observed between BMI categories and all three composite endpoints, and individually for pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes mellitus (GDM), large-for-gestational-age (LGA) neonates; but not for small-for-gestational-age neonates and preterm birth. Within the reference interval, BMI was associated with the composite maternal endpoint, PIH, GDM and LGA, with adjusted relative risks of 1.15 (95%CI 1.06-1.26), 1.12 (95%CI 1.00-1.26), 1.31 (95%CI 1.11-1.55) and 1.09 (95%CI 1.01-1.17). Graded increase in maternal BMI appears to be an indicator of risk for adverse pregnancy outcomes even among women with a BMI within the reference interval. The extent to which BMI directly contributes to the increased risk in this group should be evaluated in order to determine strategies most valuable for promoting safety and long-term health for mothers and their offspring.

Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women.

The teratogenic effects of alcohol are well documented, but there is a lack of screening methods to detect alcohol use during pregnancy. Phosphatidylethanol 16:0/18:1 (PEth) is a specific and sensitive biomarker reflecting alcohol intake up to several weeks after consumption. The aim of this study was to investigate the prevalence of positive PEth values as an indicator of early prenatal alcohol exposure in a general population of pregnant women. Rhesus typing is routinely performed in Norway in all pregnancies around gestational week 12. Rhesus-negative women have an additional test taken around week 24. Blood samples submitted to St. Olav University Hospital in Trøndelag, Norway, for Rhesus typing during the period September 2017 to October 2018 were collected. A total of 4,533 whole blood samples from 4,067 women were analyzed for PEth (limit of quantification of 0.003µM). Fifty-eight women had a positive PEth sample. Of these, 50 women were positive around gestational week 12, 3 women were positive around week 24, and in 5 cases, the timing was unknown. There were no significant differences in proportions of women with positive PEth values related to age, or rural versus urban residency. In an unselected pregnant population in Norway, 1.4% had a positive PEth sample around gestational week 12, whereas 0.4% had a positive sample around week 24. The use of PEth as an alcohol biomarker should be further investigated as a diagnostic tool in the antenatal setting.

41. Views and preferences of medical professionals and pregnant women about a novel primary prevention intervention for hypertensive disorders of pregnancy: A qualitative research

Objective To explore the acceptability, views and preferences of pregnant women and primary healthcare providers for a fixed-dose combined preparation of aspirin and calcium (the polypill) as primary prevention of hypertensive disorders in pregnancy in an unselected pregnant population. Method A qualitative study was conducted, consisting of seven focus group discussions with 25 women with low-risk pregnancies and eight in-depth semi-structured interviews with primary care midwives and general practitioners of varying primary care practices in the Netherlands. Topics discussed were: perceptions of preeclampsia; information provision about preeclampsia and the polypill within antenatal care; views on the polypill concept; and preferences and needs regarding implementation of the polypill. MAXQDA computer software was used to carry out thematic analysis of the data transcripts to identify emerging themes. Results Two major themes shaped medical professionals’ and women’s views on the polypill: ‘Informed Choice’ and ‘Medicalization’. Both could be divided into subthemes related to information provision, personal choice and discussions with regard to the balance between ‘unnecessary medicalization’ and ‘scientific progress’. Discussion In general, women and healthcare practitioners expressed a positive attitude towards the polypill intervention as primary prevention strategy with aspirin and calcium, providing some conditions are met. The most important conditions for implementation of such a strategy were safety, effectiveness and the possibility to make a well-informed autonomous decision.

Perceived Financial Satisfaction, Health Related Quality of Life and depressive Symptoms in Early Pregnancy.

Objectives To assess the associations of perceived financial satisfaction and health-related quality of life (HRQoL) and depressive symptoms in an unselected pregnant population in early pregnancy. Methods 750 consecutive pregnant women attending the first communal ultrasound examination before gestational week 14 were invited to participate. Questionnaires assessing HRQoL (15D), depressive symptoms (Edinburgh Depression Scale, EPDS), medical, obstetric, and socioeconomic status were handed out. The participants were divided into three groups according to their satisfaction with their financial status, (unsatisfied, somewhat satisfied, and satisfied). Main outcome measures were 15D and EPDS-scores and dimensions of HRQoL. Results 325 (43,3%) questionnaires were returned. The mean 15D-score for HRQoL was 0,926 (SD 0,056). The financially unsatisfied women had lower HRQoL than women in more satisfied groups (0.906, 0.923 and 0.931, p = 0.012). The result remained significant, even after adjusting for age and education(p = 0.032). The unsatisfied women had a higher mean body mass index (BMI) (25.4, 24.4 and 23.2kg/m2, p for linearity = 0.002), were more often smokers, (13 vs. 4 and 3%, p = 0.029), and had experienced at least one abortion (18, 14 and 7%, p = 0.017). Dimensions of depression, distress and sleep explained the differences between the groups. 27% of unsatisfied women scored EPDS ≥10 points suggesting increased risk of depression. Conclusions Financial satisfaction in early pregnancy associates with HRQoL and risk of perinatal depressive symptoms. Unsatisfied women more often have risk factors for unfavourable pregnancy outcomes which may influence the later health and wellbeing of the mother and child.

Effectiveness of ovarian age as the background risk for aneuploidy screening in an unselected pregnant population

The aim of this study was to assess the performance of first-trimester combined screening when replacing the chronological maternal age by Anti-Müllerian hormone (AMH) and antral follicle count (AFC)-derived ovarian ages, as the background risk in trisomy risk estimation. A total of 639 pregnant women who completed first-trimester combined screening together with AMH and AFC determination were included. Trisomy risks were estimated based on three distinct ‘maternal ages’ as a-priori risk (chronological age, AMH- and AFC-derived ovarian age). The screening performance was assessed using three different approaches: received operator curve; detection rate and false positive rates for a fixed 1/250 threshold; and detection rates for a fixed 3% false positive rate. A non-significant trend was shown for AMH-derived age for both an increased area under the curve (0.986 versus 0.979) and an increased detection rate (from 83% to 100%) for a 1/250 risk threshold. For a 3% false-positive rate, a non-significant trend for increased detection with the use of both AMH- and AFC-derived ovarian ages was observed (from 67% to 83%). These results indicate that, although ovarian derived ages seem to potentially reflect a more precise background risk for fetal trisomies, the improvement in screening performance is only residual.

Incidence of major structural cardiac defects in fetuses with increased nuchal translucency and normal karyotype

Background Nuchal translucency (NT) is the sonographic appearance of a collection of fluid under the skin behind the fetal neck in the first-trimester of pregnancy. In fetuses with chromosomal abnormalities, cardiac defects and many genetic syndromes NT thickness is increased. The aim of the study was to evaluate the incidence of major cardiac defects in relation to the fetal NT in chromosomally normal fetuses in an unselected Slovenian pregnant population.

Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women

The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark's score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark's score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women.

Noninvasive Single-Exon Fetal RHD Determination in a Routine Screening Program in Early Pregnancy

To develop a simple and robust assay suitable for fetal RHD screening in first-trimester pregnancy and to estimate the sensitivity and specificity of the test after its implementation in an unselected pregnant population. Pregnant women attending their first antenatal visit were included, and fetal RHD determination was performed for all women who typed RhD-negative by routine serology. DNA was extracted by an automated system and quantitative polymerase chain reaction was done by an assay based on exon 4. Reporting criteria were simple and strict. Four thousand one hundred eighteen pregnancies, with a median gestational age of 10 weeks, were included. After 211 (5.1%) reanalyses, fetal RHD was reported positive in 2,401 (58.3%), negative in 1,552 (37.7%), and inconclusive in 165 (4.0%) based on the first sample. After a second sample in 147 of 165, only 14 remained inconclusive, all resulting from a weak or silent maternal RHD gene. Using blood group serology of the newborns as the gold standard, the false-negative rate was 55 of 2,297 (2.4%) and the false-positive rate was 15 of 1,355 (1.1%). After exclusion of samples obtained before gestational week 8, the false-negative rate was 23 of 2,073 (1.1%) and the false-positive rate was 14 of 1,218 (1.1%). Both sensitivity and specificity were close to 99% provided samples were not collected before gestational week 8. From gestational week 22, sensitivity was 100%. Fetal RHD detection in early pregnancy using a single-exon assay in a routine clinical setting is feasible and accurate. I.

P18.21: 4D vs 2D ultrasound-guided amniocentesis

Second trimester amniocentesis performed on unselected pregnant population, guided by 2D and 4D ultrasound. The study was conducted on 100 consecutive cases in each group. In 4D guided ultrasound amniocentesis, operators need time to acquire a new spatial configuration of the amniotic cavity as it is imaged in the three-dimensional multiplanar modality. No significant statistical differences were observed except for the time-related procedure that was longer with 4D technique. As with conventional 2D invasive procedure, 4D is an equally safe and reliable technique when performed by experienced operators. It can be used in training specialists in maternal-fetal medicine, it enhances the visualization of the fetus and its behavioral state and may be superior to 2D amniocentesis in selected cases such as increased maternal size and oligo-hydramnios.

P11.05: Fetal aneuploidy and structural abnormalities by a 11-14-week routine ultrasound scan in an unselected Serbian population

A prospective observational cohort study of unselected pregnant women attending an 3D/4D abdominal and vaginal ultrasound examination in 11–14 weeks' gestation. Prenasal thickness, NT and jugular lymphatic sacs (JLS) as markers for aneuploidy. Morphological data revealed that nuchal edema is associated with jugular lymphatic distension. We used the multiplanar mode to obtain the exact mid-sagittal plane and measured the prenasal thickness as the shortest distance between the anterior edge of the lowest part of the frontal bone and the skin anteriorly. Out of 2824 pregnant women, 56 (2.0%) were found to have a missed abortion at the time of the ultrasound scan and 36 (1.3%) were diagnosed as twins. One case was occasionally diagnosed as a mola. 24 major structural abnormalities were detected, 2 cases of holoprosencephaly with hypothelorisam (one case also had a spina bifida), 1 case with hydranencephaly, 2 hydrocephalic fetuses, 2 cases with gastroschisis, 2 case with a bilateral hydronephrosis, 2 unilat. kidney agenesis, 1 megacistis, 2 osteogenesis imperfecta, 2 transposition of great vessels, 2 hypoplastic left ventricle, 1 stenosis A. pulmonalis with ASD, 4 case with a generalized hydrops and 1 fetus with multiple malformations. An additional number of 6 structural defects were detected at birth, including 2 polydactily and 4 non operative VSD. The antenatal ultrasound detection rate was 80% (24/30). Ten patients had a nuchal translucency greater than 3 mm; three of them had chromosomal abnormalities (trisomy 21, trisomy 18). Fetal structural abnormalities at a routine 11–14 weeks ultrasound scan for dating, in an unselected pregnant population, were detected in 80% of the cases. Three out of ten fetuses with a nuchal translucency greater than 3mm. and prenasal thickness and JLS was above the 95th centile had a chromosomal abnormality.

Diagnostic performance of routine ultrasound screening for fetal abnormalities in an unselected Swedish population in 2000–2005

To determine the detection rate of fetal malformations and chromosomal abnormalities and the rate of false-positive ultrasound diagnoses at routine ultrasound examinations carried out by specially trained midwives in an unselected pregnant population from 2000 to 2005, and to describe the consequences of true-positive and false-positive ultrasound diagnoses of fetal malformations. A retrospective analysis was undertaken of all babies born in Malmö, Sweden, between January 2000 and December 2005 by mothers residing in Malmö and of all fetuses with an ultrasound diagnosis of malformation made in the same time interval at the two units performing all routine pregnancy scans in Malmö. All women underwent two routine scans, at 18 and 32 weeks, including scrutiny of the fetal anatomy. Detection rates and false-positive rates were calculated per fetus. The prevalence of chromosomally abnormal fetuses was 0.31% (52/16 775); that of chromosomally normal fetuses with major and minor malformations was 1.80% (302/16 775) and 1.32% (222/16 775), respectively. The detection rate of fetuses with major malformations but normal chromosomes was 68% (205/302), with a detection rate at < 22 weeks of 37% (112/302). In addition, 46% (24/52) of all chromosomally abnormal fetuses were diagnosed before birth because a malformation was detected at ultrasound imaging, 33% (17/52) being detected at < 22 gestational weeks. In all, 68 pregnancies were terminated because of an ultrasound diagnosis of fetal malformation (0.4% of all pregnancies and 47% of the pregnancies in which a fetal malformation was detected by ultrasound examination before 22 weeks). A false-positive ultrasound diagnosis of malformation was made in 0.19% (31/16 180) of the normally formed fetuses and in 20 (0.12%) fetuses the abnormal finding persisted during pregnancy. No fetus assigned a false-positive diagnosis was lost by termination of pregnancy, but most were subjected to one or more unnecessary interventions before birth (e.g. amniocentesis), at birth (e.g. Cesarean section) or after birth (e.g. electrocardiogram, X-ray, ultrasound examination or treatment with antibiotics). In a screening program consisting of one fetal anomaly scan at 18 weeks and another at 32 weeks the detection rate of major malformations in chromosomally normal fetuses was 68% with a detection rate of 37% at < 22 weeks. The corresponding detection rates of chromosomally abnormal fetuses were 46% and 33%. Fewer than one in 500 screened fetuses had an ultrasound diagnosis of an anomaly that was not confirmed after birth.

A significant linear association exists between nuchal translucency thickness and adverse perinatal outcome in euploid fetuses

Objective. Evaluating the correlation between the nuchal translucency (NT) measurement throughout its range of values independent of gestational age, and adverse pregnancy outcome: in euploid structurally normal fetuses.Methods. A prospective observational study was conducted in which NT measurements were made in consecutive singleton euploid fetuses derived from an unselected pregnant population. Pregnancies terminated before the 22nd gestational week, and those with major malformations (diagnosed before or after delivery) were excluded from the analysis. We evaluated the linear association between NT thickness and selected obstetric outcomes.Results. A total of 2205 euploid singleton fetuses were evaluated during the study period. Significant linear-by-linear association was documented between the NT measurement and perinatal mortality (p < 0.001). Thicker NT was significantly associated with diabetes (either gestational or pre-gestational) (p = 0.013).Conclusions. A linear association exists between NT thickness in chromosomally and structurally normal fetuses, and the risk for gestational diabetes and perinatal mortality.

Prevalence of blood and injection phobia among pregnant women

The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes. A cross-sectional study. Antenatal care clinics in the southeast region of Sweden. Sample. In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife. The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored>20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV. Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years. Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.

Thyroid function tests and thyroid autoantibodies in an unselected population of women undergoing first trimester screening for aneuploidy

Thyroid dysfunction in early pregnancy is associated with a number of adverse outcomes. Furthermore, the presence of thyroid autoantibodies has been associated with an increased risk of miscarriage. To determine the prevalence of thyroid autoantibodies and their effect on thyroid function tests in an unselected population of women in early pregnancy. Cross-sectional study of samples that were collected for aneuploidy screening between 10 and 14 weeks gestation in Northern Sydney Area Health Service. Thyroid function tests (free T3, free T4 and thyroid-stimulating hormone) and thyroid autoantibodies to thyroperoxidase and thyroglobulin were measured. Thyroid function tests were performed on a random sample of 257 blood samples. The presence of thyroid autoantibodies was common (18.3%) and was associated with subtle changes in thyroid function consistent with impaired thyroidal reserve. The prevalence of antithyroid Abs in an unselected pregnant population in the late first trimester was about 18%.

508: A significant linear association exists between NT thickness and adverse perinatal outcome in euploid fetuses

ADVERSE PERINATAL OUTCOME IN EUPLOID FETUSES. BOAZ SHEIZAF, EYAL SHEINER, MIRIAM FINK, RELI HERSHKOVITZ, MOSHE MAZOR, ARNON WIZNITZER, Soroka University Medical Center, Beer-Sheva, Israel OBJECTIVE: To evaluate whether there is a correlation between the nuchal translucency (NT) measurement throughout its range, independent of gestational age, and adverse pregnancy outcome, in euploid fetuses. STUDY DESIGN: A prospective observational study was conducted in which NT measurements were made in consecutive singleton euploid fetuses derived from an unselected pregnant population. Examinations were performed at 11 0/7 to 13 6/7 weeks gestation, between January 1999 and October 2006 in a University Medical Center. Pregnancies terminated before 22 weeks gestation were excluded from the analysis. RESULTS: A total of 2205 euploid fetuses were evaluated during the study period. Significant linear-by-linear association was documented between the NT measurement and perinatal mortality (P 0.001, Figure). Additionally, thicker NT was significantly associated with diabetes (either gestational or pre-gestational) (P 0.013). Selected outcomes are presented in the table.

By how much does increased nuchal translucency increase the risk of adverse pregnancy outcome in chromosomally normal fetuses? A study of 16 260 fetuses derived from an unselected pregnant population

In this study we aimed to estimate the magnitude of a possible increase in risk of adverse outcome in fetuses with normal karyotype and increased nuchal translucency (NT), and to determine how well NT measurements can distinguish between fetuses with normal and adverse outcome. We studied 16,260 consecutive fetuses with normal karyotype derived from an unselected pregnant population. The following cut-offs for increased risk of adverse outcome were chosen a priori: NT > or = 95th percentile, > or = 3 mm, > or = 3.5 mm, and > or = 4.5 mm. The positive and negative likelihood ratios (+LR, - LR) of the risk cut-offs with regard to fetal malformation, miscarriage, perinatal death, termination of pregnancy and total adverse outcome were calculated, and receiver-operating characteristics (ROC) curves were drawn. The total rate of adverse outcome was 2.7%. + LR and - LR of NT > or = 3.0 mm were: for lethal or severe malformation, + LR 15.0 (95% CI 7.0-28.6), - LR 0.89 (95% CI 0.81-0.95); for malformation of at least intermediate severity, + LR 8.1 (95% CI 4.3-14.0), - LR 0.95 (95% CI 0.92-0.97); for termination of pregnancy, + LR 41.6 (95% CI 17.1-86.6), - LR 0.67 (95% CI 0.41-0.85); for any adverse outcome, + LR 6.4 (95% CI 3.4-11), - LR 0.96 (95% CI 0.94-0.98). The odds for these adverse outcomes increased with increasing NT. NT > or = 3 mm did not significantly increase the risk of miscarriage or perinatal death. Areas under ROC curves for NT were small, with 95% CI below or only slightly above 0.5. Our likelihood ratios can be used to calculate the individual risk of unfavorable outcome, but NT screening cannot reliably distinguish between normal and adverse outcome in fetuses with normal karyotype.

Detection of fetal structural abnormalities by an 11–14‐week ultrasound dating scan in an unselected Swedish population

To determine the detection rate of fetal structural abnormalities by a routine 11-14-week ultrasound scan for dating in an unselected pregnant population. A prospective observational cohort study of 2,708 unselected pregnant women attending an abdominal ultrasound examination at 11-14 weeks gestation. The number of major fetal structural abnormalities diagnosed after birth was obtained from a computerized database at the same unit. Out of 2,708 pregnant women, 89 (3.3%) were found to have a missed abortion at the time of the ultrasound scan and 33 (1.2%) were diagnosed as twins. Thirteen major structural abnormalities were detected, three cases of anencephaly (one case also had a spina bifida), one case with hydranencephaly, one fetus with Dandy-Walker syndrome, two cases with gastroschisis, one case with a bilateral hydronephrosis, one case with a generalized hydrops, one fetus with multiple malformations, and three cystic hygromas. An additional 19 major structural defects were detected at birth. Four cases of neural tube defects and nine fetuses with congenital heart defects were diagnosed. The antenatal ultrasound detection rate was 40.6% (13/32). Nine patients had a nuchal translucency greater than 3.0 mm (excluding cystic hygromas); two of them had chromosomal abnormalities (trisomy 21 and trisomy 18). Fetal structural abnormalities were detected in 41% (95%CI = 24-59) of the cases in an unselected pregnant population at a routine 11-14-week ultrasound scan for dating purpose. Two out of nine fetuses with a nuchal translucency greater than 3.0 mm had a chromosomal abnormality.