Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. a nation-wide study

Objective: To estimate the association between gestational diabetes mellitus (GDM) and adverse pregnancy and neonatal outcomes in Denmark.

Methods: A population-based cohort study including all singleton pregnancies in Denmark from 2004 to 2010 (n?=?403?092). Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases 10th Revision.

Results: The final study population consisted of 398?623 women. Of these, 9014 (2.3%) had GDM. Data were adjusted for maternal age, parity, smoking, gestational age, birth weight, BMI, gender of the fetus and calendar year. The risk of preeclampsia, caesarean section (both planned and emergency) and shoulder dystocia was increased in women with GDM. In the unadjusted analysis, the risk of thrombosis was increased by a factor 2 in the GDM patients, but in the adjusted analysis this association disappeared. Post-partum hemorrhage was similar in the two groups. The GDM women had an increased risk of giving birth to a macrosomic neonate although the unadjusted analysis did not show any difference between the two groups. Low Apgar score was increased in the GDM, but this association disappeared in the adjusted analysis. Stillbirth was comparable in the two groups.

Conclusions: Women with GDM still have increased incidence of obstetric and neonatal complications, which could imply that treatment of women with GDM should be tightened.     

Idiopathic early ovarian aging: is there a relation with premenopausal accelerated biological aging in young women with diminished response to ART?

Journal of Assisted Reproduction and Genetics - To evaluate whether young women with idiopathic early ovarian aging, as defined by producing fewer oocytes than expected for a given age over...     

Patient reported outcome measures in women undergoing surgery for urinary incontinence and pelvic organ prolapse in Denmark, 2006–2011

Introduction and hypothesis

The aim of this study was to evaluate the impact of urogynecological surgery on quality of life based on patient reported outcome measures (PROMs).

Methods

Data were retrieved from the Danish Urogynaecological Database. Inclusion criteria were Danish women undergoing surgery for urinary incontinence (UI) or pelvic organ prolapse (POP) from 2006 to 2011. Using frequency of symptoms and a visual analogue scale (VAS) both pre- and postoperatively, their severity of symptoms and quality of life were measured by questionnaires.

Results

During the study period, 20,629 urogynecological procedures were performed. The questionnaires on severity of symptoms and the VAS had been completed both pre- and postoperatively for approximately one third of women undergoing surgery. For UI surgery, 83 % had improved symptoms, 13 % were unchanged, and 4 % had worse symptoms postoperatively. For POP surgery, 80, 17, and 3 % were improved, unchanged, and worsened, respectively. The postoperative bother of symptoms and interference in everyday life evaluated by VAS were significantly reduced for both UI [preoperative median VAS score 9, postoperative median score 1 (p?<?0.001)] and POP [8 preoperatively and 0 postoperatively (p?<?0.001)].

Conclusions

Based on PROMs, surgery for UI and POP is effective in alleviating symptoms associated with UI or POP, and it can improve quality of life in symptomatic women. Pre- and postoperative questionnaires are useful tools in assessing symptomatic outcome measures after surgery.     

The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: a matched historical cohort study

Introduction and hypothesis

This study compares vaginal hysterectomy with uterosacral ligament suspension (VH) with the Manchester-Fothergill procedure (MP) for treating pelvic organ prolapse (POP) in the apical compartment.

Methods

Our matched historical cohort study is based on data from four Danish databases and the corresponding electronic medical records. Patients with POP surgically treated with VH (n?=?295) or the MP (n?=?295) in between 2010 and 2014 were matched for age and preoperative POP stage in the apical compartment. The main outcome was recurrent or de novo POP in any compartment. Secondary outcomes were recurrent or de novo POP in each compartment and complications.

Results

The risk of recurrent or de novo POP in any compartment was higher after VH (18.3%) compared with the MP (7.8%) (Hazard ratio, HR?=?2.5, 95% confidence interval (CI): 1.3–4.8). Recurrence in the apical compartment occurred in 5.1% after VH vs. 0.3% after the MP (hazard ratio (HR)?=?10.0, 95% confidence interval (CI) 1.3–78.1). In the anterior compartment, rates of recurrent or de novo POP were 11.2% after VH vs. 4.1% after the MP (HR?=?3.5, 95% CI 1.4–8.7) and in the posterior compartment 12.9% vs. 4.7% (HR?=?2.6, 95% CI 1.3–5.4), respectively. There were more perioperative complications (2.7 vs. 0%, p?=?0.007) and postoperative intra-abdominal bleeding (2 vs. 0%, p?=?0.03) after VH.

Conclusions

This study shows that the MP is superior to VH; if there is no other indication for hysterectomy, the MP should be preferred to VH for surgical treatment of POP in the apical compartment.

     

Use of radiotracer for sentinel lymph node mapping in breast cancer optimizes staging independent of site of administration

PURPOSE: In an effort to optimize sentinel lymph node (SLN) mapping for breast cancer, sites of mapping agent administration and types of mapping agents used continue to be evaluated. This study compares SLN mapping using peritumoral (PT) or subareolar (SA) injection of radiolabeled colloid and examines the relative contributions of radiotracer and blue dye to SLN identification. MATERIALS AND METHODS: A retrospective review was performed of 456 patients with breast cancer and clinically negative axillae who underwent SLN mapping. Sequential groups of patients were injected with filtered Tc-99m SC, 326 peritumorally (group 1) and 130 subareolarly (group 2). All patients had intraoperative SA injection of 1% isosulfan blue dye. RESULTS: The SLN identification and isotope success rates were 97% and 96% in group 1 and 98% and 98% in group 2, respectively. Eighty-one patients (25%) in group 1 and 44 patients (34%) in group 2 had positive SLNs. Of these patients, 15% from group 1 and 14% from group 2 had only positive nodes detected by radiotracer, and 9 of these patients (6 from group 1 and 3 from group 2) had other nodes identified by both radiotracer and blue dye that were negative for metastases. Six percent of patients with positive SLNs were upstaged because of use of radiotracer. CONCLUSIONS: PT and SA injection of radiotracer have comparable success rates for axillary SLN identification. Given that 15% of patients in group 1 and 14% in group 2 had only positive SLNs detected by radiotracer, independent of site of administration, radiotracer remains essential for optimizing breast SLN mapping.     

Informed consent: providing information about prenatal examinations

BACKGROUND: Choice in prenatal care has moved on from a paternalistic approach, to increased patient autonomy and informed decision-making. This review summarises the existing literature on the information of pregnant women about prenatal examinations. The extent to which information about Down syndrome and screening tests empowers informed decision-making are investigated, as are different ways of expressing a risk estimate. RESULTS: Knowledge scores can be improved and decisional conflict reduced by group counselling, individual sessions, and by use of leaflets. None of the interventions leads to a raise in anxiety scores or influence uptake rates. Satisfaction with information provided was found unrelated to level of knowledge, but associated with having expectations for information met. Information on Down syndrome is missing (13-21%), or restricted (13%), limitations of screenings tests rarely mentioned, and written materials often insufficient. Women experience risk expressed as proportions or relative risk ratio significantly higher than percentage, number needed to treat, or absolute risk reduction. More women correctly understand relative risk reduction compared to absolute risk reduction and number needed to treat (60 versus 42 and 30%). Using medical words rather than lay terms significantly alter risk perception. CONCLUSIONS: Information can increase the level of knowledge and reduce decisional conflict, without raising anxiety scores. A clarification of the women's expectations seems paramount to obtain a perception of good information and informed consent. The information provided about Down syndrome and screening tests does not empower an informed consent based on relevant knowledge.     

Maternal characteristics and lifestyle factors and the risk of delivering high birth weight infants

OBJECTIVE: To identify factors associated with an increased risk of giving birth to infants weighing more than 4000 g and to study whether changes in these factors over time can explain the increasing proportion of high birth weight infants over the last decade. METHODS: Our analyses included 24,093 pregnancies of nondiabetic women with information on potential risk factors for high birth weight: maternal prepregnancy weight, height, age, parity, smoking habits, alcohol and caffeine intake, marital status, educational level, gestational age, and infant gender. Information was obtained from questionnaires completed during pregnancy and birth registration forms at the Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark, from 1990 to 1999. RESULTS: We found a statistically significantly increased risk of giving birth to infants weighing more than 4000 g for women with high prepregnancy weight and height, parity greater than 2, gestational age greater than 42 weeks, and male infant gender and for nonsmokers. Women with a low caffeine intake or 10 or more years of education were also at statistically significantly higher risk. The variation found in birth weight over the past 10-year period was explained by changes in maternal prepregnancy weight, height, smoking habits, educational level, and caffeine intake over the same period. CONCLUSION: Risk factors associated with a higher proportion of high birth weight infants may be clinically significant and have an impact on public health. High birth weight increases the risk of adverse outcomes of delivery as well as the risk of childhood morbidity.     

Self reported alcohol intake in pregnancy: comparison between four methods

STUDY OBJECTIVE: To assess the agreement between four different measures of alcohol intake in pregnancy. DESIGN AND SETTING: Danish speaking pregnant women referred to the Midwife Centre in Aarhus, Denmark, for routine antenatal care were contacted at their first visit at approximately 15-16 weeks gestation from October to December 1998. The women were interviewed about current average alcohol intake and intake within the previous week, and subsequently filled in a two week diary on alcohol intake. When booking for delivery at the end of the first trimester the women were also asked to complete a questionnaire including a one item question on current average alcohol intake. PARTICIPANTS: Participants were 441 pregnant women. MAIN RESULTS: Per cent agreement +/- 1 category ranged between 73 and 82. Mean (SD) intake ranged between 1.09 (1.35) drinks/week for diaries, and 0.69 (0.85) for questionnaires. Mean differences between methods were all close to zero. Three of the four measures yielded comparable distributions of average alcohol intake, but reports of intake within the past seven days seemed to be an inappropriate measure of average intake, yielding three times as many abstainers as expected when combining the methods. CONCLUSIONS: When assessing the distribution of alcohol intake in pregnancy or when studying adverse pregnancy outcomes that are probably caused mainly by sustained exposure it seems that for pregnant women with low to moderate alcohol intake diaries or an average measure from interviews or a simple one item questionnaire may be applied. A measure of intake for the previous week seems to be a relevant measure only when studying adverse pregnancy outcomes that are most probably caused by binge-like exposure.