23 research outputs found
Dansk embryologikompendium
No full textKompendiet er først og fremst rettet mot medisinstudenter, men kan leses av alle med interesse for feltet eller ønske om en kort repetisjon av embryologien. Det er kortfattet og nærmest stikkordspreget, i A4-størrelse og paperback.publishedVersio
Har nye nasjonale retningslinjer for diagnostisering av svangerskapsdiabetes ført til endringer i prevalens, håndtering og utfall av svangerskapene? En retrospektiv studie
No full textIntroduction: In 2017 the Norwegian Health authorities implemented new guidelines and reference ranges for diagnosing gestational diabetes. The high prevalence of diabetes globally and the increased occurrence in women of gestational age, generated new research on the association between high blood glucose levels and pregnancy outcome. The aim of this study is to explore whether these new guidelines have led to any changes in the prevalence of gestational diabetes, pregnancy handling and outcome in women diagnosed with gestational diabetes.
Method: Pregnancies complicated with gestational diabetes at St. Olavs Hospital in 2016 and 2018 where included. Variables such as gestational age, induction rate, mode of delivery and birth weight were recorded. Seven women were excluded due to twin-pregnancies, two because their PID-number could not be searched for in Doculive and one due to pre gestational diabetes type 1. That left 261 women for inclusion, 149 delivered in 2016 and 112 delivered in 2018.
Results: There are minor changes in the pregnancy outcomes from 2016 to 2018 after implementation of new guidelines. Some important findings are that a higher proportion of these women gave a vaginal birth in 2018 compared to 2016 (69.6 % vs. 52.3 % p<0.05). More deliveries occured between week 37+0 and 38+6 in 2018 (46.4 % vs. 26.8 % p<0.05) and less women gave birth in or after gestational week 41 (5.4 % vs. 13.4 % p<0.05) in 2018. The prevalence of gestational diabetes declined from 3.9 % in 2016 to 3.2 % in 2018. There was an increase in consultations with endocrinologists (mean: 1.66 more consultations per woman). Mean birthweight did not change significantly from 2016 to 2018 (3623 grams vs. 3559 grams).
Conclusion: Our findings suggest that the new guidelines did not lead to any major changes in pregnancy handling or outcomes. There was no significant increase in the prevalence of gestational diabetes after implementation of new guidelines
Har nye nasjonale retningslinjer for diagnostisering av svangerskapsdiabetes ført til endringer i prevalens, håndtering og utfall av svangerskapene? En retrospektiv studie
No full textIntroduction: In 2017 the Norwegian Health authorities implemented new guidelines and reference ranges for diagnosing gestational diabetes. The high prevalence of diabetes globally and the increased occurrence in women of gestational age, generated new research on the association between high blood glucose levels and pregnancy outcome. The aim of this study is to explore whether these new guidelines have led to any changes in the prevalence of gestational diabetes, pregnancy handling and outcome in women diagnosed with gestational diabetes.
Method: Pregnancies complicated with gestational diabetes at St. Olavs Hospital in 2016 and 2018 where included. Variables such as gestational age, induction rate, mode of delivery and birth weight were recorded. Seven women were excluded due to twin-pregnancies, two because their PID-number could not be searched for in Doculive and one due to pre gestational diabetes type 1. That left 261 women for inclusion, 149 delivered in 2016 and 112 delivered in 2018.
Results: There are minor changes in the pregnancy outcomes from 2016 to 2018 after implementation of new guidelines. Some important findings are that a higher proportion of these women gave a vaginal birth in 2018 compared to 2016 (69.6 % vs. 52.3 % p<0.05). More deliveries occured between week 37+0 and 38+6 in 2018 (46.4 % vs. 26.8 % p<0.05) and less women gave birth in or after gestational week 41 (5.4 % vs. 13.4 % p<0.05) in 2018. The prevalence of gestational diabetes declined from 3.9 % in 2016 to 3.2 % in 2018. There was an increase in consultations with endocrinologists (mean: 1.66 more consultations per woman). Mean birthweight did not change significantly from 2016 to 2018 (3623 grams vs. 3559 grams).
Conclusion: Our findings suggest that the new guidelines did not lead to any major changes in pregnancy handling or outcomes. There was no significant increase in the prevalence of gestational diabetes after implementation of new guidelines
Uterine Artery Doppler in Pregnancy: Women with PCOS Compared to Healthy Controls
No full textThe objective of this study was to investigate possible differences in uterine artery pulsatility index (UtAPI) between pregnant women with PCOS and healthy controls and to explore possible effects of metformin on UtAPI. Material and Methods. The study was conducted in a tertiary center. Forty-eight pregnant women diagnosed with PCOS before pregnancy and 124 healthy pregnant women were included. Women with PCOS were randomly assigned to metformin 2000 mg daily or a placebo. UtAPI was measured five times during 1st and 2nd trimesters of pregnancy in women with PCOS and four times in healthy controls. Results. There was no difference in UtAPI between PCOS women and healthy controls at any point in time (p=0.34–0.77). In women with PCOS, randomly assigned to metformin 2000 mg or placebo, UtAPI was unaffected by metformin two hours after intake of the first dose of study medication (p=0.34). All PCOS women, regardless of randomization, had higher UtAPI two hours after intake of study medication and a meal compared to before a meal (p=0.02). Conclusions. In the first and second trimesters of pregnancy, there was no difference in UtAPI between women with PCOS and healthy controls. Metformin had no immediate effect on the UtAPI. Interestingly, blood flow decreased after a meal, suggesting that time since last meal should be taken into consideration when interpreting the results of UtAPI measurements in pregnancy. This trial is registered with ClinicalTrials.gov (NCT00466622) Metformin in Pregnant PCOS women (PregMet) (NCT00159536)
Uterine artery Doppler in pregnancy: Women with PCOS compared to healthy controls
No full textThe objective of this study was to investigate possible differences in uterine artery pulsatility index (UtAPI) between pregnant women with PCOS and healthy controls and to explore possible effects of metformin on UtAPI. Material and Methods. The study was conducted in a tertiary center. Forty-eight pregnant women diagnosed with PCOS before pregnancy and 124 healthy pregnant women were included. Women with PCOS were randomly assigned to metformin 2000 mg daily or a placebo. UtAPI was measured five times during 1st and 2nd trimesters of pregnancy in women with PCOS and four times in healthy controls. Results. There was no difference in UtAPI between PCOS women and healthy controls at any point in time (). In women with PCOS, randomly assigned to metformin 2000 mg or placebo, UtAPI was unaffected by metformin two hours after intake of the first dose of study medication (). All PCOS women, regardless of randomization, had higher UtAPI two hours after intake of study medication and a meal compared to before a meal (). Conclusions. In the first and second trimesters of pregnancy, there was no difference in UtAPI between women with PCOS and healthy controls. Metformin had no immediate effect on the UtAPI. Interestingly, blood flow decreased after a meal, suggesting that time since last meal should be taken into consideration when interpreting the results of UtAPI measurements in pregnancy. This trial is registered with ClinicalTrials.gov (NCT00466622) Metformin in Pregnant PCOS women (PregMet) (NCT00159536)
Does Metformin Treatment during Pregnancy Modify the Future Metabolic Profile in Women with PCOS?
No full textContext
Worldwide, metformin is prescribed to improve pregnancy outcome in polycystic ovary syndrome (PCOS). Metformin may also benefit future health by modulating increased metabolic stress during pregnancy.
Objective
To investigate whether metformin during pregnancy modified future metabolic health in women with PCOS.
Design
Follow-up study of a randomized controlled trial that compared metformin with placebo in women with PCOS. Mean follow-up period was 7.7 years (range, 5 to 11 years).
Setting
Three university hospitals, seven local hospitals, and one gynecological specialist practice.
Participants
Women with PCOS according to Rotterdam criteria; all former participants in the Metformin in Pregnant PCOS Women Study.
Intervention
Metformin 2000 mg daily or placebo from first trimester to delivery in the original study. No intervention in the present follow-up study.
Main Outcomes and Measures
Main outcome measure was weight gain in the follow-up period. Weight, body mass index (BMI), waist and hip circumferences, and blood pressure (BP) were registered. Body composition was assessed by bioelectrical impedance analysis, and fasting lipids, glucose, and insulin were analyzed.
Results
Of 239 invited women, 131 (55%) participated in the follow-up. Weight gain was similar in women given metformin (2.1 ± 10.5 kg) and women given placebo (1.8 ± 11.2 kg) at 7.7 years’ follow-up after pregnancy (P = 0.834). No difference was found in BMI, waist/hip ratio, BP, body composition, lipids, glucose and insulin levels, or prevalence of metabolic syndrome at follow-up between those treated with metformin and those treated with placebo during pregnancy.
Conclusion
Metformin treatment during pregnancy did not influence the metabolic profile in women with PCOS at 7.7 years of follow-up
Does Metformin Treatment During Pregnancy Modify the Future Metabolic Profile in Women With PCOS?
No full textContext Worldwide, metformin is prescribed to improve pregnancy outcome in polycystic ovary syndrome (PCOS). Metformin may also benefit future health by modulating increased metabolic stress during pregnancy. Objective To investigate whether metformin during pregnancy modified future metabolic health in women with PCOS. Design Follow-up study of a randomized controlled trial that compared metformin with placebo in women with PCOS. Mean follow-up period was 7.7 years (range, 5 to 11 years). Setting Three university hospitals, seven local hospitals, and one gynecological specialist practice. Participants Women with PCOS according to Rotterdam criteria; all former participants in the Metformin in Pregnant PCOS Women Study. Intervention Metformin 2000 mg daily or placebo from first trimester to delivery in the original study. No intervention in the present follow-up study. Main Outcomes and Measures Main outcome measure was weight gain in the follow-up period. Weight, body mass index (BMI), waist and hip circumferences, and blood pressure (BP) were registered. Body composition was assessed by bioelectrical impedance analysis, and fasting lipids, glucose, and insulin were analyzed. Results Of 239 invited women, 131 (55%) participated in the follow-up. Weight gain was similar in women given metformin (2.1 ± 10.5 kg) and women given placebo (1.8 ± 11.2 kg) at 7.7 years' follow-up after pregnancy (P = 0.834). No difference was found in BMI, waist/hip ratio, BP, body composition, lipids, glucose and insulin levels, or prevalence of metabolic syndrome at follow-up between those treated with metformin and those treated with placebo during pregnancy. Conclusion Metformin treatment during pregnancy did not influence the metabolic profile in women with PCOS at 7.7 years of follow-up.</p
Extra-uterine placental transfusion and intact-cord stabilisation of infants in caesarean sections: an intervention development and pilot-study (INTACT-1)
No full textAbstract Background Keeping the umbilical cord intact the first minutes after delivery is beneficial for both term and preterm infants. However, this may be challenging in caesarean sections (CS) due to lack of mobile resuscitation equipment, maintenance of sterility or concern for excessive maternal blood loss. The objective of this study was to develop and pilot-test extra-uterine placental transfusion and intact-cord stabilisation of infants in CS. Methods The intervention development process (phase 1) covered: (A) placenta delivery without cord clamping, (B) intact-cord stabilisation of the infant and (C) physiology-based cord clamping. Different scenarios were tested through in-situ simulation and adjusted through multiple feedback rounds. The involved staff were trained prior to pilot-testing (phase 2). Women having a CS in regional anaesthesia, expecting a term or near-term singleton infant were included in the pilot-study after written consent. Primary outcome was the proportion of successfully completed interventions. For assessment of safety, maternal estimated intraoperative blood loss, infant 5-minute Apgar scores and infant rectal temperature during stabilisation were compared to pre-defined accept criteria. Dry-electrode ECG (NeoBeat™) was used for early detection of infant heart rate. Any respiratory support was registered. Early skin-to-skin contact between mother and infant was attempted for vigorous infants. Results A detailed intervention protocol was developed and tested. Twenty-nine mother-infant-dyads were included in the pilot study. Gestational age ranged from 37 to 42 weeks. The intervention was successfully completed in 26 of 29 cases, of which 31% were planned CS. Median (SD) infant heart rates at one and five minutes were 159 (32) and 168 (21) beats per minute respectively. Eight infants (28%) had intact-cord respiratory support. One infant had a 5-minute Apgar score 1000 ml. Conclusion Extra-uterine placental transfusion to facilitate intact-cord stabilisation and physiology-based cord clamping for term and near-term infants delivered by CS was feasible according to predefined accept criteria. Further investigation of safety of this complex intervention in larger, comparative studies is warranted. Trial registration Regional Committee for Medical Research Ethics Central Norway (REK-Midt), #399101
Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs
No full textExtra-uterine placental transfusion and intact-cord stabilisation of moderately preterm to term infants in caesarean deliveries - A feasibility study with historical control (INTACT-2)
No full textBackground: Although delayed umbilical cord clamping (DCC) is universally recommended, implementation has been difficult in caesarean deliveries. The study objective was to test if extra-uterine placental transfusion (delivering the placenta before cord clamping) to facilitate intact-cord stabilisation could be a feasible and safe alternative to DCC (≥ 1 min) for moderately preterm to term infants with caesarean delivery in regional anaesthesia and their mothers. Methods: This feasibility study included infants with GA 320 to 423 weeks with planned or emergency caesarean delivery. Primary outcome was intervention compliance. Safety outcomes were prevalence of blood loss ≥1000 ml or postoperative wound infection in mothers, and prevalence of early cord clamping (ECC), low 5-min Apgar scores and hypothermia in infants. Results: We included 123 mother-infant pairs in the intervention group and 158 in the historical control group. The intervention was successfully completed in 121 of 123 cases. There were no statistically significant differences in maternal outcomes. Significantly less infants in the intervention group had ECC before 60 s (OR 0.07, CI (0.01–0.51), P = 0.009) and 5-min Apgar scores <7 (P = 0.003) compared to historical controls. There was no significant difference in infant hypothermia. Conclusion: Extra-uterine placental transfusion may be a reasonable alternative to DCC for term and near term preterm infants with caesarean delivery in regional anaesthesia. The intervention may be especially useful in low-income birth settings with high prevalence of iron deficiency/anaemia and no mobile resuscitation equipment
