| 1. |
- Nikkilä, Annamari, et al.
(author)
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Early amniocentesis and congenital foot deformities
- 2002
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In: Fetal Diagnosis and Therapy. - 1015-3837. ; 17:3, s. 129-132
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Journal article (peer-reviewed)abstract
- Objective: Several studies have shown an increased risk of congenital foot derformities after early amniocentesis. These studies have comprised amniocenteses performed before 13 completed gestational weeks. In this study, the risk of foot deformities after amniocentesis performed at 12-14 completed gestational weeks was determined. Methods: 3,469 genetic amniocenteses in singleton pregnancies performed before 15 completed gestational weeks were studied. The intention was to perform the amniocenteses at 12-14 weeks of gestation, but 32 amniocenteses were performed at the gestational age 11 weeks + 5 days or 11 weeks + 6 days. The pregnancies were followed up with regard to fetal loss and leakage of amniotic fluid. After birth, newborns with a diagnosis of foot deformity were identified from the Swedish Medical Birth Registry. The observed number of foot deformities was then compared with the expected number which was calculated stratified for delivery hospital, year of birth, and maternal age. Results: The observed number of foot deformities was significantly higher than the expected: exact odds ratio 1.74 (exact 95% confidence interval 1.06-2.69). The rate of spontaneous abortions after the procedure was 1.8%, and the rate of leakage of amniotic fluid was 1.9%. There was a significant trend for all complications to decrease with increasing gestational age at amniocentesis. Conclusion: Women undergoing amniocentesis at 11 + 5 to 14 + 6 gestational weeks have an increased risk of giving birth to a child with a congenital foot deformity.
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| 2. |
- Nikkilä, Annamari, et al.
(author)
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Fetal growth and congenital malformations.
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 29:3, s. 289-295
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Journal article (peer-reviewed)abstract
- Objectives To ascertain whether the risk for congenital malformations is increased in pregnancies with deviating fetal growth, i.e. in those in which the estimated date of delivery (EDD) was postponed more than 1 week at the second- trimester ultrasound fetometry scan, or those suspected of intrauterine growth restriction at routine ultrasound fetometry in the third trimester. Methods The study period was 1994-2003. We used the Swedish Medical Birth Register to identify pregnancies with appropriate data (n = 605 845). A regional ultrasound database consisting of 73 092 pregnancies was used for more detailed data and analysis of the third-trimester fetal growth. The number of congenital malformations was ascertained from three national health registers. Results We found a moderately increased risk for any malformation in the group of fetuses in which the EDD was postponed > 1 week. The strongest effect was seen for chromosome anomalies and central nervous system malformations, including neural tube defects. In the third trimester, an increased risk for fetal malformations was found in asymmetrically vs. symmetrically growth-restricted fetuses, perhaps more strongly when adjustment of the EDD had been done at the dating scan. Conclusions Fetuses in which the EDD differs between that calculated by the last menstrual period and that calculated by second-trimester ultrasound measurement seem to have an increased risk for congenital malformations, including chromosomal anomalies. A targeted ultrasound examination for malformation screening might be recommended for this group. A similar policy might be recommended when intrauterine growth restriction, especially of the asymmetrical type, is suspected later in pregnancy. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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| 3. |
- Nikkilä, Annamari, et al.
(author)
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Prenatal diagnosis of congenital heart defects-a population based study.
- 2007
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In: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:1, s. 49-52
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Journal article (peer-reviewed)abstract
- Aim: The aim of this study was to describe the efficiency of routine prenatal ultrasound screening for the detection of cardiac defects in a Swedish region and to study the effect of prenatal diagnosis on the survival and outcome of the child. Methods: We identified all fetuses and infants with a diagnosed major cardiac defect born in 1999-2003 in a region of Sweden using a register of the regional paediatric cardiac clinic, various health-care registers and registers of prenatally detected malformations. The outcome of newborns with and without a prenatal diagnosis of a cardiac defect was compared. Results: During the study period, 77 241 infants were born in the area. Among 145 major cardiac defects, 21% were detected prenatally. For the two university departments the detection rate was 38%. Of the major cardiac defects diagnosed < 23 gestational weeks, 30% were terminated. No significant difference in the outcome was found between children with and without a prenatal is of a major cardiac defect. Conclusions: It could not be shown that survival and outcome for children with major cardiac defects was better when the defect was known prenatally than if it was detected postnatally. The size of the study prohibits conclusions on moderate differences.
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| 4. |
- Nikkilä, Annamari, et al.
(author)
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The incidence of spina bifida in Sweden 1973-2003: the effect of prenatal diagnosis.
- 2006
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 16:6, s. 660-662
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Journal article (peer-reviewed)abstract
- Background: Many studies have been conducted on the accuracy of prenatal ultrasound diagnosis of foetal CNS-malformations. These studies were mostly hospital-based or, sometimes, multicentre studies. We present here a population-based study of the prenatal diagnosis of spina bifida in Sweden over a period of 31 years. Methods: We compared the number of newborns with spina bifida and the elective terminations because of the prenatal diagnosis of spina bifida for different periods. Results: The rate of spina bifida among newborns diminished gradually from 0.55 per 1000 to 0.29 per 1000 during the study period. In M county the rate of spina bifida at birth decreased very rapidly and from 1993 onwards was about half of that in the rest of the country. Conclusion: There has been a decline in the rate of spina bifida at birth. This decline can be seen earlier in the southern part of the country, M county. The decline is probably, to a great extent, a consequence of prenatal ultrasound screening.
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| 5. |
- Nikkilä, Annamari
(author)
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Ultrasound screening for fetal anomalies
- 2006
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Doctoral thesis (other academic/artistic)abstract
- We studied the prenatal detection rate of various malformations during a study period of 16 years in a population in southern Sweden consisting of 141 240 deliveries. The overall detection rate was 28.4% and the false positive diagnoses were very few. We studied the effect of prenatal diagnosis on the rate of spina bifida in southern Sweden compared with the rest of the country and could show that the rate of spina bifida at birth has decreased. This decrease was seen earlier and was steeper in the study area compared with the rest of the country. The decrease is probably an effect of prenatal diagnosis. The effect of prenatal diagnosis of cardiac defects was studied during years 1999-2003 in the South Health Care Region. The detection rate of major cardiac defects was higher in the university hospitals than in other hospitals in the area. We could not confirm that the prognosis or outcome for children with cardiac defects was better if the defect was diagnosed prenatally compared with those diagnosed postnatally. We studied how the postponement of expected day of delivery by at least one week at the second trimester ultrasound scan affects the prognosis for the newborn. The risk for congenital malformations and the risk for growth restriction later in pregnancy are increased for pregnancies with the dates postponed. This is probably due to an early growth retardation already in the second trimester when the routine scan is made. The complications of amniocenteses performed in gestational weeks 12, 13, and 14 were studied. The risk for miscarriage and leakage of amniotic fluid decreased with increasing gestational week. There was a significantly increased risk for foot deformities if amniocentesis was performed before 14 gestational weeks. Conclusions: The detection rate of some types of malformations e.g. cardiac defects and spina bifida increased during the studied period. There were differences in the detection rates of these malformations between the study region and rest of the country (for spina bifida) and between different types of hospitals in the study area (for cardiac defects). This is probably due to differences in education and experience of personnel and quality of ultrasound equipment.
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| 6. |
- Nikkilä, Annamari, et al.
(author)
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Ultrasound screening for fetal anomalies in Southern Sweden: a population-based study
- 2006
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 85:6, s. 688-693
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Journal article (peer-reviewed)abstract
- Background. The accuracy of ultrasound in the diagnosis of congenital malformations has been the subject of many studies. Most of these are hospital-based studies over a limited period of years presenting high detection rates and also relatively high incidence of major malformations. We present here a large population-based study over a long period of years. Methods. The prenatal diagnoses are compared with the diagnoses of the newborns and aborted fetuses, including autopsy results. The detection rate of some common structural malformations is studied. Results. The overall detection rate of malformations in our study was 28.4%. We noticed an improved detection rate of heart defects and cleft lip during the study period. The prevalence of malformations in the population was 2.6%. The false positive diagnoses were few, 54 cases, and mainly of a mild nature. Conclusions. Ultrasound screening of fetal malformations in our population has a low false positive rate and even though the overall sensitivity is low, 28.4%, the detection rate for many common structural malformations is relatively good.
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| 7. |
- Sperling, L, et al.
(author)
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How to identify twins at low risk of spontaneous preterm delivery
- 2005
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 26:2, s. 138-144
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Journal article (peer-reviewed)abstract
- Objective The aim of this study was to evaluate transvaginal sonograpbic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery. Methods In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was >= 15 mm. The rates of spontaneous delivery at different cut-off levels of cervical length were determined. Results Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic twins) before 28 weeks and 18.5% (17.1% for DC and 29.5% for MC twins) before 35 weeks. The screen-positive rate was 5% for a cervical length <= 20, 7-8% at <= 25, 16-17% at <= 30 and 34-48% at <= 35mm depending on chorionicity. The false-negative rate (1 - negative predictive value) ranged from 1.2% at 28 weeks to 18.6% at 35 weeks for all twins. Receiver-operating characteristics curves showed that the sensitivity increased with declining gestation I age with cut-off levels of highest accuracy at 21 mm for 28 weeks and 29 mm for 33 weeks. Conclusions Cervical length measurement at 23 weeks of gestation is a good screening test for predicting twins at low risk of preterm and very preterm delivery, especially in DC twins. The present results suggest that a cut-off of 25 mm should be recommended.
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