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All cases of ichthyosis prematurity syndrome (IPS), registered at the National Center for Fetal Medicine in Trondheim, Norway between 1987 and 2010 were identified and the findings analyzed. Five fetuses with IPS were identified between 1988 and 2000. All five developed polyhydramnios between 28 and 31 weeks. The fetal stomach appeared to be empty in four cases, and was not described in one case. The fetal skin was described as 'uneven' at ultrasound examination in two cases. Separation of chorionic and amniotic membranes with a peculiar appearance of echo-free fluid in the chorionic cavity and echogenic sediment in the amniotic cavity were observed between 28 + 5 and 32 + 3 weeks in all cases. All fetuses were delivered prematurely between 30 and 34 weeks. All neonates had difficulties in breathing, two developed aspiration pneumonia, and one had bilateral pneumothorax after intubation and died at 6 months because of pulmonary and cardiac sequelae. Prenatal sonographic signs of IPS are separation of the membranes, echogenic amniotic fluid and echo-free chorionic fluid occurring between 28 and 32 weeks' gestation. Delivery occurs at 30-34 weeks and, as there is a high risk of asphyxia, an experienced neonatal intensive care unit team should be present at delivery., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To study intraobserver repeatability and intermethod agreement between two- (2D) and three-dimensional (3D) transperineal ultrasound methods in assessing fetal head descent during the first stage of labor., Methods: Fetal head descent was measured with transperineal ultrasound as the fetal head-perineum distance and the angle of progression in 106 primiparous women with prolonged first stage of labor. A single obstetrician performed all the scans, and another obstetrician analyzed the acquired 2D images and 3D volumes, blinded to clinical assessments and labor outcome. Intraobserver repeatability and intermethod agreement between 2D and 3D methods were analyzed., Results: The repeatability coefficient was ± 4.1 mm in 2D acquisitions and ± 1.7 mm in 3D acquisitions of fetal head-perineum distance. The intraclass correlation coefficients (ICC) were 0.94 for 2D and 0.99 for 3D measurements. The angle of progression repeatability coefficients were ± 6.7° using 2D and ± 5.7° using 3D ultrasound and ICCs were 0.91 and 0.94, respectively. The intermethod ICC for fetal head-perineum distance in 2D vs 3D acquisitions was 0.95 and for angle of progression it was 0.93; the intermethod 95% limits of agreement were - 5.8 mm to + 7.2 mm and - 8.9° to + 13.7°, respectively. Cohen's kappa for 2D vs 3D acquisitions was 0.85 using 40 mm as a cut-off level for fetal head-perineum distance and 0.79 using 110° as cut-off level for angle of progression., Conclusions: For one ultrasound operator the intraobserver repeatability and agreement between 2D and 3D ultrasound methods in prolonged first stage of labor were good. Given that 2D methods are simpler to learn and can be analyzed quickly online, 2D equipment might therefore be preferred in the labor room., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To study the association between exposure to ultrasound in pregnancy and non-right handedness in children with available data from randomized trials., Methods: Follow-up data of 8865 children aged 8-14 years from three randomized trials on routine ultrasonography at 15-20 weeks' gestation were available. Handedness was assessed through questionnaires to the parents and classified according to five, 10 or 11 questions. Children not classified as right handed were regarded as non-right handed., Results: There was a statistically significant increased prevalence of non-right handedness in ultrasonographically screened children compared with controls (odds ratio (OR) 1.15; 95% CI, 1.03-1.29). The results in subgroups according to gender are consistent with the overall results, with no significant differences between boys and girls. Among boys, the association became stronger when an exploratory analysis according to ultrasound exposure before 19-22 weeks' gestation was done (OR 1.30; 95% CI, 1.10-1.53)., Conclusion: There is a statistically significant-albeit weak-association between ultrasound screening during pregnancy and being non-right handed later in life., (Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.)

Background: Both maternal pre-pregnancy obesity and excessive gestational weight gain are increasing in prevalence and associated with a number of adverse pregnancy outcomes for both mother and child. Observational studies regarding physical activity in pregnancy have found reduced weight gain in active mothers, as well as reduced risk of adverse pregnancy outcomes. There is however a lack of high quality, randomized controlled trials on the effects of regular exercise training in pregnancy, especially those with a pre-pregnancy body mass index (BMI) at or above 30 kg/m2., Methods: We are conducting a randomised, controlled trial in Norway with two parallel arms; one intervention group and one control group. We will enroll 150 previously sedentary, pregnant women with a pre-pregnancy BMI at or above 30 kg/m2. The intervention group will meet for organized exercise training three times per week, starting in gestation week 14 (range 12-16). The control group will get standard antenatal care. The main outcome measure will be weight gain from baseline to delivery. Among the secondary outcome measures are changes in exercise capacity, endothelial function, physical activity level, body composition, serum markers of cardiovascular risk, incontinence, lumbopelvic pain and cardiac function from baseline to gestation week 37 (range 36-38). Offspring outcome measures include anthropometric variables at birth, Apgar score, as well as serum markers of inflammation and metabolism in cord blood., Discussion: The results of this trial will provide knowledge about effects of regular exercise training in previously sedentary, obese pregnant women. If the program proves effective in reducing gestational weight gain and adverse pregnancy outcomes, such programs should be considered as part of routine pregnancy care for obese women., Trial Registration: ClinicalTrials.gov: NCT01243554.

Objective: To investigate if fetal head-perineum distance and angle of progression measured with two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound could predict outcome of labor in primiparous women with prolonged first stage of labor., Methods: This was a prospective observational study of 110 primiparous women with singleton cephalic presentation at term diagnosed with prolonged first stage of labor. Digital assessment of fetal station was related to the ischial spine. Fetal head descent was measured with transperineal ultrasound as the shortest distance from the fetal head to the perineum, and the angle between the pubic symphysis and the fetal head. Receiver-operating characteristics (ROC) curves were constructed and 2D and 3D data acquisitions were compared. The stored 3D volumes were assessed by an examiner blinded to all other data. Vaginal delivery vs. Cesarean section was the primary outcome., Results: Cesarean section was performed in 25% of the women. Areas under the ROC curves for prediction of vaginal delivery were 81% (95% confidence interval (CI), 71-91%) (P < 0.01) and 76% (95% CI, 66-87%) (P < 0.01) for fetal head-perineum distance and angle of progression, respectively, as measured by 2D ultrasound and 66% (95% CI, 54-79%) for digital assessment of fetal station (P = 0.01). In 50% of women fetal head-perineum distance was ≤ 40 mm and 93% (95% CI, 83-97%) of them delivered vaginally vs. 18% (95% CI, 5-48%) with distance > 50 mm. In 48% of women the angle of progression was ≥ 110° and 87% (95% CI, 75-93%) of them delivered vaginally vs. 38% (95% CI, 21-57%) with angle < 100°. Results from 2D and 3D acquisitions were similar., Conclusion: Fetal head-perineum distance and angle of progression measured with 2D or 3D ultrasound can predict labor outcome, with similar predictive values for the two techniques., (Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.)

A pregnancy reaching 42 completed weeks (294 days) is defined as postterm (PT). The use of ultrasound in early pregnancy for precise dating significantly reduces the number of PT pregnancies compared to dating based on the last menstrual period. Although the fetal, maternal and neonatal risks increase beyond 41 weeks, there is no conclusive evidence that prolongation of pregnancy, per se, is the major risk factor. Other specific risk factors for adverse outcomes have been identified, the most important of which are restricted fetal growth and fetal malformations. In order to prevent PT and associated complications routine induction before 42 weeks has been proposed. There is no conclusive evidence that this policy improves fetal, maternal and neonatal outcomes as compared to expectant management. It is also unclear if the rate of cesarean sections is different between the two management strategies. After careful identification and exclusion of specific risks, it would seem appropriate to let women make an informed decision about which management they wish to undertake. There is consensus that the number of inductions necessary to possibly avoid one stillbirth is very high. If induction is preferred, procedures for cervical ripening should be used, especially in nulliparous women. Close intrapartum fetal surveillance should be offered, irrespective of whether labor was induced or not.

Background: It is known that onset of rheumatoid arthritis (RA) is increased post partum., Objective: To compare incidence rates between RA and other chronic arthritides (OCA) 0-24 months after delivery, and to compare the incidence rates within each group 0-24 versus 25-48 months post partum., Methods: Premenopausal women from a Norwegian patient register were linked with the Medical Birth Registry of Norway to study the interval between delivery and time of diagnosis. Cox regression analysis with adjustments for age at delivery and birth order was applied to compare proportions of incident cases of RA and OCA with onset 0-24 months post partum. Poisson regression analysis with adjustment for the population at risk was applied to estimate the incidence rate ratio (IRR) 0-24 versus 25-48 months post partum., Results: Of 183 RA and 110 patients with OCA diagnosed after delivery, 69 (37.7%) had RA and 31 (28.2%) OCA during the first 24 months post partum (p = 0.09). The IRR (95% CI) for diagnosis during 0-24 months versus 25-48 months was 1.73 (1.11 to 2.70) (p = 0.01) for RA, 1.05 (0.59 to 1.84) (p = 0.86) for OCA. The IRR was 2.23 (1.06 to 4.70) and 1.87 (0.67 to 5.21), respectively, when only considering diagnoses after the first pregnancy. Clinical characteristics were similar within each diagnostic group., Conclusion: The proportions of incident cases with onset 0-24 months after delivery were not different between RA and OCA. A peak in incidence during 0-24 months was seen in the RA group, both when considering all pregnancies and only the first pregnancy.

Objectives: To evaluate fetal head-perineum distance measured by ultrasound imaging as a predictive factor for induction of labor, and to compare this distance with maternal factors, the Bishop score and ultrasound measurements of cervical length, cervical angle and occiput position., Methods: The study included 275 women admitted for induction of labor. The fetal head-perineum distance was measured by transperineal ultrasound imaging as the shortest distance from the outer bony limit of the fetal skull to the skin surface of the perineum. Cervical length and angle was measured by transvaginal ultrasound examination, and fetal head position was assessed by transabdominal ultrasound imaging. The Bishop score was assessed without knowledge of ultrasound measurements. Receiver-operating characteristics (ROC) curves were used for evaluation of the probability of a successful vaginal delivery. The time from induction to delivery was tested using Cox regression analysis with ultrasound measurements, parity and body mass index (BMI) as possible predictive factors., Results: Areas under the ROC curve for prediction of vaginal delivery were 62% (95% CI, 52-71%) for fetal head-perineum distance (P = 0.03), 61% (95% CI, 51-71%) for cervical length (P = 0.03), 63% (95% CI, 52-74%) for cervical angle (P = 0.02), 61% (95% CI, 52-70%) for Bishop score (P = 0.03) and 60% (95% CI, 51-69%) for BMI (P = 0.05). The Cesarean delivery rate was 22% among nulliparous and 5% among parous women (P < 0.01). Parity, fetal head-perineum distance, cervical length and cervical angle were contributing factors predicting vaginal delivery within 24 h in a Cox regression model. Occiput posterior position had no significant predictive value., Conclusions: Fetal head-perineum distance measured by transperineal ultrasound examination can predict vaginal delivery after induction of labor, with a predictive value similar to that of ultrasonographically measured cervical length and the Bishop score. However, we judge none of these methods used alone to be good enough in a clinical setting., ((c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.)

Purpose: To evaluate the proportion of fetal head rotation from occiput posterior (OP) to occiput anterior (OA) during labour after term prelabour rupture of membranes (PROM), and to study if OP before labour are associated with a higher risk of operative deliveries and a longer duration of labour., Materials and Methods: A transabdominal ultrasound examination was performed in 152 women with PROM after 37 weeks with a single live fetus in cephalic position. The course of labour was compared in women with the fetal head in occiput posterior position or other positions before the start of labour., Results: Before the start of labour, 40 (26%) fetuses were in occiput posterior position (OP), but 34 (85%) of them rotated to occiput anterior (OA) during labour. Ten (6.6%) fetuses were delivered in OP, and six of them were in OP before the start of labour. There were no statistically significant associations between the head position before the start of labour and the duration from PROM to delivery, induction of labour, use of epidural analgesia, augmentation with oxytocin, operative deliveries, perineal tears, Apgar scores, pH or base excess in the umbilical artery., Conclusions: Transabdominal ultrasound examination can determine the fetal head position before the start of labour, but the position of the head did not predict the course of labour, probably because the fetal head may rotate during labour even after PROM.

Background: Investigation of a possible effect of metformin on androgen levels in pregnant women with polycystic ovary syndrome (PCOS)., Methods: A prospective, randomized, double-blind, placebo-controlled pilot study was conducted. Forty pregnant women with PCOS received diet and lifestyle counselling and were randomized to either metformin 850 mg twice daily or placebo. Primary outcome measures were changes in serum levels of dehydroepiandrosterone sulphate, androstenedione, testosterone, sex hormone-binding globulin, and free testosterone index. Secondary outcome measures were pregnancy complications and outcome. Two-tailed t-tests and chi2-tests were used., Results: Maternal androgen levels were unaffected by metformin treatment in pregnant women with PCOS. While none of the 18 women in the metformin group experienced a severe pregnancy or post-partum complication, seven of the 22 (32%) women experienced severe complications in the placebo group (P = 0.01)., Conclusions: Metformin treatment did not reduce maternal androgen levels in pregnant women with PCOS. In the metformin-treated group we observed a reduction of severe, pregnancy and post-partum complications. Metformin treatment of pregnant PCOS women may reduce complications during pregnancy and in the post-partum period., (Copyright 2004 European Society of Human Reproduction and Embryology)

Objective: To determine if the influence of preeclampsia on birth size varies with clinical manifestations of the disease, and to evaluate whether maternal factors, such as smoking, modify the effect of preeclampsia on fetal growth., Methods: Among 12,804 deliveries in a population of approximately 239,000 over a 3-year period, 307 live singleton infants were born after preeclamptic pregnancies. We compared those with a sample of 619 control infants. Preeclampsia was defined as increased diastolic blood pressure (BP) (increase of at least 25 mmHg to at least 90 mmHg) and proteinuria after 20 weeks' gestation. Clinical manifestations were classified according to BP and proteinuria into subgroups of mild, moderate, or severe (including cases with eclampsia and hemolysis, elevated liver enzymes, low platelets [HELLP] syndrome) preeclampsia, and according to gestational age at onset, as early or late preeclampsia. Birth size was expressed as the ratio between observed and expected birth weights, and infants smaller than two standard deviations from expected birth weights were classified as small for gestational age (SGA)., Results: Preeclampsia was associated with a 5% (95% confidence interval [CI] 3%, 6%) reduction in birth weight. In severe preeclampsia, the reduction was 12% (9%, 15%), and in early-onset disease, birth weight was 23% (18%, 29%) lower than expected. The risk of SGA was four times higher (relative risk [RR] = 4.2; 95% CI 2.2, 8.0) in infants born after preeclampsia than in control pregnancies. Among nulliparas, preeclampsia was associated with a nearly threefold higher risk of SGA (RR = 2.8; 1.2, 5.9), and among paras, the risk of SGA was particularly high after recurrent preeclampsia (RR = 12.3; 3.9, 39.2). In relation to preeclampsia and maternal smoking, the results indicated that each factor might contribute to reduced growth in an additive manner., Conclusion: Severe and early-onset preeclampsia were associated with significant fetal growth restriction. The risk of having an SGA infant was dramatically higher in women with recurrent preeclampsia. Birth weight reduction related to maternal smoking appeared to be added to that caused by preeclampsia, suggesting that there is no synergy between smoking and preeclampsia on growth restriction.

Objective: To study associations between established risk factors for pre-eclampsia and different clinical manifestations of the disease., Design: A population-based, nested case-control study., Setting: Information from 12,804 consecutive deliveries that took place over three years at a birth clinic, which alone serves a population of nearly 240,000 in Rogaland county, Norway., Subjects: Cases of pre-eclampsia (n = 323) and healthy controls (n = 650) were selected. Pre-eclampsia was defined as increase in diastolic blood pressure (> or = 25 mmHg to > or = 90 mmHg) and proteinuria (> or = 1+ by dipstick testing) after 20 weeks of pregnancy., Main Study Measures: Parity, previous pre-eclampsia, blood pressure, maternal weight, and maternal smoking were included as study variables. Women with pre-eclampsia were grouped according to clinical manifestations of the disease (i.e. severity [mild, moderate or severe]) and time of onset (early or late gestation). Associations with the study factors were estimated as relative risks (odds ratio, OR)., Results: Both nulliparity and hypertension increased pre-eclampsia risk, with no clear preference for any clinical subtype. High maternal weight was related to a higher risk of mild and moderate, but not severe, pre-eclampsia. Previous pre-eclampsia strongly increased the risk for pre-eclampsia in the current pregnancy, and the risk of early onset disease was especially high (OR 42.4; 95% CI 11.9-151.6). Overall, smoking was associated with a reduced risk for pre-eclampsia (OR 0.6; 95% CI 0.4-0.9). However, no effect of smoking was observed in the early onset disease group and among women with repeated pre-eclampsia., Conclusion: Nulliparity and hypertension increased the risk for each subgroup of pre-eclampsia, but high maternal weight, previous pre-eclampsia and smoking were not consistently associated with each clinical subtype. This observation may suggest that heterogeneous clinical manifestations of pre-eclampsia may be preceded by different pathological mechanisms.

Background: We wanted to study a possible association between smoking during pregnancy and preterm birth., Methods: A population based prospective study was performed among 7,236 consecutive pregnancies over seven years delivered at one birth clinic. Smoking habits were obtained at a routine ultrasound examination around 18 gestational weeks, and preterm birth was defined as delivery of a child between 24 and 37 gestational weeks. We estimated relative risk (odds ratio) between smoking, possible confounding variables and preterm birth using multiple logistic regression analysis., Results: Overall, 1,769 (25%) women said that they smoked every day during their pregnancy. The smoking women had an increased risk of preterm delivery compared with non-smokers (odds ratio 1.53, 95% confidence interval 1.24, 1.89). However, this association was only demonstrated among the multiparous women (odds ratio 1.88, 95% confidence interval 1.39, 2.54). The association was statistically significant after adjusting for maternal age, diabetes, cervical conization, preeclampsia, placental abruption and placenta previa in a multivariate analysis, and we observed a dose-response effect of maternal smoking on preterm birth among multiparous women., Conclusion: For multiparous women smoking during pregnancy increases the risk of preterm delivery, and there seems to be a dose-response effect of smoking.

Objective: To assess the teratogenic risk of low dose weekly pulses of methotrexate (MTX) inadvertently taken during the first trimester of pregnancy., Methods: We assessed pregnancy and neonatal outcome of 4 patients with rheumatic disease treated with weekly pulses of 5 to 15 mg of MTX for a mean duration of 4 years., Results: The 4 patients had continued MTX treatment from one to 6 weeks of gestation. One patient miscarried at Week 6, the other pregnancies ended with the delivery of healthy children. Chromosome analysis of one child was normal., Conclusion: In spite of the absence of congenital anomalies in our cases, safe contraception in fertile patients who start low dose weekly MTX is mandatory.

The present paper summarizes some of the epidemiological studies of in utero ultrasound exposure and subsequent childhood development. Emphasis is placed on birthweight, childhood malignancies and neurological development. A meta-analysis, including neurological outcomes such as handedness, speech development, motor development, hearing and vision, is presented. The epidemiological evidence does not indicate any association between diagnostic ultrasound exposure during pregnancy and reduced birthweight, childhood malignancies or neurological maldevelopment. The possible association between ultrasound and nonrighthandedness among boys needs further evaluation.

Prenatal screening for group B streptococcus colonisation in pregnant women is controversial, though recommended in some countries. We aimed to compare the detection rate when pregnant women performed their own vaginal/anorectal swabs with the standard practice of physician obtained swabs. During six months, 89 pregnant women with high risk for premature labor collected their own vaginal/anorectal swab after instruction from a midwife. Afterwards a physician took a similar sample among 80 of the women. All together, 30 (34%) out of 89 women were carriers of group B streptococcus. Comparing the efficacy of the sampling procedures among 80 women who had taken both tests, we found that 25 of 26 positive cultures were identified by self-collected samples, while 17 out of 26 were identified by samples collected by the physicians. The difference in sensitivity (96% vs 65%) was statistically significant (p < 0.001) with a kappa value of 0.68. Self-collected vaginal/anorectal swabs for the identification of group B streptococcus carriers are at least as sensitive as the practice of physician performed swabs.

Aim: To study the detection rates of second trimester ultrasound screening for neural tube defects (NTD), abdominal wall defects (AWD) and Down's syndrome (DS) in low risk populations at tertiary centers, and to compare the ultrasound screening detection rates with those that were obtainable by biochemical serum screening (double test: alpha-fetoprotein/human chorion gonadotrophin/age test)., Study Design: Prospective multicenter study with a three year inclusion period: 1/1/1989-31/12/1991., Subjects: 27,844 low-risk women at 18-34 years of age who had a second trimester ultrasound screening examination. Of these, 10,264 also had a serum test., Methods: An ultrasound malformation scan and a serum test were carried out at 17-19 weeks of gestation. Risk calculations regarding DS were based on alpha-fetoprotein, human chorion gonadotrophin and maternal age; performed retrospectively for the first two years., Results: In total 73 cases were identified in the study population: NTD (n=34), AWD (n=7) and DS (n=32). The detection rates, (%, with 95% confidence interval) for ultrasound screening were: NTD: 79.4 (62.1-91.3); AWD: 85.7 (42.1-99.6); DS: 6.3 (0.8-20.8). In the subgroup of women who had both tests, the detection rates for ultrasound screening vs double test were: NTD: 62.5 (24.5-91.5) vs 75.0 (34.9-96.8); AWD: 66.7 (9.4-99.2) vs 100 (29.2-100.0); DS: 7.7 (0.2-36.0) vs 46.2 (19.2-74.9). The false positive rates (%) for ultrasound screening vs double test were: NTD: 0.01/3.3; AWD: 0.01/3.3; DS: 0.1/4.0., Conclusion: Second trimester ultrasound screening in a low risk population gave a low detection rate for fetal DS (6.3%) and an acceptable detection rate for NTD (79.4%) and AWD (85.7%). In the subgroup of women who had both tests, serum screening performed better than ultrasound as applied in the present study, especially regarding DS.

Foetal or intrauterine nutrition is a subject of increasing interest. There are two main reasons for this. The first one is the observation that being born small for gestational age is associated with increased risk of cardiovascular disease and diabetes later in life. The second one is the discovery that nutritional factors directly influence activity of genes. If nutritional inadequacies in the foetal period permanently alter the expression of genes, the individual's susceptibility to perinatal complications and diseases later in life may be altered. The main causes of intrauterine malnutrition are poor maternal diet, placental insufficiency, and impaired foetal usage of nutrients. The consequences of foetal malnutrition may include intrauterine growth retardation, congenital malformation, a variety of neurological dysfunctions, susceptibility to birth asphyxia, and diseases later in life; all of these are important determinants of health throughout life.

Objective: To test the null hypothesis of no association between ultrasound exposure in early fetal life and impaired neurologic development in childhood., Methods: Study of children age 8-9 years whose mothers participated in a randomized controlled trial of ultrasound screening during pregnancy in Sweden during 1985-1987. Of 4637 eligible singletons, 3265 (70%) were studied through a questionnaire to their mothers. Assessment of neurologic development was based on parents' report of their child's speech and motor development. Behavioral disorders were assessed by a ten-item parent scale. Analyses were performed according to both assignment and ultrasound exposure. With a sample size of 1600 children in each group, a two-sided alpha of .05 and beta of .10, a risk ratio of less than 1.4 for the studied variables could not be detected., Results: Delayed speech development was reported by 2.9% in the screening group compared with 2.4% in the nonscreening group (odds ratio [OR] 1.21; 95% confidence interval [CI] 0.79, 1.88). Similar prevalences were found when analysis was according to ultrasound exposure (OR 1.19, 95% CI 0.78, 1.83). Delayed motor development was reported by 7.6% in the screening group compared with 7.2% in the nonscreening group (OR 1.05; 95% CI 0.81, 1.37). Corresponding figures for ultrasound-exposed and -unexposed were 7.7% and 7.2%, respectively (OR 1.08; 95% CI 0.83, 1.40). There also were no significant differences in behavioral disorders between screened and unscreened children or between exposed and unexposed children, respectively, according to parents' ratings., Conclusion: No significant difference in impaired neurologic development between ultrasound-exposed and -unexposed children was found in this study.

Aims: To investigate the smoking prevalence the last three months before pregnancy and at 18 weeks of gestation among women in Norway and to evaluate the impact of pre-pregnancy smoking habits, maternal age, level of education, civil status and parity on smoking cessation., Material and Methods: A prospective, multicenter survey. The study population included 4 766 pregnant women who attended a routine ultrasound examination at 18 weeks of pregnancy in six Norwegian hospitals during the period from September 1994 to March 1995. Smoking habits before and during pregnancy were recorded., Results: The point prevalence of self-reported daily smoking among the women three months before the pregnancy was 34%. At 18 weeks of pregnancy, 21% of the women reported smoking daily (p<0.001). A multiple logistic regression analysis revealed that a low number of cigarettes smoked per day during the last three months before pregnancy was the best predictor for smoking cessation. Educational level, maternal age, parity and civil status were also statistically significant contributors to smoking cessation. Eighty percent of the women who were unable to stop smoking, reported a reduction in cigarette consumption. The mean number of cigarettes per day was reduced from 13.9 before pregnancy to 7.3 at 18 weeks of pregnancy (p<0.001)., Conclusion: In a national survey, 21% of the pregnant women reported smoking daily in the second trimester. Thirty-eight percent of the women who were daily smokers before the pregnancy stopped smoking in early pregnancy. A low cigarette consumption prior to the pregnancy was the best predictor for smoking cessation.

Objective: To study a possible association between ultrasound screening in early pregnancy and altered cerebral dominance measured by the prevalence of non-right handedness among children, particularly boys., Methods: Follow-up of 8 to 9 year old children to women who participated in a randomised controlled trial on ultrasound screening during pregnancy in 1985-87. The children were followed up through a questionnaire sent to their mothers. The dominant hand of the child was assessed by eleven questions. The dominant foot by one question., Results: No differences were found in non-right handedness between children in the screening and non-screening group. In separate analyses on ultrasound exposure and non-right handedness among boys a significant difference was found (odds ratio 1.33; 95% confidence interval 1.02-1.74)., Conclusion: This study could not rule out a possible association between non-right handedness among boys and ultrasound exposure in early fetal life. The association was, however, confined to analyses comparing exposed and non-exposed boys and no associations were found when the comparisons were performed according to the randomised groups.

Objective: The purpose was to study any long-term therapeutic effects of maximal electrical stimulation in female urge incontinence., Methods: A postal questionnaire containing six questions about urinary incontinence was distributed to 30 women who had been treated with maximal stimulation because of unstable detrusor and urge incontinence 9-13 years earlier. The response rate was 90% (27 women). The mean age at follow-up was 62 years., Results: Twenty-one (78%) women reported symptoms of urge incontinence. Among them, 13 had this problem daily, whereas eight only had problems weekly or even more seldom. Nineteen (70%) women reported symptoms of stress incontinence. Twenty-one women would have recommended maximal stimulation to a friend today., Conclusion: After approximately ten years most of the women had symptoms of urge incontinence. This was, however, a minor problem among a third of them. A majority of the women were satisfied with maximal stimulation as a treatment modality. The treatment had not prevented a later occurrence of stress incontinence.

Background: The aim of the study was to investigate changes in smoking habits among pregnant women in the city of Trondheim and its surroundings. We also wanted to register the effect of a national campaign against smoking in pregnancy introduced in December 1989., Material and Methods: From 1987-1994 midwives interviewed 21 348 women in a non-selected population during a routine ultrasound examination at 18 weeks of pregnancy. Smoking habits and cigarette consumption were recorded., Results: The point prevalence smoking rate among pregnant women decreased from 34% in 1987 to 22% in 1994 (p<0.001). A stratified analysis indicated that the reduction was not confounded by changes in age and parity over time. The mean number of cigarettes per pregnant smoker decreased from 8.6 cigarettes per day to 7.0 cigarettes per day during the study period (p<0.001). In 1987, 49% of the pregnant smokers consumed > or = 10 cigarettes compared with 35% in 1994 (p<0.001). The national campaign may have reinforced the on-going decline in smoking rate, but no significant effect was observed., Conclusions: The study demonstrated a statistically significant reduction in smoking prevalence among pregnant women in the study area. A similar decrease was not observed among women in the general population. No significant effect of the national campaign against smoking during pregnancy was observed.

Norway introduced an offer of one routine ultrasound examination to all pregnant women in 1986. Since then, an improved ultrasound technology and more skillful operators have made it possible to detect foetal malformations at a much higher rate. A new consensus conference on the use of diagnostic ultrasound during pregnancy will be held in Norway in 1995. The present paper reviews the recent literature on ultrasound screening. Three randomized controlled trials (the Uppsala-trial from 1988, the Helsinki-trial from 1990, and the RADIUS-trial from 1993) and one meta-analysis (Bucher and Scmidt, 1993) are evaluated. The author also comments on the recent epidemiological studies on the safety aspects of routine ultrasonography during pregnancy.

The purpose of the study was to investigate the use of teacher assessments in screening for learning disabilities. In a longitudinal study, 603 children were rated by their teachers in the second grade (age 8 to 9 years), and the ratings were correlated with examinations of reading, spelling, and intelligence in the third grade. The third-grade tests for reading, spelling, and intelligence classified children into groups with low achievement and dyslexia, and these two groups were compared with normally achieving children. The accuracy of teacher assessments, measured with correlation analysis, ROC curves, and kappa indices, showed that teachers were quite accurate in their judgment of low achievement, but somewhat less efficient in their judgment of specific reading difficulties.

The present study evaluates two strategies for partner notification among young women with genital Chlamydia trachomatis infection. The study included 443 women, aged 14-21 years, who visited one of 20 youth clinics during a two months period in 1991. The youth clinics were randomized to use patient referral or provider referral. In the latter group, 11 of 14 women with genital Chlamydia infection revealed their sexual partners. Only five of 24 sexual partners were notified by a letter, and six of 24 partners turned up for examination. In the patient referral group, 16 of 34 women asked to notify their partner, and ten of 31 partners were examined. Partner notification in young women with genital Chlamydia infection seems to be difficult.

50 general practitioners (GPs) in Norway answered a questionnaire on their use of ultrasonic fetal heart detectors in 1979-80 and 1989. 21 of 50 GPs (42%) had an ultrasonic fetal heart detector in 1979-80, and 32 of 44 GPs (73%) had such a device in 1989 (p less than 0.01). The use of the detector had not changed much over the years. 85% of the doctors who had such a device used it on all or most pregnant women. 70% of the GPs usually listened to the fetal heart beat for 10-30 seconds each time, and about 1/3 of the GPs used the detector more than eight times during each pregnancy. There was a linear relationship between the GPs' conception of the energy output level of the fetal heart beat detector and his/her use of the instrument. GPs who believed the device to have a relatively high energy output level compared with standard B-scan equipment used the device for shorter time periods (r = -0.49, p less than 0.05) and less often during pregnancy (r = -0.54, p less than 0.01).

A total of 8,923 children were born at the Regional Hospital, Trondheim, Norway between 1 January 1986 and 30 June 1989 to mothers from surrounding municipalities. Among these children, 14 were diagnosed after birth as having Down's syndrome. A proportion of 85% of the pregnant women in these municipalities had had a routine examination with ultrasound in the 16th to 22nd weeks of gestation at the Ultrasound Laboratory at the Regional Hospital. Ten of the children/fetuses with Down's syndrome in the study population had been subjected to a routine scan. Five of the ten were suspected to have Down's syndrome after the routine scan, and the diagnosis was confirmed by prenatal chromosomal analysis. (All these five fetuses were examined in 1987-88, which means that five of seven were detected in 1987-88). Another two fetuses (out of three) were suspected to have Down's syndrome after an ultrasound scan later in pregnancy. The diagnoses were confirmed by chromosome analyses after birth. One fetus was diagnosed in a 38 year old woman by amniocentesis in the 15th week of gestation. Our study suggests that routine ultrasonic scans can detect a significant proportion of fetuses with Down's syndrome in the second trimester.