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Objectives To describe the distributional properties and assess the performance of placental growth factor (PlGF) measured in blood samples collected before 11 weeks’ gestation in prediction of preeclampsia. Methods The study population consisted of pregnant women included in the PRESIDE study (Preeclampsia Screening in Denmark) with a PlGF measurement from the routine combined first trimester screening (cFTS) blood sample collected at 8–14 weeks’ gestation. PRESIDE was a prospective multicenter study investigating the predictive performance of the Fetal Medicine Foundation (FMF) first trimester screening algorithm for preeclampsia in a Danish population. For the current study, serum concentration of PlGF in the cFTS blood samples was analyzed in batches between January and June 2021. Results A total of 8,386 pregnant women were included. The incidence of preeclampsia was 0.7% <37 weeks and 3.0% ≥37 weeks. In blood samples collected at 10 weeks’ gestation, multiples of the median (MoM) of PlGF were significantly lower in pregnancies with preeclampsia <37 weeks. However, PlGF MoM did not differ significantly between pregnancies with preeclampsia and unaffected pregnancies in samples collected before 10 weeks’ gestation. Conclusions Gestational age for PlGF samples might be expanded from 11–14 weeks to 10–14 weeks in risk assessment for preeclampsia using the FMF first trimester screening model. There is little evidence to support the use of PlGF collected before 10 weeks’ gestation., OBJECTIVES: To describe the distributional properties and assess the performance of placental growth factor (PlGF) measured in blood samples collected before 11 weeks' gestation in prediction of preeclampsia.METHODS: The study population consisted of pregnant women included in the PRESIDE study (Preeclampsia Screening in Denmark) with a PlGF measurement from the routine combined first trimester screening (cFTS) blood sample collected at 8-14 weeks' gestation. PRESIDE was a prospective multicenter study investigating the predictive performance of the Fetal Medicine Foundation (FMF) first trimester screening algorithm for preeclampsia in a Danish population. For the current study, serum concentration of PlGF in the cFTS blood samples was analyzed in batches between January and June 2021.RESULTS: A total of 8,386 pregnant women were included. The incidence of preeclampsia was 0.7% <37 weeks and 3.0% ≥37 weeks. In blood samples collected at 10 weeks' gestation, multiples of the median (MoM) of PlGF were significantly lower in pregnancies with preeclampsia <37 weeks. However, PlGF MoM did not differ significantly between pregnancies with preeclampsia and unaffected pregnancies in samples collected before 10 weeks' gestation.CONCLUSIONS: Gestational age for PlGF samples might be expanded from 11-14 weeks to 10-14 weeks in risk assessment for preeclampsia using the FMF first trimester screening model. There is little evidence to support the use of PlGF collected before 10 weeks' gestation. This article is protected by copyright. All rights reserved.

Introduction This study aimed to assess risk factors for difficult fetal extraction in emergency caesarean sections, focusing on top-up epidural anesthesia compared to spinal anesthesia. Additionally, this study addressed consequences of difficult fetal extraction on neonatal and maternal morbidity. Material and Methods This retrospective registry-based cohort study included 2,332 of 2,892 emergency caesarean sections performed with local anesthesia during 2010–2017. Main outcomes were analyzed by crude and multiple adjusted logistic regression providing odds ratios. Results Difficult fetal extraction was found in 14.9% of emergency caesarean sections. Risk-factors for difficult fetal extraction included top-up epidural anesthesia (aOR:1.37[95 %CI 1.04–1.81]), high pre-pregnancy BMI (aOR:1.41[95 %CI 1.05–1.89]), deep fetal descent (ischial spine: aOR:2.53[95 %CI 1.89–3.39], pelvic floor: aOR:3.11[95 %CI 1.32–7.33]), and anterior placental position (aOR:1.37[95 %CI 1.06–1.77]). Difficult fetal extraction was associated with increased risk of low umbilical artery pH 7.00–7.09 (aOR:3.50[95 %CI 1.98–6.15]) pH ≤ 6.99 (aOR:4.20[95 %CI 1.61–10.91]), five-minute Apgar score ≤ 6 (aOR:3.41[95 %CI 1.49–7.83]) and maternal blood loss (501–1,000 ml: aOR:1.65[95 %CI 1.27–2.16], 1,001–1,500 ml: aOR:3.24[95 %CI 2.24–4.67], 1,501–2,000 ml: aOR:3.94[95 %CI 2.24–6.94] and ≥ 2001 ml: aOR:2.76[95 %CI 1.12–6.82]). Conclusion This study identified four risk factors for difficult fetal extraction in emergency caesarean section: top-up epidural anesthesia, high maternal BMI, deep fetal descent and anterior placental position. Additionally, difficult fetal extraction was associated with poor neonatal and maternal outcomes., Introduction: This study aimed to assess risk factors for difficult fetal extraction in emergency caesarean sections, focusing on top-up epidural anesthesia compared to spinal anesthesia. Additionally, this study addressed consequences of difficult fetal extraction on neonatal and maternal morbidity. Material and Methods: This retrospective registry-based cohort study included 2,332 of 2,892 emergency caesarean sections performed with local anesthesia during 2010–2017. Main outcomes were analyzed by crude and multiple adjusted logistic regression providing odds ratios. Results: Difficult fetal extraction was found in 14.9% of emergency caesarean sections. Risk-factors for difficult fetal extraction included top-up epidural anesthesia (aOR:1.37[95 %CI 1.04–1.81]), high pre-pregnancy BMI (aOR:1.41[95 %CI 1.05–1.89]), deep fetal descent (ischial spine: aOR:2.53[95 %CI 1.89–3.39], pelvic floor: aOR:3.11[95 %CI 1.32–7.33]), and anterior placental position (aOR:1.37[95 %CI 1.06–1.77]). Difficult fetal extraction was associated with increased risk of low umbilical artery pH 7.00–7.09 (aOR:3.50[95 %CI 1.98–6.15]) pH ≤ 6.99 (aOR:4.20[95 %CI 1.61–10.91]), five-minute Apgar score ≤ 6 (aOR:3.41[95 %CI 1.49–7.83]) and maternal blood loss (501–1,000 ml: aOR:1.65[95 %CI 1.27–2.16], 1,001–1,500 ml: aOR:3.24[95 %CI 2.24–4.67], 1,501–2,000 ml: aOR:3.94[95 %CI 2.24–6.94] and ≥ 2001 ml: aOR:2.76[95 %CI 1.12–6.82]). Conclusion: This study identified four risk factors for difficult fetal extraction in emergency caesarean section: top-up epidural anesthesia, high maternal BMI, deep fetal descent and anterior placental position. Additionally, difficult fetal extraction was associated with poor neonatal and maternal outcomes.

Objectives To investigate the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for pre-eclampsia in a Danish population and compare screening performance with that of the current Danish strategy, which is based on maternal risk factors. Methods This was a prospective study of women with a singleton pregnancy attending for their first-trimester ultrasound scan and screening for aneuploidies at six Danish university hospitals between May 2019 and December 2020. Prenatal data on maternal characteristics and medical history were recorded, and measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and serum placental growth factor (PlGF) were collected without performing a risk assessment for pre-eclampsia. Information on acetylsalicylic acid use was recorded. After delivery, pregnancy outcome, including gestational age at delivery and pre-eclampsia diagnosis, was recorded. Pre-eclampsia risk assessment for each woman was calculated blinded to outcome using the FMF screening algorithm following adjustment to the Danish population. Detection rates (DRs) of the FMF algorithm were calculated for a fixed screen-positive rate (SPR) of 10% and for the SPR achieved in the current Danish screening. Results A total of 8783 pregnant women were included, with a median age of 30.8 (interquartile range (IQR), 28.1–33.9) years. The majority were white (95%), naturally conceiving (90%), non-smokers (97%) and had no family history of pre-eclampsia (96%). The median body mass index was 23.4 (IQR, 21.2–26.6) kg/m2. A complete risk assessment including maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A was available for 8156 women (92.9%). In these women, UtA-PI was measured bilaterally with a median value of 1.58 (IQR, 1.27–1.94) and the median resting MAP of 80.5 (IQR, 76.1–85.4) mmHg in two consecutive measurements. Amo, Objectives: To investigate the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for pre-eclampsia in a Danish population and compare screening performance with that of the current Danish strategy, which is based on maternal risk factors. Methods: This was a prospective study of women with a singleton pregnancy attending for their first-trimester ultrasound scan and screening for aneuploidies at six Danish university hospitals between May 2019 and December 2020. Prenatal data on maternal characteristics and medical history were recorded, and measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and serum placental growth factor (PlGF) were collected without performing a risk assessment for pre-eclampsia. Information on acetylsalicylic acid use was recorded. After delivery, pregnancy outcome, including gestational age at delivery and pre-eclampsia diagnosis, was recorded. Pre-eclampsia risk assessment for each woman was calculated blinded to outcome using the FMF screening algorithm following adjustment to the Danish population. Detection rates (DRs) of the FMF algorithm were calculated for a fixed screen-positive rate (SPR) of 10% and for the SPR achieved in the current Danish screening. Results: A total of 8783 pregnant women were included, with a median age of 30.8 (interquartile range (IQR), 28.1–33.9) years. The majority were white (95%), naturally conceiving (90%), non-smokers (97%) and had no family history of pre-eclampsia (96%). The median body mass index was 23.4 (IQR, 21.2–26.6) kg/m2. A complete risk assessment including maternal characteristics, MAP, UtA-PI, PlGF and PAPP-A was available for 8156 women (92.9%). In these women, UtA-PI was measured bilaterally with a median value of 1.58 (IQR, 1.27–1.94) and the median resting MAP of 80.5 (IQR, 76.1–85.4) mmHg in two consecutive measurements. Among these, 303

Background: The use of oral opioids as standard treatment after cesarean delivery has been linked to persistent use in opioid-naïve women in the USA. In Denmark, the use of opioids after cesarean delivery is typically restricted to in-hospital use. The aim of this study was to estimate the incidence of persistent postpartum opioid use in Denmark and compare it by mode of delivery. Methods: This was a national cohort study of all women giving birth in Denmark in 2016, with one-year follow-up. Data from Danish registries were retrieved and combined using each woman's unique identification number. Persistent use of opioids was defined as ≥3 redeemed opioid prescriptions 31–365 days postpartum. Results: A total of 62 520 births were included in the cohort: 49 859 vaginal deliveries, 5310 intrapartum cesarean deliveries, and 7351 pre-labor cesarean deliveries. For all births, persistent postpartum opioid use occurred in 85 (140 in 100 000) women of whom 36 (42%) had opioid use during pregnancy. The incidence of persistent opioid use was highest in the pre-labor cesarean delivery cohort (n=27; 360 in 100 000) and lowest in the intrapartum cesarean delivery cohort (n=3, 60 in 100 000; P<0.001). Women taking opioids during pregnancy were at increased risk of persistent opioid use (odds ratio 63.3; 95% CI 43.9 to 91.4). Conclusions: Women giving birth in Denmark, where use of post-discharge opioid treatment is generally restricted, have a low risk of developing persistent use of opioids, with very few women seeking additional analgesic treatment from their general practitioner.

STUDY QUESTION: Do 8- to 9-year-old singletons conceived after frozen embryo transfer (FET) or fresh embryo transfer (Fresh-ET) have increased arterial stiffness compared to naturally conceived (NC) children? SUMMARY ANSWER: The process of FET or Fresh-ET is not associated with altered cardiovascular function in 8- to 9-year-old singletons, including arterial stiffness, as compared to NC children. WHAT IS KNOWN ALREADY: ART has been suggested to influence cardiovascular risk factors (i.e. endothelial dysfunction, increased arterial blood pressure and insulin resistance). It is not known if ART procedures alter arterial stiffness in singletons. STUDY DESIGN, SIZE, DURATION: A cohort study was carried out, including 8- to 9-year-old singletons conceived after FET, Fresh-ET and NC children (50 children in each group). This study was conducted between November 2018 and August 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: In total, 150 singletons were identified through the Danish IVF Registry and the Medical Birth Registry. They underwent cardiac magnetic resonance imaging (CMR) and anthropometric measurements. Parental data were collected using questionnaires. NC children were matched by sex and birth year with FET/Fresh-ET children. Exclusion criteria were congenital heart disease, maternal gestational diabetes or maternal diabetes mellitus. Our primary outcome was arterial stiffness, which is assessed from noninvasive arterial blood pressure and aortic ascendens distensibility. The secondary outcome was the pulse wave velocity of total aorta and exploratory outcomes were left ventricular ejection fraction, mean arterial pressure, cardiac output and total peripheral resistance. Measurements and analyses were performed blinded to the child group. MAIN RESULTS AND THE ROLE OF CHANCE: Aortic ascendens distensibility of children conceived after FET and Fresh-ET did not differ from NC children (mean (SD): FET 11.1 (3.6) 10-3 mmHg-1, Fresh-ET 11.8 (3.0) 10-3 mmHg-1, NC