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The aim of this study is to determine the influence of withdrawal of reimbursement on the uptake of the first-trimester combined test. Until January 2007 the combined test was offered to all pregnant women in a designated geographical area as a pilot study before the introduction of the national screening program in the Netherlands, to test the logistic procedures. In January 2007 the insurance companies suddenly stopped paying for the combined test with respect to women aged ≤35 years by decision of the government. In 2006 the combined test was performed in 4616 women compared with 3459 who had the combined test in 2007, a reduction of 25% (95% CI 23.8-26.3%, p < 0.001). A decline was observed in the uptake of the combined test in women aged ≤35 years (p < 0.001) as opposed to an increase in uptake in women aged ≥36 years (p < 0.001). The financial impact on the uptake of the first-trimester combined test should not be underestimated., (© 2014 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: Women with a short cervical length in mid-trimester pregnancy have a higher risk of preterm birth and therefore a higher rate of neonatal mortality and morbidity. Progesterone can potentially decrease the number of preterm births and lower neonatal mortality and morbidity. Previous studies showed good results of progesterone in women with either a history of preterm birth or a short cervix. However, it is unknown whether screening for a short cervix and subsequent treatment in mid trimester pregnancy is effective in low risk women., Methods/design: We plan a combined screen and treat study among women with a singleton pregnancy without a previous preterm birth. In these women, we will measure cervical length at the standard anomaly scan performed between 18 and 22 weeks. Women with cervical length ≤ 30 mm at two independent measurements will be randomly allocated to receive either vaginal progesterone tablets or placebo between 22 and 34 weeks. The primary outcome of this trial is adverse neonatal condition, defined as a composite outcome of neonatal mortality and severe morbidity. Secondary outcomes are time to delivery, preterm birth rate before 32, 34 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We will assess growth, physical condition and neurodevelopmental outcome of the children at two years of age., Discussion: This study will provide evidence for the usefulness and cost-effectiveness of screening for short cervical length at the 18-22 weeks and subsequent progesterone treatment among low risk women., Trial Registration: Netherlands Trial Register (NTR): NTR207.

A pregnancy during which both beta-adrenergics and indomethacin were administered in order to stop preterm uterine contractions is reported. After 8 wk of therapy a Caesarean section was performed. The female neonate had all the characteristics of a Potter's facies, was anuric and died after 47 h of extra-uterine life. A possible relationship between this perinatal death and the prolonged intra-uterine exposure to indomethacin is discussed.

Since the nature and the level of urinary protein excretion have considerable clinical implications in the course of pregnancy, the early detection of even minor degrees of hyperproteinuria is important. Quantitation of 24-h urinary protein excretion is the only definite method of establishing the presence of hyperproteinuria, but this method shows practical failures particularly in an outpatient setting. Dipstick analysis as a screening for hyperproteinuria also lacks reliability, since the normal rate of protein excretion in primigravid pregnancy has recently been shown to be less that 150 mg per day. In this study, therefore, we propose the determination of the protein/creatinine ratio in a single voided urine sample, obtained during normal daylight activity, as a screening test for hyperproteinuria during pregnancy which can replace the quantitation of 24-h urinary protein excretion.