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Introduction: The aim was to investigate the parental decisions about prenatal screening and diagnosis among infants with trisomy 21 (T21) in a national cohort with high uptake of combined first-trimester screening (cFTS). Material and Methods: This was a nationwide population-based study including infants born in 2009-2012. Information from the cFTS, fetal karyotype results and pregnancy outcome was obtained from the Danish Fetal Medicine Database on all women with a cFTS risk assessment. Cut-off for referral for invasive testing was ≥1:300. Karyotype results from pregnancies with no cFTS were obtained from the Danish Cytogenetic Central Registry. Results: The uptake rate of cFTS was 91.6%, and 82.8% (8,032/9,704) of the screen-positive women opted for invasive testing. Overall, 82.2% (454/552) chose to terminate an affected pregnancy. In the 4-year period, 102 of 232,962 singletons were born alive with T21. The cFTS risk was true-positive, false-negative or not obtained in 21.6, 48.0 and 30.4%, respectively, of these pregnancies. Discussion: In this large national cohort, 4.4 per 10,000 live-born infants had T21. Of 102 infants with T21 from 2009 to 2012, 52.0% were born after the women had not opted for cFTS or were true-positive but declined invasive testing or termination, and 48.0% were born after a false-negative risk assessment.

OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy.METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion - clinical quality database (PreCAb) and the Danish Fetal Medicine Database). Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA).RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351) days. The mean "fetal growth index" was 0.99 (SD, 0.02) days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09) days/day, pCONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

Objective To assess the relationship between the finding of fetal femur diaphysis length (FL) below the 5th percentile at the second-trimester scan and pregnancy outcome, in a population in which more than 90% of women attend first-trimester screening. Methods This was a retrospective study of all Danish singleton pregnancies with a 17–22-week anomaly scan between 1 January 2008 and 30 June 2011. Information on FL and gestational age (GA) at anomaly scan, on birth weight and GA at delivery and on chromosomal abnormalities was obtained from the Danish Fetal Medicine Database. Results Short FL was identified in 2718 (1.8%) of 147 766 fetuses and was present in 11 (16.2%) of the 68 fetuses affected by trisomy 21 (positive likelihood ratio (LR+) 8.8 (95% CI, 5.1–15.2)). Trisomy 13/18 and unbalanced autosomal structural abnormalities were also associated with a short FL in three (12.0%, LR+ 6.5 (95% CI, 2.3–18.9)) and eight (32.0%, LR+ 17.4 (95% CI, 9.8–30.9)) of the cases, respectively. The risk of a fetus having trisomy 21, trisomy 18, trisomy 13 or an unbalanced autosomal structural abnormality was 1 : 123 (95% CI, 79–192), given a short FL. Pregnancies with a fetus with short FL were more often affected by early preterm delivery (before 34 weeks) (5.6%; odds ratio (OR) = 4.2 (95% CI, 3.5–4.9)) and small-for-gestational-age (SGA) infants (13.9%; OR = 4.3 (95% CI, 3.8–4.8)). Conclusion Short FL at the second-trimester anomaly scan is associated with a significantly higher relative risk of chromosomal abnormalities, and a substantially higher absolute risk for SGA and early preterm delivery. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd

Background: Although management of twin deliveries has been a topic ofdiscussion for decades, a consensus on how to deliver twins is lacking. The objective of thisstudy was to examine short-term neonatal outcome of the second twin delivered by cesareansection after vaginal delivery of the first-born twin (combined delivery) and to identifypredictors of combined delivery. Methods: This study was a 3-year, population-based,retrospective cohort investigation of 1,254 twin births in Denmark. The twin births weredivided into three groups: vaginal deliveries, planned cesarean deliveries, and combineddeliveries. Data were extracted from medical records, a fetal medicine software program(Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measuredas a 5-minute Apgar score 7, umbilical cord pH 7.10, and admission to neonatalintensive care unit for more than 3 days. Results: Vertex-nonvertex fetal presentations weremore prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5–7.8). Nonvertexsecond twins born by combined delivery had a higher risk of Apgar score 7 and umbilicalcord pH 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1–18), andunadjusted OR 3.9 (1.6–9.5). Prenatal ultrasound scans were evaluated in combineddeliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy(mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth. Conclusions:Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combineddeliveries are associated with increased neonatal morbidity for the second twin. (BIRTH 40:1March 2013)Key words: combined delivery, fetal presentation, neonatal outcome, twin deliveryManagement of twin deliveries has been a topic ofdiscussion for decades, yet the lack of randomized tri-als on the subject still leaves unanswered the questionconcerning optimal mode of twin delivery. In Denmark,there is a consensus that vaginal delivery may beattempted in women with cephalic presenting twins ofsimilar size, no contraindications to trial of labor, andno intrauterine growth restriction of one or both twins.However, controversy on mode of delivery still remainswhen the second twin presents as nonvertex.

OBJECTIVE: To prospectively evaluate the performance of first-trimester combined screening for trisomy 21 using the biochemical markers pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (free β-hCG) obtained before and at the time of the nuchal translucency (NT) scan.METHODS: Three fetal medicine departments in Denmark participated in the study. Screening for trisomy 21 was set up as a two-step approach with blood sampling performed before the NT scan (early sample) and again at the time of the NT scan (late sample). PAPP-A and free β-hCG were measured on both the early and late samples. Age-standardized detection and false-positive rates for different screening protocols were calculated.RESULTS: We collected two blood samples in 27 pregnancies affected by trisomy 21 and in 3891 control pregnancies. The early samples were taken between gestational ages 8 + 0 and 13 + 6 weeks, and the late samples between 11 + 3 and 14 + 6 weeks. The median interval between the samples was 17 (range, 1-40) days. We found a significantly better estimated screening performance when using early sampling vs late sampling (P < 0.05). With a risk cut-off of 1 in 100, at the time of the risk assessment the estimated detection and false-positive rates when using the early sample were 91% (95% CI, 81-98%) and 1.6% (95% CI, 1.3-2.0%), respectively. For fixed false-positive rates the highest detection rates were achieved using both blood samples. When comparing early sampling vs double sampling there was no significant difference in screening performance.CONCLUSION: In combined first-trimester screening for trisomy 21, use of early sampling with measurement of PAPP-A and free β-hCG before the time of the NT scan can optimize screening performance. Using maternal serum markers obtained both before and at the time of the NT scan has the potential to further improve performance, but larger studies are needed to confirm this potential.

Seven hospital departments were enrolled in the first step in a quality assurance process regarding pressure sores. A total of 2317 patients representative of a Danish hospital population were included. At the time of admission 2.2% had pressure sores and 1.1% pressure marks (point prevalence), and during hospitalization 2.9% developed pressure sores pressure sores and 1.1% pressure marks (point prevalence), and during hospitalization 2.9% developed pressure sores and 1.4% pressure marks (absolute incidence). The incidence of pressure sores and pressure marks varied between the department from 0-11.3% and from 0 to 7.7% respectively. The relative risk (RR) of developing pressure sores was highest (RR 11.7) for patients who had pressure marks on admittance. Other significant risk factors were admission to one specific surgical department compared to the reference department (RR 7.9), age > 81 years compared to age < 54 years (RR 6.0), length of stay > 8 days compared to < 8 days (RR 5.9) and the diagnosis fractura partis proximalis femoris compared to other diagnoses (RR 4.7). The longer the duration of surgery the higher the incidence of pressure sores, but there was no significant relation between the waiting time from admission to surgery and incidence of pressure sores. The study documents that the development of pressure sores in Danish hospital patients is not a serious quality problem. However, individual differences between departments show the need for some departments to continue the quality improvement efforts.

Fifty-five women aged 21-51 years were treated in 1977 and 1978 with cryocoagulation (single-freezing technique) for cervical intraepithelial neoplasia (CIN I-III). 92% of these patients were followed up 7-8 years after this treatment. The primary success rate i.e. the proportion between the number of women in whom dysplastic changes were not re-encountered within the first 15 months after treatment and the total number of women treated was 94.5%. After the period of observation of 7-8 years, the success rate was 100% for CIN I + II and 79.5% for CIN III.

During a five-year period, direct vision internal urethrotomy was used for the treatment of urethral strictures in 34 men. After the primary operation the patients were followed for an average period of 29 months (range 3-73 months). During this period 53% of the patients were found to have one or more recurrences. In most cases the new stricture was diagnosed during the first 12 months of observation. In a few cases, re-stricture was found as late as 36 months after the first treatment. Because of this tendency, a longer period of postoperative observation, including flow rate measurements at regular intervals is recommended. The operation is preferred for the treatment of strictures in the male urethra because it is easy to master and because of the low rate of complications.