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Objective To estimate common determinants of breech presentation at parturition. Study design A population-based cohort study (between 1/1/2001 and 31/12/2010) was conducted among all women who delivered a singleton baby in breech presentation from 22 completed weeks of gestation. A binary logistic regression was used to determine independent feto–maternal characteristics of breech presentation at birth, adjusted odds ratios and 95% confidence intervals. Variables were: gestational age, birth weight, maternal age, parity and gender of the baby, presence or absence of a history of cesarean section, gestational diabetes, gestational hypertension, pregnancy after assisted reproduction technology and congenital malformations. Results From a population of 611,021 women; 28,059 were delivered in breech presentation (4.59%). Independent determinants of breech presentation at delivery were: gestational age and birth weight (the lower, the higher the incidence of breech at birth), parity (the frequency of breech decreased with increasing parity) and maternal age (the older the mother, the higher the odds for breech presentation). Women who had a scarred uterus, due to a previous cesarean section, women who gave birth to a female offspring and women whose baby showed a congenital malformation, were more prone to be delivered in breech presentation. Conclusion Low gestational age and birth weight, advanced maternal age, a scarred uterus, a female baby and a baby with a congenital malformation increased the odds for singleton breech presentation at parturition. The latter gradually decreased with increasing parity.

Our objective was to determine the perinatal outcome of first- and second-born twins compared to singletons, born at the same gestational age. To that end we conducted a case-control study in Flanders (Northern Belgium). During a 10-year period (01.01.1999–31.12.2008), the entire twin population — 11,154 first- and 11,118 second-born twins (cases) — was compared to 22,228 singletons (controls) with respect to fetal and neonatal (0–27 days) mortality. Only case and control infants of ≥ 500 grams were included, which explained the unequal number of first- and second-born twins. Mothers and their infants of cases and of controls were derived from the Flemish perinatal database and were matched for maternal age and parity, gestational age and gender of the offspring. The main outcome measures were fetal and neonatal mortality according to gestational age. The frequency of fetal death was statistically significantly less frequent in preterm born twins than in singletons, except at term where the reverse was seen in second-born twins compared to controls. After adjustment for congenital malformations, the results stayed unchanged. Below 28 weeks gestation, singletons had a significantly lower neonatal mortality rate than twins that persisted after adjustment for congenital malformations: the first-born twin versus singleton OR 1.71 (1.17–2.51) and second-born versus singleton OR 2.09 (1.43–3.05). Between 28 and 32 weeks, the second-born twin showed a survival advantage over the control singleton. Between 32 and 36 6/7 weeks both twins had a significantly higher survival rate than the corresponding singleton controls. However, after adjustment for congenital malformations, the aforementioned differences between 28 and 36 6/7 weeks disappeared. When at term, twins and singletons had a comparable, though very low, neonatal death rate. These results confirm previous published data. In conclusion, we demonstrated that the neonatal death rate was lower for twins between 32 and 36 weeks (from 28 weeks for the second born twin) when compared to a singleton of the same gestational age. After adjusting for congenital malformations, there was no statistical significant difference.

BACKGROUND: Diverse early-life mortality outcomes have been documented in immigrant populations in northern Europe. A recent meta-analysis has suggested that national integration policy is a key factor in understanding this heterogeneous pattern. In this study, we investigated the variation of stillbirth and neonatal mortality between societies in northern Europe in one minority population, the Turkish. METHOD: Data on stillbirth and neonatal deaths in 239 387 births during 1990-2005, where the mother was of Turkish origin, was drawn from birth registries or surveys in nine northern European countries. Rates were compared with births from mothers who were born in the society of residence. Logistic regression was used to calculate odds ratios adjusted for year of birth of the offspring. RESULTS: The risks for stillbirth were, or tended to be, elevated for Turkish mothers in all countries compared with the native population, with the highest risk in Austria (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.4-2.1) and Switzerland (OR 1.6; 1.4-1.9). For neonatal mortality the results were heterogeneous, indicating no excess risk for Turkish-born children in the Netherlands, the UK and Norway, and elevated risks in Denmark (OR 1.3; 1.0-1.6), Switzerland (OR 1.3; 1.1-1.5), Austria (OR 1.4; 1.0-1.8) and Germany (OR 1.3; CI 1.2-1.5). CONCLUSION: This study suggests that preventable society-specific determinants are important for early-life mortality in Turkish migrants in Europe. An active integration policy is consistent with a favourable neonatal mortality outcome in continental Europe, but not with patterns in Scandinavia and the UK.

Objective: This study aimed to investigate pregnancy outcomes in Somali-born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden. Design: Meta-analyses of routinely collected data on confinements and births. Setting: National or regional perinatal datasets spanning 3-6 years between 1997 and 2004 from six countries. Sample: A total of 10 431 Somali-born women and 2 168 891 receiving country-born women. Methods: Meta-analyses to compare outcomes for Somali-born and receiving country-born women across the six countries. Main outcome measures: Events of labour (induction, epidural use and proportion of women using no analgesia), mode of birth (spontaneous vaginal birth, operative vaginal birth and caesarean section) and infant outcomes (preterm birth, birthweight, Apgar at 5 minutes, stillbirths and neonatal deaths). Results: Compared with receiving country-born women, Somali-born women were less likely to give birth preterm (pooled OR 0.72, 95% CI 0.64-0.81) or to have infants of low birthweight (pooled OR 0.89, 95% CI 0.82-0.98), but there was an excess of caesarean sections, particularly in first births (pooled OR 1.41, 95% CI 1.25-1.59) and an excess of stillbirths (pooled OR 1.86, 95% CI 1.38-2.51). Conclusions: This analysis has identified a number of disparities in outcomes between Somali-born women and their receiving country counterparts. The disparities are not readily explained and they raise concerns about the provision of maternity care for Somali women postmigration. Review of maternity care practices followed by implementation and careful evaluation of strategies to improve both care and outcomes for Somali women is needed. © 2008 The Authors., SCOPUS: ar.j, FLWOA, info:eu-repo/semantics/published

The study was intended to analyse the independent effect of some facets of the socio-economic status of both parents on perinatal, neonatal and post-neonatal mortality in the northern region of Belgium (the Flanders).Perinatal data collected by the Study Centre for Perinatal Epidemiology were linked with socio-economic data collected by the district council. Mothers agedor =25 years are included in the study.50796 births were analysed. 452 infants died either before birth or during the first year of life. 52% of the foeto-infantile mortality occurred before birth and 57% of the infant mortality in the first week of life. The educational level was strongly related to foetal (p0.001) and, to a lesser degree, to early-neonatal mortality (p=0.001). Employment did not correlate with any mortality item. Except for foetal mortality, the strongest correlation was always observed for maternal rather than paternal social items. In a logistic regression model, foetal mortality, perinatal mortality and infantile mortality remained strongly correlated with the educational level of the mother. Infant mortality beyond the first week of life was not correlated with any aspect of the social status of the parents.The educational level of the mother is the single most important determinant of infantile mortality in the Flanders representing the totality of hospital births by mothers agedor =25 years in 1999 in the Flanders.Does education, profession and actual employment of both parents, independently operates discrimination in the outcome of pregnancy up to one year? Results: Maternal education is the only significant and independent determinant of foetal as well as neonatal and foeto-infantile mortality. Results: The status of the mother is by far more important than that of the father in determining the outcome of pregnancy.

To evaluate maternal serum screening for trisomy 21 (MSS) in Flanders between 1992 and 2002.Data of a large database on the results of MSS, nuchal translucency (NT) and pregnancy outcome were analysed retrospectively.Despite an excellent performance of second trimester MSS at a maternal ageor = 35 years (94.4% detection rate (DR) of trisomy 21 at a false positive rate (FPR) of 22.4%), the proportion of patients above 35 years of age in the study population was significantly lower than in the Flemish general pregnant population (5.5% versus 8.9%, P0.001). In the population screened by MSS and NT, the DR of second trimester MSS at a 5% FPR was 44.4%, which was lower than 66.6% in the population screened by MSS without NT. When nine trisomy 21-affected pregnancies were compared to 3265 normal pregnancies, the mean NT-MoM values were not significantly different (1.16 +/- 0.89 versus 1.00 +/- 0.46, P0.05). Both the findings comply to a sequential screening practice where second trimester MSS is only performed after a normal measurement of NT in the first trimester.In Flanders, the uptake of second trimester maternal serum screening is low in women aged 35 years or more. Its screening performance decreased after the introduction of sequential screening.

A retrospective study evaluating the clinical discernment of chin deviations in general, and especially in relation to unilateral posterior crossbite (UPXB), was carried out to determine whether (1) there is a correlation between UPXB and clinically discernible chin deviation, (2) there are differences between the judgement of professional dental observers and laymen, (3) visual assessment of chin deviation compares well with computer-assisted assessment and (4) how large a chin deviation should be before it is noticed. The experimental group consisted of 72 patients (30 males and 42 females, average age 14.5 years) with a UPXB. A control group of 72 subjects without a UPXB was matched for age and sex. In addition, one computer-designed face was added with chin deviations of 0, 2, 4, 6 and 8 mm to the left. The fullface slides of all subjects were shown twice, with an interval of 2 weeks, to an audience of seven orthodontists, ten dental students and five laymen judging by eye. A computer-assisted assessment was carried out by one observer, in order to create a standardized comparison to visual scoring. Inter-observer examination of visual scoring showed moderate agreement (kappa = 0.48). When comparing the computer-assisted and visual scores, the intra-class correlation coefficient (ICC) was 0.87. There were no major differences between professional observers and laymen, although the latter gave significantly more responses in the direction opposite to the crossbite. In 70.3 per cent (on average) of the subjects with a crossbite, a deviation in the same direction as the crossbite was noticed visually. The majority of the observers observed a chin deviation of at least 4 mm.

The aim of this study was to compare the risk of secondary caesarean section in induced versus spontaneous labour in the second delivery of low risk women who had a vaginal delivery in their first pregnancy. The data were retrospective cohort from an existing regional database, comparing term (between 37 and 42 gestational weeks) second deliveries in cephalic position in women who had previously given vaginal birth. Diabetes, hypertension and multiple pregnancy were excluded as were those with a birth weight less than 2500 g or more than 4500 g. The difference was not significant when induction was performed after 41 weeks. The results showed a total number of 29693 deliveries were included, 21243 in spontaneous labour and 8450 after induction of labour. In the spontaneous group 312 (1.5%) underwent secondary caesarean section, as compared to 237 (2.8%) in the induced group, p < 0.001, OR 1.93 (95% confidence interval 1.63-2.29). It was concluded that elective induction of labour in low risk women who have previously given vaginal birth is associated with an almost doubled rate of secondary caesarean section if performed before 41 weeks.

Objective: We conducted a case-control study of all pregnancies obtained with assisted reproduction technology in the Dutch-speaking part of Belgium from 1992 until 1997 to investigate differences in peripartum obstetric events and the perinatal outcome. Study Design: Three thousand fifty-seven singleton and 1241 twin pregnancies were studied. About 90% of pregnancies resulted from in vitro fertilization; the remainder resulted from intracytoplasmic sperm injection. Control subjects were selected from a regional register and were matched for maternal age, parity, fetal sex, plurality, and date of delivery. The main outcome measures were duration of gestation, birth weight, perinatal death, perinatal morbidity, incidence of congenital malformations, and incidence of cesarean delivery. Results: Odds ratios and 95% confidence intervals were 2.6 (1.4-4.8) for perinatal mortality, 3.5 (2.2-5.7) for birth before 33 weeks of gestation, and 1.7 (1.5-1.9) for cesarean delivery in singleton pregnancies that resulted after in vitro fertilization. Twin pregnancies obtained with in vitro fertilization, on the contrary, were similar for all outcome measures, except for the incidence of cesarean delivery (odds ratio, 1.4; 95% confidence interval, 1.2-1.7) compared with spontaneously conceived twin pregnancies. Conclusion: The perinatal outcome of singleton pregnancies obtained with in vitro fertilization is significantly worse than that of spontaneously conceived pregnancies, mainly because of the increased rate of preterm birth. The outcome of twin pregnancies obtained with in vitro fertilization is comparable with that of normally conceived twins. For both singleton and twin pregnancies obtained with in vitro fertilization, the incidence of cesarean delivery is increased. (Am J Obstet Gynecol 1999;181:688-95.)

We analysed retrospectively the link between the incidence of epidural analgesia and the frequency distribution of instrumental delivery, caesarean section, labour induction and parity in a selected group of women with a low risk labour profile in all (85) obstetric units in Flanders (Northern Belgium). A group of 104 932 women with presumed low risk labour profile was subjected to analysis. The main outcome measures were the incidence of obstetric intervention in each obstetric unit in relation to the extent of their use of epidural analgesia. There was a wide variation in the rate of epidural analgesia (3-75%), labour induction 'for convenience' (4-48%) and instrumental delivery (4-50%) among the Flemish obstetric units. The incidence of instrumental delivery in a given unit was greatly influenced by the rate of epidural analgesia and labour induction for convenience (P0.001). However, the incidence of caesarean section in a given unit was not determined by either the rates of epidural, labour induction, attempted instrumental delivery or the size of the unit.

To describe the obstetric outcome in women at ages >= 45. A retrospective cohort study on a large existing database covering all deliveries in the Flanders region, Belgium, was performed, comparing obstetric outcomes at age 25, 35, 40 and 45 or older, for the period 2005-2010. In the period studied, 421 women gave birth at maternal age >= 45 vs 3,405, 15,206, 22,586 at ages 40, 35 and 25, respectively. With advancing maternal age, a significant linear increase for low birth weight (< 2,500 g) and preterm delivery (< 37, < 35 weeks and < 29 weeks), maternal hypertension and diabetes, both primary and secondary caesarean section, was noted. Between ages 40 and >= 45, both fetal and early neonatal death demonstrated a significant rise from 4.9/1,000 and 1.8/1,000 to 26/1,000 and 9.5/1,000, respectively. With advancing maternal age, a gradual but not statistically significant decline in the proportion of male fetuses was noted, from 51.6% at 25, to 47.2% in the oldest group. Multivariate analysis confirmed advanced maternal age to be a significant factor in low birth weight, preterm delivery, hypertension, diabetes, caesarean section and perinatal mortality. In Flanders, mothers at age 45 and older have a significantly increased risk for low birth weight, preterm delivery, hypertension, diabetes, caesarean section and perinatal mortality.

Objective To compare fetal and infant mortality between immigrant and native-born mothers in Flanders, Belgium. Methods In a population-based study, data from 326 166 neonatal deliveries, collected by the Study Center for Perinatal Epidemiology and the Belgian Civil Birth Registration system between January 2004 and December 2008, were analyzed. Immigrant mothers were defined as women born in any country other than Belgium, and were grouped by country of origin according to the World Bank Atlas definition of low-, middle-, and high-income countries. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between immigration and fetal/infant outcome. Results In univariate analysis, fetal and infant mortality rates were significantly higher among immigrants than among native-born mothers (fetal: crude OR, 1.50; 95% CI, 1.29–1.75; infant: crude OR, 1.47; 95% CI, 1.29–1.67). Fetal/infant death rates were highest among mothers originating from low-income countries. In multivariate analysis, however, most differences became non-significant: only the early neonatal death rate remained significantly higher (adjusted OR, 1.30; 95% CI, 1.06–1.60), whereas the fetal death rate appeared lower (adjusted OR, 0.67; 95% CI, 0.57–0.80), among immigrant mothers. Conclusion After adjustment for relevant characteristics, fetal/infant mortality was comparable between immigrant women and native-born women in Flanders.

Objectives: To assess Flemish obstetricians' preferences about mode of delivery for themselves or their partners and to determine the frequency of caesarean section on demand in Flanders. Study design: A structured anonymous postal questionnaire was sent to all 672 registered gynaecologist-obstetricians in Flanders. Results: The response rate was 44%. In the case of an uncomplicated singleton first pregnancy with a cephalic presentation 2% preferred elective caesarean section. There was no difference between male and female obstetricians. Seventy percent said that they would never perform caesarean section on demand. At least 2.6% of all caesarean sections in Flanders seems to be performed on patient's demand. Conclusion: The attitude of Flemish gynaecologist-obstetricians is clearly in favour of vaginal delivery both for themselves, their partners and their patients. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

Background: As the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS.Methods: Data from the Flemish birth register 'Study Centre for Perinatal Epidemiology' (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N = 14016). By means of the Robson classification, births by Caesarean section were ordered in 10 groups according to mother - and delivery characteristics.Results: Over a period of eight years, the CS rise is most prominent in women with previous sections and in nulliparous women with a term cephalic in spontaneous labor. The proportion of inductions of labor decreases in favor of elective CS, while the ongoing inductions of labor more often end in non-elective CS.Conclusions: In order to turn back the current CS trend, we should focus on low-risk primiparae. Avoiding unnecessary abdominal deliveries in this group will also have a long-term effect, in that the number of repeat CS will be reduced in the future. For the purpose of self-evaluation, peer discussion on the necessity of CS, as well as accurate registration of the main indication for CS are recommended. © 2012 Delbaere et al; licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Estriol (E3) and progesterone (P) concentrations in saliva were determined by direct chemiluminescence immunoassays, using solid-phase monoclonal antibodies bound to the wells of microtitre plates, and isoluminol-labelled steroids conjugates. Saliva samples were obtained from women during pregnancy, from 34 to 1 weeks before delivery. The smoothed median and mean salivary E3:P ratios in normal pregnancy rose gradually from 0.45 at -34 weeks to 1.5 at -1 week. In twin pregnancy a similar rise was observed. However, in preterm delivery the smoothed mean ratio rose more slowly, from 0.6 at -30 weeks to 1.1 at -1 week. In pregnancy associated with intra-uterine growth retardation, the smoothed mean ratio did not reach a value of 1 towards the end of pregnancy. In all instances high and low E3:P ratios were observed shortly before spontaneous delivery. This raises the question of whether the E3:P ratio could be used as a predictor providing useful information in relation to the onset of labour.

Background: Interventions to influence the time and way to be born have been a global concern for decades. Yet, limited information is available on what drives these interventions and their variation in frequency among countries, institutions, and practitioners. The objective of this study was to examine to what extent first-time mothers' educational achievement contributes to the frequency of childbirth interventions. Methods: Childbirth interventions, including induction of labor, cesarean section, instrumental delivery, and epidural analgesia, registered by the Flemish Study Center for Perinatal Epidemiology for Belgian-born nulliparous women from 1999 to 2006, were linked to the level of maternal education, recorded by the Belgian civil birth registration. Education was divided into four levels based on the highest diploma attained and adjusted for marital and occupational status. Results: Frequencies of all interventions were inversely related to the level of maternal education. The effect remained after adjustment for birth year, maternal age, marital status, occupation, infant birthweight, gestational age, assisted conception, and type of hospital. Effect sizes between highest and lowest levels of education were relatively small for operative (31% vs 36%) and instrumental vaginal birth (20.7% vs 22.3%) compared with "initiated delivery" (defined as labor induction and prelabor cesarean section; 30.2% vs 40.3%) and epidural analgesia (66.8% vs 78.0%). The educational gradient in initiated delivery occurred at all gestational ages, contributing to lower gestational age and lower birthweight of term infants with decreasing levels of education. Conclusions: In an affluent society with universal and equitable access to maternity care, the more educated women are, the more likely they are to have a spontaneous labor and spontaneous birth without intervention. (BIRTH 38:3 September 2011) © 2011, the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

Objective: To assess, in a homogenous population of primiparous women, how fetal and infant (=first year of life) mortality varied by the mothers' level of education. Study design: We conducted an observational study in Flanders (Northern Belgium) involving 170,948 primiparous women who delivered in Flanders during the period 1999-2006, and their 174,495 babies. We linked the maternal education (3 levels) with a series of obstetrical and perinatal events, with special emphasis on fetal and infant death. A logistic regression analysis was performed to adjust for confounders. Results: The incidence of fetal (0.21% - high level of education: 0.35% - medium level; 0.84% - low level) and infant mortality (0.32%; 0.41%; 0.70%, respectively), followed an inverse maternal educational gradient: higher with a lower level of education. However, neonatal death (0-27 days) was independent of the educational level of the mother. The age of the woman at delivery, the use of assisted reproductive technology and the incidence of twin birth increased while the rates of preterm birth (7.7% - high level: 8.9% - medium level; 10% - low level) and low birth weight (7.2%; 9.5%; 11.8%, respectively) decreased with the mother's educational level. Conclusion: Perinatal and obstetrical outcome differ according to the level of the education of the mother, which is a determinant of the incidence of fetal and post-neonatal death but not of early and late neonatal death (0-27 days). (C) 2009 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND: The aim of this study was to assess the outcome of twin pregnancies in women of advanced age (� 35 years) compared with women aged 25–29 years old. METHODS: This population-based retrospective study compared perinatal outcome of twin pregnancies in primiparae aged 35 or older (N 5 240) to that of twin pregnancies in primiparae aged 25–29 years (N 5 940). Observed outcomes are adjusted for intermediate (mode of conception and hypertension during pregnancy) and confounding variables (level of education). The possible effect of zygosity and chorionicity was tested in a subset of this database, recorded in the East Flanders Prospective Twin Survey (EFPTS). RESULTS: In twin pregnancies, maternal age of 35 or over is associated with a lower incidence of preterm birth [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) 0.44–0.79] and low birthweight (AOR 0.75, 95% CI 0.58–0.98) compared with younger women. Differences in zygosity and chorionicity between both cohorts do not seem to affect the result. CONCLUSIONS: In comparison with primiparae aged 25–29 years, perinatal outcome of twin pregnancies is more favourable in primiparae aged 35 or over.

Objective To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors. Study design In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more (n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25–29 years old (n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable logistic regression analysis. Results Older maternal age correlated, independently of confounding and intermediate factors, with very preterm birth (gestational age

AIM: To compare the perinatal outcome of grand multi-parous women (giving birth for the fifth to ninth time) and pauciparous (parity 2 to 4) women in the region of Flanders, Belgium. METHODS: Population-based, retrospective, age-matched study. RESULTS: 2832 grand multiparous women were compared with 2832 pauciparous women. In univariate analysis grand multiparous women showed more transverse lie, macrosomia, and fetal death and had less frequently epidural analgesia and episiotomy. Logistic regression demonstrated that grand multiparity was a significant factor contributing to fetal death and macrosomia. CONCLUSION: Grand multiparity is associated with fetal death and macrosomia in the region of Flanders, Belgium.

It has been claimed that agenesis of permanent teeth has increased over the years. The present study tested this hypothesis in Caucasians. Published data on the prevalence of children with one or more congenitally missing permanent teeth were selected on the basis of strictly imposed criteria. Using a meta-analysis, the data were evaluated and presented chronologically. Furthermore, the selected publications were checked for differences in the prevalence of agenesis between the male and female populations. Finally, information on the occurrence of upper and lower premolars as well as upper incisor agenesis was collected and calculated as a percentage of the total number of congenitally missing teeth. From 42 studies on this subject, 19 were selected based upon six stringently applied criteria. Chronological classification of the percentage of children with congenital absence of one or more permanent teeth revealed relatively higher percentages since 1957. Fourteen out of the selected studies presented data on sex distribution. In all but one publication girls tended to have a slightly higher occurrence of missing teeth compared with boys of the same age. The second lower premolars were most often agenetic, whereas missing upper laterals occurred almost equally as agenesis of the upper second premolars. The considered period of time is too short and the available data too limited to describe a possible trend in the human dentition. However, this meta-analysis seems to confirm that hypodontia has been diagnosed more often in recent studies.

To compare perinatal outcome of singleton versus twin pregnancies a matched cohort study was performed in Flanders, Belgium. All twins delivered in the region of Flanders during 1998-1999 were compared to singletons, matched for gestational age, fetal sex and maternal parity, resulting in 4384 infants in each group. Above 32 weeks of gestation, birthweight was significantly lower in twins (2095 +/- 364 g versus 2315 +/- 523 g; p0.001, 95% confidence interval 193 to 246 g). Perinatal mortality was also significantly lower in twins (1.98% versus 1.26%; odds ratio for twins 0.63; 95% confidence interval 0.53-0.75; p0.001 ), this was mostly due to fetal and not to early neonatal mortality. Congenital malformations occurred less frequently in twins (2.5% versus 3.7%; odds ratio for twins 0.80, 95% confidence interval 0.69-0.92; p = 0.001). From gestational age of 32 weeks on, respiratory distress syndrome was less frequent in twins (6.7% versus 8.0%; odds ratio for twins 0.81; 95% confidence interval 0.68-0.97; p = 0.011 ). No significant differences were noted with regard to intraventricular haemorrhage, neonatal infections and retinopathy of prematurity. Although twins have a lower birthweight, their outcome is more favorable compared to singletons, when matched for gestational age.

To investigate the bone tissue response at the interface of loaded and non-loaded implants used in an orthopedic anchorage system after a continuous, non-axial force application of 5 N over 2 months.Twenty-nine Brånemark System implants were placed in the zygomatic arches of 5 dogs. After a healing period of 8 weeks, 20 implants (4 in each dog) were loaded during 8 weeks with a large non-axial orthopedic force application of 5 N. This force was directed between the implants and a maxillary splint to move the maxilla forward. Nine implants were not loaded during this period. At the termination of the experiment, all 29 implants were retrieved for radiographic as well as for histologic analysis. Computer-based histomorphometric quantifications were performed via light microscopy and computer software. Bone-metal contact (BMC), bone surface area (BSA) inside the threads, and the bone mirror area (BMA) of the implants were measured. Statistical comparisons between the loaded and non-loaded implants were carried out. In the group of loaded implants a 2-factor analysis of variance was used.There were no statistically significant differences found in BMC, BSA, and BMA between the loaded and non-loaded implants, both for all the threads and for only the cervical region of the implants. Nor were there statistically significant differences between the non-pressure and pressure sides or for different lengths of the loaded implants.The loaded implants maintained the osseointegration achieved during the 8-week healing period.The results of this study indicate that titanium implants can be used as anchorage for orthopedic force application systems.

Objective: To determine whether elective induction of labor in nulliparous women is associated with changes in fetomaternal outcome when compared with labor of spontaneous onset. Study Design: All 80 labor wards in Flanders (Northern Belgium) comprised a matched cohort study. From 1996 through 1997, 7683 women with elective induced labor and 7683 women with spontaneous labor were selected according to the following criteria: nulliparity, singleton pregnancy, cephalic presentation, gestational age at the time of delivery of 266 to 287 days, and birth weight between 3000 and 4000 g. Each woman with induced labor and the corresponding woman with spontaneous labor came from the same labor ward, and they had babies of the same sex. Both groups were compared with respect to the incidence of cesarean delivery or instrument delivery and the incidence of transfer to the neonatal ward. Results: Cesarean delivery (9.9% vs 6.5%), instrumental delivery (31.6% vs 29.1%), epidural analgesia (80% vs 58%), and transfer of the baby to the neonatal ward (10.7% vs 9.4%) were significantly more common (P

Item does not contain fulltext The aim of the study was to investigate whether the orthodontic leveling of the curve of Spee is a treatment procedure with a stable result on a long-term basis. Measurements were made on the plaster casts of 149 orthodontically treated patients (57 males and 92 females). The mean age before treatment was 12.8 years (range, 8-25 years). Study casts were taken before treatment (T1), at the completion of orthodontic therapy (T2), and 6.7 years (mean) posttreatment (T3). Inclusion criteria were no extractions, all Angle classifications except Class III malocclusions, and all permanent teeth fully erupted except second and third molars. The curve of Spee and the irregularity index were measured on standardized digital photographs of the casts. Overjet and overbite were assessed with a ruler. Changes in the curve of Spee were correlated with changes in irregularity index, overjet, and overbite from T1 to T3. The following results were noted: (1) leveling of the curve of Spee is a relatively stable treatment procedure compared with a return of incisor crowding and deepening of the bite; (2) neither the initial depth of the curve of Spee nor the initial irregularity index is an indicator for the amount of relapse; (3) the amount of leveling is not correlated with the relapse of the 4 tested parameters (curve of Spee, irregularity index, overjet, and overbite); and (4) there is a mild correlation between the relapse of the curve of Spee and the relapse of the irregularity index, overjet, and overbite. According to the results of the study, leveling the curve of Spee during orthodontic treatment seems to be very stable on a long-term basis; it was weakly correlated with the other variables tested.

Objective: The study was conducted because of the still considerable controversies about the variation in obstetric management in breech presentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the assumed improvement in neonatal and maternal morbidity and mortality obtained by increasing section rate in breeches. Study design: Two hundred and sixty eight consecutive breech presentations in two university hospitals were studied longitudinally and prospectively. In principle, vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. X-ray pelvimetry was not used. Results: The incidence of caesarean section was 34%. The trial of vaginal delivery succeeded in 64% of the nulliparas and in 60% of the non-frank breeches, without statistically significant differences in outcome measures compared with the multiparous women and the frank group, respectively. Hyperextension of the foetal head rarely occurred. Conclusion: Several classic obstetric factors have a lower discriminating value for the route of delivery than is currently assumed. Progress of labour was an important factor in determining the route of delivery.

Background: Most birth weight-for-gestation charts are based on hospital populations or on birth certificates. In Flanders, the northem region of Belgium, we have aimed at obtaining standards of birth weight-for-gestation of the total population. The data were collected by the Study Center for Perinatal Epidemiology, that registers 98% of all deliveries.

Epidural analgesia (bupivacaine) was administered during labor after amniotomy, in some cases supplemented by intravenous oxytocin. A higher incidence of transient uterine hypertonus was seen after blocking. Fetal heart rate changes mainly took the form of bradycardia (in association with uterine hypertonus). At birth, the maternal biochemical condition was characterized by a lower degree of metabolic acidosis, compared to normal unanesthetized controls. The fetuses displayed a slight degree of hypoxia and hypercapnia. The mechanisms underlying these modifications are discussed. Epidural blockade in combination with elective induction of labor, whether or not supplemented by intravenous oxytocin, may carry a risk. Its magnitude is considered acceptable for both mother and fetus provided they are constantly under close surveillance, limited amounts of bupivacaine are administered and the second stage of labor is kept short. However, some warnings against epidural analgesia apply to patients with placental insufficiency and very active labor.

Labor was successfully induced at term in 55 clinically normal cases (25 nulliparae and 30 parous women) by combining low amniotomy with intravenous administration of prostaglandin E 2 (PGE 2 ). One parous woman was delivered by cesarean section because of cord prolapse. Vomiting was the only maternal side effect encountered in 11 patients (20%) but was never troublesome. The procedure was safe for the fetus and for the neonate as shown by electronic monitoring and by biochemical and clinical evaluation. As other oxytocic drugs, intravenous PGE 2 may cause uterine hyperstimulation and abnormal fetal heart rate patterns and electronic monitoring of labor is considered mandatory.

This study evaluates the efficacy and safety of PGE2 (prostaglandin E2) tablets for induction of labor in term pregnancy (38 to 42 weeks). 47 women (21 nullipara and 26 multiparae; ages 19 to 29 for nulliparae and 21 to 39 for multiparae) were studied; all were clinically normal according to the criteria of Thiery et al (1971), had intact membranes and mean Bishop scores (Bishop, 1964) of 7 for the nulliparae and 6.6 for the multiparae. In the parous group, the number of previous births ranged from 1 to 5. An initial dose of 0.5 mg PGE2 (1 tablet) was given to all except 1 patient who was given a 0.25 mg PGE2 as a test dose. A second dose of PGE2 was given if after 60 minutes, the recorded myometrial activity was less than 150 Montevideo Units. Subsequent doses of PGE2 (0.5 to 2.0 mg) were given at approximately 2-hourly intervals. Fetal scalp blood sample was collected at full cervical dilatation. 31 patients had spontaneous delivery while 16 patients (11 nulliparae and 5 multiparae) had to have vacuum extraction. The infants were assessed biochemically and clinically by Apgar scores at 1 and 5 minutes. Induction was successful in all except in a 23-year old obese nulliparous female at 40 weeks gestation who had a Bishop score of 5. This patient was given oxytocin infusion 27 hours after the first dose of PGE2; the baby was born following an easy vacuum extraction. Maternal morbidity included 1 to 3 episodes of vomiting in 8 of 21 nulliparae and 3 of 26 parous patients; elevated blood pressure during labor in 2 normotensive parous patients; postpartum hemorrhage which was easily controlled in 1 nullipara; and retained placenta in 1. Test dose to delivery interval ranged from 2 hours and 37 minutes to 18 hours and 29 minutes for the nulliparae and from 1 hour and 57 minutes to 9 hours and 13 minutes for the parous patients. The infants were in satisfactory condition at birth.

73 early gestations (6-14 wk) were investigated with gray scale ultrasound. 7 of them ended in spontaneous first-trimester abortion, and in all of these the findings were characteristic for spontaneous interruption of pregnancy. The remaining 66 continued to term. Regression analysis was performed with respect to the diameter of the gestation sac, the fetal crown-rump length, and the placental surface and thickness. The method is considered appropriate for the diagnosis of early abortion and the study of placental morphology and morphometry. On the basis of the results obtained with gray scale techniques, various concepts derived from B-scan observations (e.g. implantation locus and early twin observation) will have to be corrected.

SummaryA randomized double-blind trial was carried out in 54 women to evaluate the effectiveness of ciramadol in a single (60 or 30 mg) oral dose regimen, compared with 60 mg codeine and placebo, in the treatment of post-episiotomy pain. Ciramadol gave a significantly better analgesic effect, at both 2 and 6 hours, and produced negligible side-effects. Codeine did less well than placebo in this study.

Labor at term was electively induced in 50 clinically normal cases by a combined procedure (low amniotomy plus oral PGE 2 given as a draught). This type of induction is efficacious in both the primi- and the multiparous patient. Maternal side effects are negligible. The procedure appears to be safer for the fetus of a multipara than for the fetus of a primipara, as indicated by a significant though slight tendency toward acidosis and hypoxia, which becomes apparent in the course of the second stage of labor. A tentative explanation for this divergence in fetal behavior is advanced. For various reasons, uninterrupted electronic surveillance of the unborn is considered mandatory in cases in which PGE 2 is administered orally for labor induction.

Buccal tablets of deaminooxytocin were used to induce (28 women) or to augment labor (130 women). 95 patients were excluded from the study on the basis of other than pharmacological possible influences. Monitoring of intrauterine pressure and fetal heart rate was done in 59 cases. There was a decrease of the mean base excess in the induction group under clinical supervision (P Two cases of fetal acidosis for which the fractional administration of oxytocin may be held responsible, stress the necessity of monitoring the hazards of administration of oxytocic drugs.

A gel containing 0.5 mg prostaglandin E2 (PGE2) was extra-amniotically instilled to 90 clinically normal gravidae at term, for ripening of the cervix before elective induction of labor by amniotomy and intravenous PGE2. An acceptable increase in the Bishop score was noted to have occurred in 87/90 women, when assessed eight hours after administration of the gel; 14 of these women were then in established labor, which progressed uneventfully. Four of the 90 subjects required cesarean section for cephalopelvic disproportion. No adverse maternal or fetal effects of the procedure were detected under careful clinical, electronic and biochemical monitoring. However, epidural anesthesia adversely influenced the acid-base equilibrium of the fetus.

Echographic measurement of the early postpartum uterus was performed, mainly to investigate whether involution patterns correlate with parity, the administration of oxytocin during labor, and lactation. Our findings suggest that these factors do not have a marked effect on uterine involution.

In 100 clinically-normal women, labor was induced at term by low amniotomy and PGE2. The drug was administered by either the oral or the oromucosal route, the same incremental dose scheme (initial dose of 0.5 mg; hourly increment of 0.5 mg until adequate uterine stimulation or a maximum single dose of 3.0 mg) being applied. Both routes of administration had comparable efficacy and were equally safe. The incidence of abnormal monitoring findings (uterine hypertonus, transient bradycardia and dips II during the first stage; late decelerations, progressive and transient bradycardia during the second stage of labor) and of low Apgar scores was similar. Acid-base and lactate-pyruvate equilibria in mother and fetus were not influenced by the route of drug administration in parous women. In nulliparae treated with PGE2 by the oromucosal route, higher values were found for the fetal-maternal difference in excess lactate than in those given oral PGE2; however, this is probably of little clinical importance.

Ripening of the unfavorable cervix (Bishop score less than or equal to 4) was obtained in 92 clinically normal gravidae at term (68 nulliparae and 24 parous women), not in labor and with intact membranes, by injecting one or two doses (250 to 500 mug each) of prostaglandin (PG)E2 suspended in a viscous gel (5% Tylose) into the extra-ovular space. On average 7 to 8 hours after the injection the mean increase of the cervical score was 3.7 and 4.1 in the nulliparous and parous women, respectively. Complications associated with placement of the catheter were few. The method is simple, well tolerated and no untoward maternal or perinatal effects could be directly attributed to it. However, suitable criteria for predicting both the effect of the procedure and the optimal PG dose to be administered are still needed.

In an earlier trial [7, 11] with intravenously administered PGF2# for the elective induction of multiparae at term, amniotomy was delayed to comply with FD A regulations. As a consequence, the Start of the electronic supervision was also postponed and thus the refined assessment of the potential fetal ha2ards of PGF2& was prevented. The present study was tailored in accordance with the dual purpose of meeting our primary objective (to study the effects of PGF2# in the fetus and the newborn) by relying on a procedure actually used in clinical obstetrics, i. e. amniotomy followed by the intravenous infusion of an oxytocic drug.

The oxygen effect in the gas-phase photochlorination of trichloroethylene has been investigated at 363 and 403°K in a conventional kinetic apparatus and in a reaction cell combined with a rapid mass spectrometer. Once initiated by light at 4358 A, the chlorination in presence of oxygen proceeds further in the dark. This " after-effect " has been investigated under various experimental conditions. The results can be represented by a reaction mechanism comprising (i) formation and decomposition of a peroxidic radical, (ii) the accumulation of a semi-stable peroxidic compound during the period of illumination, (iii) its monomolecular decomposition in the gas-phase to give free radicals both in the light and dark periods, (iv) the monomolecular destruction of the semi-stable peroxide at the wall to yield a stable product(s). Relevant rate constants have been measured. The values obtained and the results of mass spectrometric experiments imply that the semi-stable compound could be a peroxidic dimer such as Cl4HC2-O-O- C2HCl4.