44 results on '"Synnøve Lian Johnsen"'
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2. Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies.
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Cathrine Ebbing, Torvid Kiserud, Synnøve Lian Johnsen, Susanne Albrechtsen, and Svein Rasmussen
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Medicine ,Science - Abstract
ObjectivesTo determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.DesignPopulation-based registry study.SettingMedical Birth Registry of Norway 1999-2009.PopulationAll births (gestational age >16 weeks to MethodsDescriptive statistics and odds ratios (ORs) for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.Main outcome measuresVelamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU), malformations, birthweight, and perinatal death.ResultsThe prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal) in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal) in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1-4.6)), and placental abruption (OR = 2.6, (95% CI = 2.1-3.2)). The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5-4.3).ConclusionThe prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more common than velamentous. The conditions were associated with common risk factors and an increased risk of adverse perinatal outcomes; these risks were greater for velamentous than for marginal insertion.
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- 2013
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3. The human yolk sac size reflects involvement in embryonic and fetal growth regulation
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Torvid Kiserud, Svein Rasmussen, Gro Trae, Synnøve Lian Johnsen, Henriette Odland Karlsen, and Hilde M. T. Reistad
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Crown-rump length ,Fetus ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,Embryogenesis ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,embryonic structures ,Lean body mass ,medicine ,Gestation ,030212 general & internal medicine ,Yolk sac ,business ,Body mass index - Abstract
INTRODUCTION The human yolk sac provides the embryo with stem cells, nutrients, and gas exchange. We hypothesized that more maternal resources, reflected in body size and body composition, would condition a a larger yolk sac, ensuring resources for the growing embryo. Thus, we aimed to determine the relation between maternal size in early pregnancy and yolk sac size. MATERIAL AND METHODS This subsidiary study was embedded in the multinational World Health Organization fetal growth project that included healthy women with a body mass index of 18-30, reliable information of their regular last menstrual period and singleton pregnancies. Yolk sac diameter, crown-rump length, and maternal height, weight, body mass index, and body composition were assessed before 13 weeks of gestation, and the fetal biometry was repeated during the pregnancy. RESULTS Of 140 participants, 122 with a successful yolk sac measurement were entered in the present analysis. Maternal weight was negatively associated with the yolk sac diameter (P = 0.007) and so was maternal height (P = 0.011), fat mass (P = 0.037), and lean body mass (P = 0.018), but not body mass index (P = 0.121). Significant effects were predominantly due to the female embryos and could be traced at 24 weeks of gestation. That is, a small yolk sac : crown-rump length ratio in early pregnancy was associated with a high fetal abdominal circumference (P
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- 2018
4. Velamentous or marginal cord insertion and the risk of spontaneous preterm birth, prelabor rupture of the membranes, and anomalous cord length, a population-based study
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Cathrine Ebbing, Svein Rasmussen, Synnøve Lian Johnsen, Susanne Albrechtsen, Christina Vekseth, and Ingvild Dahl Sunde
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Adult ,Male ,Polyhydramnios ,Fetal Membranes, Premature Rupture ,medicine.medical_specialty ,Cord ,Population ,Oligohydramnios ,Prom ,Umbilical cord ,Umbilical Cord ,Young Adult ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Rupture of membranes ,Registries ,030212 general & internal medicine ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Norway ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Short Umbilical Cord ,Premature Birth ,Female ,business - Abstract
Anomalous cord insertion is associated with increased risk of adverse maternal and perinatal outcome. Our aim was to study whether anomalous cord insertion is associated with prelabor rupture of membranes (PROM), preterm PROM (pPROM), long or short umbilical cord, and time trend of spontaneous preterm birth (SPTB) and anomalous cord insertion.A population-based register study using data from the Medical Birth Register of Norway including all singleton births (gestational age16 weeks and45 weeks) during 1999-2013 (n = 860 465) to calculate odds ratios (ORs) for PROM, pPROM, SPTB, and cord length (95th or5th centile) according to the cord insertion site by logistic regression with adjustment for possible confounders. We also assessed time trends of SPTB and anomalous cord insertion.Velamentous insertion of the cord was associated with an increased risk of PROM (OR 1.6, 95% CI 1.5-1.7), pPROM (OR 2.7, 95% CI 2.4-3.0), SPTB (OR 2.0, 95% CI 1.9-2.2), and a short cord (OR 1.7, 95% CI 1.5-1.8). Marginal insertion was to a lesser extent associated with these complications. Occurrences of SPTB and anomalous insertion declined. The decline in SPTB persisted after including an interaction term between anomalous insertion and time.Velamentous and, to a lesser extent, marginal cord insertions were associated with increased risk of PROM, pPROM, SPTB, and short cord. This suggests a common pathogenesis behind altered function of the membranes, cord, and placenta. The decline in SPTB could not be explained by the reduction in the occurrence of anomalous cord insertion.
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- 2016
5. Prediction of adverse perinatal outcome of small-for-gestational-age pregnancy using size centiles and conditional growth centiles
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Torvid Kiserud, Synnøve Lian Johnsen, Svein Rasmussen, and Henriette Odland Karlsen
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Fetus ,Longitudinal study ,Pregnancy ,Pediatrics ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Neonatal intensive care unit ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Perinatal outcome ,General Medicine ,Hypoglycemia ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Fetal distress ,medicine ,Small for gestational age ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,business - Abstract
OBJECTIVE To test whether adding conditional growth centiles to size centiles of estimated fetal weight (EFW) improves prediction of adverse perinatal outcome in pregnancies with or at risk of having a small-for-gestational-age (SGA) fetus. METHODS This prospective longitudinal study included pregnant women at risk of or diagnosed with an SGA (≤ 5(th) centile) fetus. They underwent serial ultrasound measurements and the final two were included in the analyses for this study. The EFW was categorized into normal (> 5(th) or 10(th) centile) and abnormal (≤ 5(th) or 10(th) centile) for size and conditional growth before entering the variables into log-binomial regression analyses. Adverse outcomes were delivery
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- 2016
6. Estimated date of delivery based on second trimester fetal head circumference: A population-based validation of 21 451 deliveries
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Jörg Kessler, Torvid Kiserud, Svein Rasmussen, Henriette Odland Karlsen, Cathrine Ebbing, and Synnøve Lian Johnsen
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Adult ,medicine.medical_specialty ,media_common.quotation_subject ,Population ,Gestational Age ,Crown-Rump Length ,Ultrasonography, Prenatal ,Fetal Development ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Fetal head ,030212 general & internal medicine ,education ,Menstrual cycle ,media_common ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,Circumference ,body regions ,Pregnancy Trimester, Second ,Gestation ,Female ,Live birth ,business ,Head - Abstract
INTRODUCTION Fetal biometry is used for determining gestational age and estimated date of delivery (EDD). However, the accuracy of the EDD depends on the assumed length of pregnancy included in the calculation. This study aimed at assessing the actual pregnancy length and accuracy of EDD prediction based on fetal head circumference measured at the second trimester. MATERIAL AND METHODS This was a population-based observational study with the following inclusion criteria: singleton pregnancy, head circumference dating in the second trimester, spontaneous onset or induction of delivery ≥ 294 days of gestation, live birth. The EDD was set anticipating a pregnancy length of 282 days. Bias in the prediction of EDD was defined as the difference between the actual date of birth and the EDD. RESULTS Head circumference measurements were available for 21 451 pregnancies. Ultrasound-dated pregnancies had a median pregnancy length of 283.03 days, corresponding to a method bias of 1.03 days (95% CI; 0.89-1.16). This bias was dependent on the head circumference at dating, ranging from -1.58 days (95% CI; -3.54 to 1.12) to 3.42 days (95% CI; 1.98-4.31). The median pregnancy length, based on the last menstrual period of women with a regular menstrual cycle (n = 12 985), was 283.15 days (95% CI; 282.91-283.31). A total of 5685 (22.9%, 95% CI; 22.4% to 23.4%) and 886 women (3.6%, 95% CI; 3.3%-3.8%) were still pregnant 7 and 14 days after the EDD, respectively. CONCLUSIONS Second trimester head circumference measurements can be safely used to predict EDD. A revision of the pregnancy length to 283 days will reduce the bias of EDD prediction to a level comparable with other methods.
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- 2018
7. Third stage of labor risks in velamentous and marginal cord insertion: a population-based study
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Svein Rasmussen, Torvid Kiserud, Cathrine Ebbing, Synnøve Lian Johnsen, and Susanne Albrechtsen
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Adult ,medicine.medical_specialty ,Cord ,medicine.medical_treatment ,Population ,Umbilical Cord ,Young Adult ,Pregnancy ,Risk Factors ,Odds Ratio ,medicine ,Humans ,Registries ,education ,Retrospective Studies ,Gynecology ,education.field_of_study ,Norway ,business.industry ,Vaginal delivery ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Odds ratio ,medicine.disease ,Curettage ,Confidence interval ,Obstetric Labor Complications ,Logistic Models ,Velamentous cord insertion ,Female ,business ,Labor Stage, Third - Abstract
To assess whether anomalous cord insertion is associated with risk of complications in the third stage of labor.A population-based study.Norwegian Medical Birth Register.All singleton births (gestational age16 weeks and45 weeks) during the period 1999-2011 (n = 738,443 singletons). Deliveries by cesarean were excluded, leaving 628,680 vaginal singleton deliveries for the analyses.Calculation of odds ratios for complications in the third stage of labor (postpartum hemorrhage, manual delivery of the placenta, curettage) in velamentous and marginal cord insertion by logistic regression with adjustment for confounders.Complications in the third stage of labor, postpartum hemorrhage, manual placental removal and curettage.Anomalous cord insertion was associated with an increased risk of complications in the third stage of labor, the risk being higher for velamentous than for marginal insertion. The risks persisted after adjusting for possible confounding factors. Velamentous cord insertion carried a 5.6% risk of a need for manual removal of the placenta, compared with the risk of 1.1% for nonvelamentous insertion (odds ratio = 5.21, 95% confidence interval 4.71-5.76) in vaginal delivery, and we found increased risks of curettage (odds ratio = 3.29, 95% confidence interval 2.87-3.77) and postpartum hemorrhage (odds ratio = 2.06, 95% confidence interval 1.77-2.39).Marginal and especially velamentous cord insertion is associated with an increased risk of hemorrhage in the third stage of labor, need for manual removal of the placenta and curettage. Anomalous cord insertion can be identified prenatally and so possibly influence obstetric management.
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- 2015
8. Gravid kvinne med polyhydramnion og foster med tynntarmsatresi
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Karin Collett, Cecilie Askeland, Synnøve Lian Johnsen, Jörg Kessler, Hallvard Reigstad, and Cathrine Ebbing
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Pregnancy ,Polyhydramnios ,medicine.medical_specialty ,Fetus ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Intestinal atresia ,General Medicine ,medicine.disease ,Umbilical cord ,Infant newborn ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Premature birth ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Cardiotocography ,business - Published
- 2017
9. Use of conditional centiles of middle cerebral artery pulsatility index and cerebroplacental ratio in the prediction of adverse perinatal outcomes
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Cathrine Ebbing, Synnøve Lian Johnsen, Svein Rasmussen, Torvid Kiserud, and Henriette Odland Karlsen
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Longitudinal study ,Pediatrics ,medicine.medical_specialty ,Neonatal intensive care unit ,Cerebroplacental ratio ,Hypoglycemia ,Ultrasonography, Prenatal ,Umbilical Arteries ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine.artery ,medicine ,Fetal distress ,Humans ,pulsatility index ,030212 general & internal medicine ,Longitudinal Studies ,Prospective Studies ,Fetus ,middle cerebral artery ,030219 obstetrics & reproductive medicine ,Fetal Growth Retardation ,business.industry ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,Umbilical artery ,General Medicine ,medicine.disease ,conditional centile ,Middle cerebral artery ,perinatal outcomes ,Apgar score ,Female ,business - Abstract
Introduction. Centiles of middle cerebral artery pulsatility index and cerebroplacental ratio are useful for predicting adverse perinatal outcomes. A ‘conditional centile’ is conditioned by a previous measurement reflecting degree of individual change over time. Here we test whether such centiles are independent predictors and whether their combination improves prediction. Material and methods. This prospective longitudinal study included 220 pregnant women diagnosed with or at risk of having a small-for-gestational-age fetus. Serial Doppler measurements of the umbilical artery and middle cerebral artery pulsatility indexs were used to calculate cerebroplacental ratio. Preterm birth, operative delivery due to fetal distress, admission to neonatal intensive care unit, 5-min Apgar score
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- 2016
10. Blood flow in the foetal superior vena cava and the effect of foetal breathing movements
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Torvid Kiserud, M. K. Nyberg, Synnøve Lian Johnsen, and Svein Rasmussen
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Adult ,Fetus ,Pregnancy ,Vena Cava, Superior ,business.industry ,Respiration ,Ultrasound ,Obstetrics and Gynecology ,Venous blood ,Blood flow ,medicine.disease ,Inferior vena cava ,Ultrasonography, Prenatal ,medicine.vein ,Superior vena cava ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Breathing ,Humans ,Medicine ,Female ,business - Abstract
article i nfo Objectives: The superior vena cava (SVC) drains venous blood from the upper foetal body, mainly the head. Data on the human foetus is scarce. Here we present reference values for the blood flow during the second half of pregnancy, and test the hypothesis that foetal breathing movements (FBM) enhance this flow. Methods: Based on a power calculation, 110 women with low-risk singleton pregnancies were recruited to a longitudinal study that included three sets of observations during the second half of pregnancy. Ultrasound was used to determine inner diameter, peak systolic blood velocity and time-average maximum velocities in the SVC during rest and respiratory activity. Results: During the second half of pregnancy, SVC blood flow increased from 57.8 mL/min (95% CI 51.7-64.3) to 221.5 (204.5-239.3). Based on 558 sets of observations obtained during foetal rest and FBM, we found an overall increase in diameter from 0.41 cm (0.40-0.42) to 0.46 (0.44-0.48), peak systolic velocity from 35.9 cm/s (34.9-37.0) to 62.2 (59.1-65.5), and time-averaged maximum velocity from 20.3 cm/s (19.7-20.8) to 27.3 (26.1-28.6). This resulted in an overall 90% increase in mean SVC blood flow, from 108.1 mL/min (98.8-117.9) at rest to 205.9 (183.2-230.5) during FBM. Conclusion: The blood flow in the SVC increases during the second half of pregnancy and is substantially augmented during FBM. Since high-amplitude FBM additionally reduces flow in the inferior vena cava, the net effect is a prioritised venous drainage from the foetal head enhancing the washout of CO2 in that area, which also contains the chemoreceptors.
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- 2012
11. Maternal weight gain: a determinant for fetal abdominal circumference in the second trimester
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Svein Rasmussen, Henriette Hellebust, Synnøve Lian Johnsen, and Torvid Kiserud
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Gynecology ,medicine.medical_specialty ,Pregnancy ,education.field_of_study ,Fetus ,Obstetrics ,business.industry ,Population ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,medicine ,Abdomen ,Gestation ,medicine.symptom ,education ,business ,Weight gain ,Body mass index - Abstract
Objective. To study the association between maternal weight gain in pregnancy and fetal abdominal circumference in the second trimester. Design. Prospective cross-sectional study. Setting. Low-risk antenatal clinic. Population. Six hundred and fifty women with low-risk pregnancy. Methods. Women with a regular menstrual period (28±4 days) and certain information on the last menstrual period were recruited when they were referred for routine ultrasound scanning. Women with a discrepancy of> 14 days between ultrasound and menstrual age were excluded. Maternal weight gain during pregnancy was derived from information in the antenatal chart and the weekly weight gain was calculated. Fetal abdominal circumference measurements were registered in gestational weeks 15-25 and their z-scores, together with the z-scores of maternal weight gain, were used in a linear regression analysis. Main outcome measures. Association between maternal weight gain and fetal abdominal circumference. Results. Based on the complete data of 515 women we found a mean maternal weight gain during pregnancy of 0.39kg/week and a positive association between this weight gain and fetal abdominal circumference in the second trimester (r=0.122 (95%CI 0.051-0.194)), with the strongest effect in women with the slowest weight gain (
- Published
- 2011
12. Fetal breathing is associated with increased umbilical blood flow
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Svein Rasmussen, Torvid Kiserud, Synnøve Lian Johnsen, and M. K. Nyberg
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Adult ,Umbilical Veins ,medicine.medical_specialty ,Adolescent ,Placenta ,Gestational Age ,Ultrasonography, Prenatal ,Umbilical Arteries ,Umbilical vein ,Young Adult ,Fetal Heart ,Pregnancy ,Internal medicine ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Fetal Movement ,Fetus ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Respiration ,Obstetrics and Gynecology ,Gestational age ,Umbilical artery ,General Medicine ,Blood flow ,Heart Rate, Fetal ,medicine.anatomical_structure ,Reproductive Medicine ,Cardiology ,Breathing ,Female ,business ,Blood Flow Velocity ,Artery - Abstract
Objectives In humans, fetal breathing movements affect blood velocities in the umbilical vein and artery, but it is not known whether fetal respiratory activity is associated with increased fetal blood flow through the placenta. We therefore tested this hypothesis in the present study. Methods One-hundred and ten women with low-risk singleton pregnancies were each examined three times by ultrasound during the second half of pregnancy. Fetal heart rate, umbilical artery blood velocity, umbilical vein diameter and blood velocity, and umbilical blood flow at the placental end were determined during fetal rest and fetal respiratory movements. Results Based on 330 observations obtained during fetal rest or breathing activity, no difference was found in the mean fetal heart rate (beats per minute (bpm)) during rest compared with breathing (142 bpm vs. 142 bpm, respectively). Although fetal breathing affected the umbilical artery waveform, there was no difference in the mean time-averaged maximum velocity between rest and breathing: 26.6 (95% CI, 25.1–28.3) cm/s vs. 28.9 (95% CI, 27.2–30.7) cm/s, respectively. The umbilical vein was 27% greater in cross-sectional area and the blood velocity 9% higher during breathing, resulting in a 42% increase in mean umbilical blood flow: 121.8 (95% CI, 109.5–135.0) mL/min at rest vs. 173.0 (95% CI, 158.0–188.6) mL/min during breathing. Venous velocity was calculated from recordings of mean duration 3.7 s at rest and 6.2 s of respiratory activity. Gestational age did not influence the relationship. Conclusion Fetal breathing is associated with increased umbilical blood flow during the second half of pregnancy. Umbilical vein distension during breathing suggests active endocrine regulation. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2010
13. The Shifting Trajectory of Growth in Femur Length During Gestation
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Tuan V. Nguyen, Åshild Bjørnerem, Ego Seeman, Torvid Kiserud, and Synnøve Lian Johnsen
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Adult ,medicine.medical_specialty ,Percentile ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Gestational Age ,Ultrasonography, Prenatal ,Fetal Development ,Pregnancy ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,Generalized estimating equation ,Fetus ,Obstetrics ,business.industry ,Body Weight ,Infant, Newborn ,Gestational age ,Middle Aged ,medicine.disease ,Body Height ,Endocrinology ,Quartile ,Gestation ,Female ,business - Abstract
Bone size is a determinant of bone strength and tracks in its percentile of origin during childhood and adolescence. We hypothesized that the ranking of an individual's femur length (FL) is established in early gestation and tracks thereafter. Fetal FL was measured serially using 2D ultrasound in 625 Norwegian fetuses. Tracking was assessed using Pearson correlation, a generalized estimating equation model, and by calculating the proportion of fetuses whose FL remained within the same quartile. Baseline FL Z-score (weeks 10 to 19) and later measurements correlated, but more weakly as gestation advanced: r = 0.59 (weeks 20 to 26); r = 0.45 (weeks 27 to 33); and r = 0.32 (weeks 34 to 39) (p < 0.001). Tracking within the same quartile throughout gestation occurred in 13% of fetuses. Of the 87% deviating, 21% returned to the quartile of origin, so 34% began and ended in the same quartile, 38% deviated by one quartile, and 28% deviated by two or more quartiles by the end of gestation. A standard deviation higher baseline FL Z-score, placental weight (150 g), maternal height (5 cm), and weight (10 kg), was associated with a 0.25, 0.15, 0.10, and 0.05 SD higher FL Z-score at the end of gestation, respectively (p ranging from
- Published
- 2009
14. Ultralydfremstilling av fostervekst
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Synnøve Lian Johnsen and Torvid Kiserud
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lcsh:Public aspects of medicine ,lcsh:RA1-1270 - Abstract
Ultralyd billeddanning er i dag den beste undersøkelsesmetoden vi har til å overvåke fosterets utvikling og vekst. Ultralydmåling av fosterets størrelse og biometriske referansetabeller for svangerskapet brukes til å fastsette svangerskapets alder, beregne termin og vurdere fosterets vekst. Optimal studiedesign er ulik for hvert av disse formålene. Det er stor variasjon i fysiologisk vekst og en utfordring å identifisere fostre som har dårlig tilvekst. En enkeltmåling av fosteret kan fortelle oss om det er lite eller stort i forhold til andre fostre, men ikke om størrelsen er passelig i forhold til forventet fysiologisk vekst for dette fosteret. Tilpassede referansemodeller ("customised") justerer forventet størrelse i relasjon til føtale og maternelle faktorer og har vist seg å bedre identifisere sanne veksthemmede fostre enn bare å klassifisere i henhold til 2,5, 5 eller 10 persentilen. Men et foster som i utgangspunktet er stort for alderen, men etter hvert vokser langsomt vil ikke nødvendigvis bli fanget opp ved en slik enkeltmåling. Serielle målinger vil hjelpe, men en slik longitudinell metode blir ikke fullt ut utnyttet før det appliseres betinget ("conditional") vekstberegning. Betingelsesleddene for variasjon i vekst og målemetode kalkuleres ut fra longitudinelle data og kan så anvendes for det enkelte foster. En første måling brukes til å beregne forventet vekst og variasjon for en neste måling. Denne metoden forventes å skjerpe diagnostikken for vekst-avvik i alle vektklasser og kan sammen med tilpasningen av andre faktorer bedre overvåkningen av risikosvangerskapUltrasonographic imaging is today the best method for assessing fetal size and monitoring fetal growth. Ultrasound measurements of fetal size are used for age, size and growth assessment, but the statistical design and analysis are different for each of these purposes. Physiological ranges for fetal growth are wide and the identification of fetal growth-restriction is correspondingly challenging. While fetal growth is reflected in various morphometric measurements, it is the estimated fetal weight (EFW) that has become the most useful method of identifying the growth-restricted fetuses. EFW is typically classified using populationbased percentiles. The most common definition of fetal growth-restriction refers to a weight below the 2.5th, 5th or 10th percentile for gestational age. This definition is controversial because it does not make a distinction between constitutionally small, small and growth-restricted, or growth-restricted but not small fetuses. Multiple variables affect fetal weight and can be incorporated into individually adjusted percentiles (e.g. fetal gender and maternal parity, ethnicity, height, weight, and age). Such customised fetal weight percentiles seem to enhance the identification of fetuses at risk of perinatal death and morbidity. A further advancement of the method is the application of serial measurements, a method that allows the detection of growth deviation. Rather than using z-score statistics based of cross-sectional studies, the method can be further sharpened by using conditional reference ranges: terms derived from longitudinal studies of fetal growth are used to establish conditional reference values for individual fetuses. I.e. the expected mean and ranges for the next examination is calculated based on the previous measurement. These conditional reference percentiles can be combined with customizing fetal and maternal factors to further optimize the diagnostic process of identifying growth deviation
- Published
- 2009
15. Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age
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Cathrine, Ebbing, Synnøve Lian, Johnsen, Jørg, Kessler, Torvid, Kiserud, and Svein, Rasmussen
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Norway ,Pregnancy ,Practice Guidelines as Topic ,Humans ,Female ,Gestational Age ,Ultrasonography, Prenatal - Published
- 2015
16. Longitudinal reference charts for growth of the fetal head, abdomen and femur
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Svein Rasmussen, Tom Wilsgaard, Synnøve Lian Johnsen, Rita Sollien, and Torvid Kiserud
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Adult ,Longitudinal study ,medicine.medical_specialty ,Percentile ,Gestational Age ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Fetal Development ,Fetus ,Pregnancy ,Reference Values ,Abdomen ,medicine ,Humans ,Fetal head ,Femur ,Longitudinal Studies ,Prospective Studies ,Cephalic index ,Obstetrics ,business.industry ,Reproducibility of Results ,Obstetrics and Gynecology ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,Regression Analysis ,Gestation ,Female ,business ,Head - Abstract
Objectives The aims of the present study were to establish improved reference charts for growth of the fetal head, abdomen and femur, and to determine the effect of fetal and maternal factors. Study design This prospective longitudinal study included 650 low-risk pregnancies. Outer–outer biparietal diameter (BPD), head circumference (HC), mean abdominal diameter (MAD), abdominal circumference (AC) and femur length (FL) were measured by ultrasound, and the statistical analysis was based on regression analysis and multilevel modeling. Results Reference percentiles for the growth of MAD, AC and FL showed continuous growth in gestational week 10–40, while BPD and HC showed a slightly blunted growth toward the end of pregnancy. FL was the only variable that was not influenced by gender. There was a significant negative association between breech presentation and all five biometrical variables, while maternal weight was positively associated with all five variables. Cephalic index significantly influenced BPD and HC. Maternal height had a positive effect on BPD, HC, AC and FL, and parity had a positive effect on MAD and AC, while smoking influenced negatively HC, MAD, and FL. Terms for calculating conditional reference values and customisation for individualised growth assessment are presented. Conclusions New reference charts for the growth of fetal head, abdomen and femur are suggested for assessing fetal size and growth, and can be adjusted for maternal and fetal factors to suite individual pregnancies.
- Published
- 2006
17. Fetal age assessment based on femur length at 10-25 weeks of gestation, and reference ranges for femur length to head circumference ratios
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Rita Sollien, Torvid Kiserud, Svein Rasmussen, and Synnøve Lian Johnsen
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Crown-rump length ,Fetus ,medicine.medical_specialty ,Percentile ,Pregnancy ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Ballard Maturational Assessment ,medicine.disease ,medicine ,Femur ,Prospective cohort study ,business - Abstract
Background. The aim of the present study is to establish new reference charts for gestational age assessment based on fetal femur length (FL), and new reference ranges for FL to head ratios at gestational weeks 10-25, and to determine the effect of maternal and fetal factors on these charts. Methods. Six hundred fifty low-risk women with regular menstrual periods and singleton pregnancies were recruited to a prospective cross-sectional study after obtaining written consent. FL, outer-outer biparietal diameter (BPD), and head circumference (HC) were measured at 10-25 weeks of gestation. We used regression analysis in order to construct mean curves and to assess the effect of maternal and fetal factors on age assessment. Results. The new chart for age assessment by means of FL was based on 636 measurements. The 95% CI of the mean corresponded to
- Published
- 2005
18. Fetal age assessment based on ultrasound head biometry and the effect of maternal and fetal factors
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Rita Sollien, Torvid Kiserud, Svein Rasmussen, and Synnøve Lian Johnsen
- Subjects
Pregnancy ,medicine.medical_specialty ,Fetus ,Obstetrics ,business.industry ,Cross-sectional study ,Ultrasound ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Fetal age ,medicine.disease ,medicine ,Gestation ,business ,Prospective cohort study - Abstract
Background: Maternal height and weight have increased during the past 20 years, as has birthweight. The aim of the present study was to establish new reference charts for gestational age (GA) assessment using fetal biparietal diameter (BPD) and head circumference (HC), and to determine the effect of maternal and fetal factors on age assessment. Methods: This was a prospective, cross-sectional study of 650 healthy women with regular menstrual periods and singleton uncomplicated pregnancies, recruited after written consent. BPD (outer-outer) and HC were measured at 10-24 weeks of gestation. We used regression analysis to construct mean curves and assess the effect of maternal and fetal factors on age assessment. Results: BPD and HC were successfully measured in 642 participants. Using BPD and HC before 20 weeks, the new charts gave 3-8 days higher GA assessment than the charts presently in use, and
- Published
- 2004
19. Twin-twin transfusion syndrome treated with serial amniocenteses
- Author
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Susanne Albrechtsen, Synnøve Lian Johnsen, and Jouko Pirhonen
- Subjects
Pregnancy ,Polyhydramnios ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,General Medicine ,medicine.disease ,medicine ,Amniocentesis ,business ,Twin Twin Transfusion Syndrome ,Severe complication - Abstract
Background. To evaluate the treatment and neonatal outcome in pregnancies complicated by twin-twin transfusion syndrome (TTS). Material and methods. Twenty-four women with TTS were identified in the period 1993-99 among 34 477 deliveries. We include a retrospective chart review of all twins with TTS. Results. The overall incidence of TTS was 4.75% of all twin pregnancies. The mean gestational age at the time of diagnosing TTS was 23 weeks (range 17.6-38), and the mean gestational age at delivery was 34.6 weeks (range 23.1-38.3). Therapeutic amniocenteses was performed in 21 women. The total volume drained varied from 0.4 to 32.31 with a mean of 2.3 l. Overall perinatal mortality in TTS was 35.4%, as nine donor twins and eight recipient twins died. The main causes for mortality were intrauterine death and prematurity. Conclusion. Twin-twin transfusion syndrome is a severe complication in monochorionic diamniotic twin pregnancies, with high perinatal mortality and morbidity even though amnioreduction prolon...
- Published
- 2004
20. WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component
- Author
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Hany Abdel-Aleem, Lisa Neerup Jensen, George Bega, Alexandra Benachi, Mario Merialdi, Guillermo Carroli, Pisake Lumbiganon, Torvid Kiserud, Sameera A. Talegawkar, Anke Diemert, José Guilherme Cecatti, Antoinette Tshefu, Alka Kriplani, Daniel Wojdyla, Mariana Widmer, Lawrence D. Platt, Ann Tabor, Synnøve Lian Johnsen, Ahmet Metin Gülmezoglu, Rogelio Gonzalez, and Kurt Hecher
- Subjects
Pediatrics ,Denmark ,Ethnic group ,Fetal growth ,Fetal Development ,Study Protocol ,Pregnancy ,Reference Values ,Germany ,Obstetrics and Gynaecology ,Ethnicity ,Growth Charts ,Child development ,education.field_of_study ,Anthropometry ,Norway ,Obstetrics and Gynecology ,Gestational age ,Growth standards ,Thailand ,Research Design ,Democratic Republic of the Congo ,Egypt ,Female ,France ,Developed country ,Brazil ,Adult ,medicine.medical_specialty ,Biometry ,Adolescent ,Population ,Reproductive medicine ,Argentina ,India ,Gestational Age ,World Health Organization ,Ultrasonography, Prenatal ,Young Adult ,Environmental health ,Ultrasound ,medicine ,Humans ,education ,Socioeconomic status ,business.industry ,medicine.disease ,Social Class ,business - Abstract
Background: In 2006 WHO presented the infant and child growth charts suggested for universal application. However, major determinants for perinatal outcomes and postnatal growth are laid down during antenatal development. Accordingly, monitoring fetal growth in utero by ultrasonography is important both for clinical and scientific reasons. The currently used fetal growth references are derived mainly from North American and European population and may be inappropriate for international use, given possible variances in the growth rates of fetuses from different ethnic population groups. WHO has, therefore, made it a high priority to establish charts of optimal fetal growth that can be recommended worldwide. Methods: This is a multi-national study for the development of fetal growth standards for international application by assessing fetal growth in populations of different ethnic and geographic backgrounds. The study will select pregnant women of high-middle socioeconomic status with no obvious environmental constraints on growth (adequate nutritional status, non-smoking), and normal pregnancy history with no complications likely to affect fetal growth. The study will be conducted in centres from ten developing and industrialized countries: Argentina, Brazil, Democratic Republic of Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand. At each centre, 140 pregnant women will be recruited between 8 + 0 and 12 + 6 weeks of gestation. Subsequently, visits for fetal biometry will be scheduled at 14, 18, 24, 28, 32, 36, and 40 weeks (+/− 1 week) to be performed by trained ultrasonographers. The main outcome of the proposed study will be the development of fetal growth standards (either global or population specific) for international applications. Discussion: The data from this study will be incorporated into obstetric practice and national health policies at country level in coordination with the activities presently conducted by WHO to implement the use of the Child Growth Standards. publishedVersion
- Published
- 2014
21. MINNEORD
- Author
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Per E. Børdahl, Synnøve Lian Johnsen, Torvid Kiserud, Cathrine Ebbing, Knut Håkon Bakke, and Susanne Albrechtsen
- Subjects
General Medicine - Published
- 2014
22. Early pregnancy termination with mifepristone and misoprostol in Norway
- Author
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Grete Augestad, Ole Erik Iversen, Ingrid Økland, Harald Helland, Sverre Stray-Pedersen †, Grete Midbøe, Line Bjørge, and Synnøve Lian Johnsen
- Subjects
Gynecology ,medicine.medical_specialty ,education.field_of_study ,Pregnancy ,Obstetrics ,business.industry ,medicine.medical_treatment ,Population ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Mifepristone ,Abortion ,medicine.disease ,Medical abortion ,Prostaglandin analog ,medicine ,education ,business ,Misoprostol ,medicine.drug - Abstract
Objectives. Medical abortion was first introduced in Norway in April 1998. The aims of this study were to assess the efficacy, side effects, and acceptability of medical abortion using mifepristone orally and misoprostol vaginally in a Norwegian population. Design. The study included the first 226 pregnant women with gestational age of
- Published
- 2001
23. Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder
- Author
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Cathrine Ebbing, Jörg Kessler, Synnøve Lian Johnsen, Torvid Kiserud, and Svein Rasmussen
- Subjects
Gerontology ,business.industry ,language ,Medicine ,General Medicine ,Norwegian ,Fetal age ,business ,language.human_language - Published
- 2015
24. Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies
- Author
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Synnøve Lian Johnsen, Susanne Albrechtsen, Torvid Kiserud, Cathrine Ebbing, and Svein Rasmussen
- Subjects
Male ,Non-Clinical Medicine ,Epidemiology ,Umbilical cord ,Umbilical Cord ,Labor and Delivery ,Pregnancy ,Risk Factors ,Odds Ratio ,Prevalence ,Public Health Surveillance ,Clinical Epidemiology ,Registries ,Young adult ,reproductive and urinary physiology ,Multidisciplinary ,Obstetrics ,Norway ,Pregnancy Outcome ,Obstetrics and Gynecology ,Middle Aged ,medicine.anatomical_structure ,Medicine ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Cord ,Adolescent ,Clinical Research Design ,Science ,Young Adult ,Population Metrics ,Placenta ,medicine ,Humans ,Biology ,Survey Research ,Health Care Policy ,Population Biology ,business.industry ,Infant, Newborn ,Health Risk Analysis ,Odds ratio ,medicine.disease ,Population based study ,Patient Outcome Assessment ,Pregnancy Complications ,Velamentous cord insertion ,business - Abstract
ObjectivesTo determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.DesignPopulation-based registry study.SettingMedical Birth Registry of Norway 1999-2009.PopulationAll births (gestational age >16 weeks to MethodsDescriptive statistics and odds ratios (ORs) for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.Main outcome measuresVelamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU), malformations, birthweight, and perinatal death.ResultsThe prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal) in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal) in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1-4.6)), and placental abruption (OR = 2.6, (95% CI = 2.1-3.2)). The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5-4.3).ConclusionThe prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more common than velamentous. The conditions were associated with common risk factors and an increased risk of adverse perinatal outcomes; these risks were greater for velamentous than for marginal insertion.
- Published
- 2012
25. Hemodynamics of fetal breathing movements: the inferior vena cava
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M. K. Nyberg, Torvid Kiserud, Svein Rasmussen, and Synnøve Lian Johnsen
- Subjects
Adult ,Male ,Adolescent ,Hemodynamics ,Vena Cava, Inferior ,Inferior vena cava ,Ultrasonography, Prenatal ,Constriction ,Young Adult ,Fetal Heart ,Fetus ,Pregnancy ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Longitudinal Studies ,Fetal Movement ,Oxygen saturation (medicine) ,Radiological and Ultrasound Technology ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,General Medicine ,Reproductive Medicine ,medicine.vein ,Anesthesia ,Fetal movement ,Breathing ,Respiratory Mechanics ,Female ,business ,Ductus venosus - Abstract
Objective Based on the hypothesis that fetal breathing movements (FBM) enhance sections of the circulation to meet the needs of gas transport, we studied the effects of FBM on the fetal inferior vena cava (IVC), which transports blood with the lowest oxygen saturation in the fetal body. Methods One-hundred and ten women with low-risk singleton pregnancies were included in a longitudinal study during the second half of pregnancy. Inner diameter, peak systolic velocity and time-averaged maximum blood velocity were measured in the IVC below the ductus venosus outlet during rest and FBM. Volume flow and pressure gradient were estimated in 55 observations of forced inspiratory movements at 36 weeks of gestation. The results are presented as mean and 95% CI of the mean. Results Based on 585 observations obtained during fetal rest and FBM, we found no difference in diameter, 0.42 (95% CI, 0.41–0.43) cm vs. 0.41 (95% CI, 0.39–0.42) cm, respectively, apart from during high-amplitude inspiratory movement, when the diameter was 0.15 (95% CI, 0.13–0.17) cm. The peak systolic velocity was different during rest and FBM, 34.0 (95% CI, 32.7–35.3) cm/s vs. 81.5 (95% CI, 76.2–87.5) cm/s, respectively, and correspondingly for time-averaged maximum velocity, 19.7 (95% CI, 18.9–20.5) cm/s vs. 37.2 (95% CI, 34.9–39.9) cm/s, respectively. Forced inspiratory movements at 36 weeks significantly reduced flow in the IVC compared with rest, 63.6 (95% CI, 44.4–88.1) mL/min vs. 186.0 (95% CI, 142.8–238.1) mL/min, respectively. The pressure gradient increased 14-fold during forced inspiration, from 0.64 to 8.76 mmHg. Conclusions High-amplitude fetal inspiration substantially constricts the abdominal IVC and creates a negative pressure in the chest. The IVC constriction withholds abdominal blood, thus temporarily giving way to other flows. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2011
26. Maternal weight gain: a determinant for fetal abdominal circumference in the second trimester
- Author
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Henriette, Hellebust, Synnøve Lian, Johnsen, Svein, Rasmussen, and Torvid, Kiserud
- Subjects
Adult ,Mothers ,Gestational Age ,Weight Gain ,Ultrasonography, Prenatal ,Body Mass Index ,Fetal Development ,Cross-Sectional Studies ,Fetus ,Pregnancy ,Pregnancy Trimester, Second ,Linear Models ,Humans ,Female ,Prospective Studies ,Waist Circumference - Abstract
To study the association between maternal weight gain in pregnancy and fetal abdominal circumference in the second trimester.Prospective cross-sectional study.Low-risk antenatal clinic.Six hundred and fifty women with low-risk pregnancy.Women with a regular menstrual period (28±4 days) and certain information on the last menstrual period were recruited when they were referred for routine ultrasound scanning. Women with a discrepancy of14 days between ultrasound and menstrual age were excluded. Maternal weight gain during pregnancy was derived from information in the antenatal chart and the weekly weight gain was calculated. Fetal abdominal circumference measurements were registered in gestational weeks 15-25 and their z-scores, together with the z-scores of maternal weight gain, were used in a linear regression analysis. Main outcome measures. Association between maternal weight gain and fetal abdominal circumference.Based on the complete data of 515 women we found a mean maternal weight gain during pregnancy of 0.39 kg/week and a positive association between this weight gain and fetal abdominal circumference in the second trimester (r=0.122 (95%CI 0.051-0.194)), with the strongest effect in women with the slowest weight gain (0.28 kg/week) (r=0.554 (95%CI 0.261-0.846)).Maternal weight gain in pregnancy is related to and may determine fetal abdominal circumference in gestational weeks 15-25, particularly in those women with a slow weight gain.
- Published
- 2011
27. [Untitled]
- Author
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Torvid Kiserud and Synnøve Lian Johnsen
- Subjects
Gynecology ,medicine.medical_specialty ,Statistical design ,Epidemiology ,business.industry ,Reference values ,Fetal growth ,Medicine ,Fetal weight ,business ,Cartography - Abstract
Ultralyd billeddanning er i dag den beste undersokelsesmetoden vi har til a overvake fosterets utvikling og vekst. Ultralydmaling av fosterets storrelse og biometriske referansetabeller for svangerskapet brukes til a fastsette svangerskapets alder, beregne termin og vurdere fosterets vekst. Optimal studiedesign er ulik for hvert av disse formalene. Det er stor variasjon i fysiologisk vekst og en utfordring a identifisere fostre som har darlig tilvekst. En enkeltmaling av fosteret kan fortelle oss om det er lite eller stort i forhold til andre fostre, men ikke om storrelsen er passelig i forhold til forventet fysiologisk vekst for dette fosteret. Tilpassede referansemodeller ("customised") justerer forventet storrelse i relasjon til fotale og maternelle faktorer og har vist seg a bedre identifisere sanne veksthemmede fostre enn bare a klassifisere i henhold til 2,5, 5 eller 10 persentilen. Men et foster som i utgangspunktet er stort for alderen, men etter hvert vokser langsomt vil ikke nodvendigvis bli fanget opp ved en slik enkeltmaling. Serielle malinger vil hjelpe, men en slik longitudinell metode blir ikke fullt ut utnyttet for det appliseres betinget ("conditional") vekstberegning. Betingelsesleddene for variasjon i vekst og malemetode kalkuleres ut fra longitudinelle data og kan sa anvendes for det enkelte foster. En forste maling brukes til a beregne forventet vekst og variasjon for en neste maling. Denne metoden forventes a skjerpe diagnostikken for vekst-avvik i alle vektklasser og kan sammen med tilpasningen av andre faktorer bedre overvakningen av risikosvangerskap Ultrasonographic imaging is today the best method for assessing fetal size and monitoring fetal growth. Ultrasound measurements of fetal size are used for age, size and growth assessment, but the statistical design and analysis are different for each of these purposes. Physiological ranges for fetal growth are wide and the identification of fetal growth-restriction is correspondingly challenging. While fetal growth is reflected in various morphometric measurements, it is the estimated fetal weight (EFW) that has become the most useful method of identifying the growth-restricted fetuses. EFW is typically classified using populationbased percentiles. The most common definition of fetal growth-restriction refers to a weight below the 2.5th, 5th or 10th percentile for gestational age. This definition is controversial because it does not make a distinction between constitutionally small, small and growth-restricted, or growth-restricted but not small fetuses. Multiple variables affect fetal weight and can be incorporated into individually adjusted percentiles (e.g. fetal gender and maternal parity, ethnicity, height, weight, and age). Such customised fetal weight percentiles seem to enhance the identification of fetuses at risk of perinatal death and morbidity. A further advancement of the method is the application of serial measurements, a method that allows the detection of growth deviation. Rather than using z-score statistics based of cross-sectional studies, the method can be further sharpened by using conditional reference ranges: terms derived from longitudinal studies of fetal growth are used to establish conditional reference values for individual fetuses. I.e. the expected mean and ranges for the next examination is calculated based on the previous measurement. These conditional reference percentiles can be combined with customizing fetal and maternal factors to further optimize the diagnostic process of identifying growth deviation
- Published
- 2009
28. Biometric assessment
- Author
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Torvid Kiserud and Synnøve Lian Johnsen
- Subjects
Observer Variation ,Biometry ,Fetal Growth Retardation ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational Age ,General Medicine ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Fetal Development ,Fetal Weight ,Pregnancy ,Reference Values ,Infant, Small for Gestational Age ,Humans ,Female - Abstract
Ultrasound is used to assess foetal age, foetal weight and growth. The error of such measurements is considerable, but the technique of averaging repeat measurements restricts random error. The use of customised foetal weight charts, that is, adjusting for ethnicity and maternal and foetal factors helps in classifying foetal weight appropriately. Commonly used cross-sectional reference ranges are useful for the foetal weight assessment at any stage of pregnancy, but not for foetal growth. Growth assessment requires serial measurements and longitudinal reference ranges, which provide conditional terms for individual foetuses. That is, an initial measurement is used for calculating individual ranges for the rest of pregnancy. Compared to the ranges for the entire population, the conditional ranges for a small foetus are narrower and skewed in the direction of the initial measurement. Quality control is recommended to ensure that such methods work when applied to the local population.
- Published
- 2009
29. Fetal age assessment based on 2nd trimester ultrasound in Africa and the effect of ethnicity
- Author
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Synnøve Lian Johnsen, Daniel Salpou, Torvid Kiserud, and Svein Rasmussen
- Subjects
medicine.medical_specialty ,Cross-sectional study ,Ethnic group ,Gestational Age ,Sensitivity and Specificity ,lcsh:Gynecology and obstetrics ,Crown-Rump Length ,Ultrasonography, Prenatal ,Pregnancy ,Reference Values ,Obstetrics and Gynaecology ,Ethnicity ,medicine ,Humans ,Cameroon ,Femur ,Prospective Studies ,Prospective cohort study ,lcsh:RG1-991 ,Observer Variation ,Crown-rump length ,Obstetrics ,business.industry ,Reproducibility of Results ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Cross-Sectional Studies ,Pregnancy Trimester, Second ,Gestation ,Female ,business ,Body mass index ,Research Article - Abstract
Background The African population is composed of a variety of ethnic groups, which differ considerably from each other. Some studies suggest that ethnic variation may influence dating. The aim of the present study was to establish reference values for fetal age assessment in Cameroon using two different ethnic groups (Fulani and Kirdi). Methods This was a prospective cross sectional study of 200 healthy pregnant women from Cameroon. The participants had regular menstrual periods and singleton uncomplicated pregnancies, and were recruited after informed consent. The head circumference (HC), outer-outer biparietal diameter (BPDoo), outer-inner biparietal diameter and femur length (FL), also called femur diaphysis length, were measured using ultrasound at 12–22 weeks of gestation. Differences in demographic factors and fetal biometry between ethnic groups were assessed by t- and Chi-square tests. Results Compared with Fulani women (N = 96), the Kirdi (N = 104) were 2 years older (p = 0.005), 3 cm taller (p = 0.001), 6 kg heavier (p < 0.0001), had a higher body mass index (BMI) (p = 0.001), but were not different with regard to parity. Ethnicity had no effect on BPDoo (p = 0.82), HC (p = 0.89) or FL (p = 00.24). Weight, height, maternal age and BMI had no effect on HC, BPDoo and FL (p = 0.2–0.58, 0.1–0.83, and 0.17–0.6, respectively). When comparing with relevant European charts based on similar design and statistics, we found overlapping 95% CI for BPD (Norway & UK) and a 0–4 day difference for FL and HC. Conclusion Significant ethnic differences between mothers were not reflected in fetal biometry at second trimester. The results support the recommendation that ultrasound in practical health care can be used to assess gestational age in various populations with little risk of error due to ethnic variation.
- Published
- 2008
30. Reply
- Author
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Synnøve Lian Johnsen, Svein Rasmussen, Rita Sollien, and Torvid Kiserud
- Subjects
Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology - Published
- 2007
31. Accuracy of second trimester fetal head circumference and biparietal diameter for predicting the time of spontaneous birth
- Author
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Svein Rasmussen, Synnøve Lian Johnsen, Rita Sollien, and Torvid Kiserud
- Subjects
Male ,medicine.medical_specialty ,Term Birth ,Gestational Age ,behavioral disciplines and activities ,Ultrasonography, Prenatal ,Fetus ,Pregnancy ,mental disorders ,medicine ,Humans ,Fetal head ,Neonatology ,Prospective Studies ,Prospective cohort study ,Gynecology ,Anthropometry ,Obstetrics ,business.industry ,Ultrasound ,Infant, Newborn ,Obstetrics and Gynecology ,Circumference ,medicine.disease ,Pregnancy Trimester, Second ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,business ,Head ,Forecasting - Abstract
Aims: Previous studies suggested that head circumference (HC) predicts the date of confinement better than the biparietal diameter (BPD). The present study aimed to prospectively test this assumption. Methods: A prospective study including 4179 consecutive women attending the second trimester routine ultrasound examination at 17-20 weeks of gestation. Outer-outer BPD and HC were determined as the average of three repeated measurements. Twins were excluded. Time of delivery was noted, the differences between this and the predicted date of delivery calculated with HC and BPD (based on a pregnancy duration of 282 days), and the two methods were compared using Wilcoxon signed rank test. Results: For the entire group, the median differences between actual and predicted delivery with HC and BPD were 0.9 and 1.2 days, respectively. For deliveries with a spontaneous onset of labor (n=3336) the corresponding differences were 0.9 and 1.4 days. The difference between the HC and BPD methods was significant (P < 0.0001). In the group of spontaneous onset of labor, there were 05.6% post-term pregnancies (≥296 days) according to HC and 5.7% according to BPD. Conclusion: Provided that the expected pregnancy duration was 282 days, both HC and BPD predicted spontaneous birth with a mean accuracy of one day, HC being significantly better than BPD.
- Published
- 2006
32. Fetal age assessment based on femur length at 10-25 weeks of gestation, and reference ranges for femur length to head circumference ratios
- Author
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Synnøve Lian, Johnsen, Svein, Rasmussen, Rita, Sollien, and Torvid, Kiserud
- Subjects
Adult ,Observer Variation ,Analysis of Variance ,Adolescent ,Norway ,Reproducibility of Results ,Gestational Age ,Sensitivity and Specificity ,Crown-Rump Length ,Ultrasonography, Prenatal ,Cross-Sectional Studies ,Pregnancy ,Pregnancy Trimester, Second ,Humans ,Female ,Femur ,Prospective Studies ,Probability - Abstract
The aim of the present study is to establish new reference charts for gestational age assessment based on fetal femur length (FL), and new reference ranges for FL to head ratios at gestational weeks 10-25, and to determine the effect of maternal and fetal factors on these charts.Six hundred fifty low-risk women with regular menstrual periods and singleton pregnancies were recruited to a prospective cross-sectional study after obtaining written consent. FL, outer-outer biparietal diameter (BPD), and head circumference (HC) were measured at 10-25 weeks of gestation. We used regression analysis in order to construct mean curves and to assess the effect of maternal and fetal factors on age assessment.The new chart for age assessment by means of FL was based on 636 measurements. The 95% CI of the mean corresponded to1 day. The variation between the mean and the 90th percentile was 5, 6, and 7 days at 13, 18, and 23 weeks, respectively, similar to the results when using BPD or HC. Maternal age modestly influenced gestational age assessment (1.3 days/10 years, P = 0.005), whereas smoking, height, body mass index, multiparity, fetal sex, cephalic index, and breech presentation had no impact. Reference charts for FL to head ratios have been presented. Maternal age, fetal sex, and cephalic index influenced the FL/BPD ratio, whereas only fetal sex influenced FL/HC.Fetal age assessment based on FL is an equally robust method as using HC. FL/HC is a more robust ratio to characterize fetal proportions than is FL/BPD.
- Published
- 2005
33. Fetal age assessment based on ultrasound head biometry and the effect of maternal and fetal factors
- Author
-
Synnøve Lian, Johnsen, Svein, Rasmussen, Rita, Sollien, and Torvid, Kiserud
- Subjects
Adult ,Male ,Biometry ,Adolescent ,Gestational Age ,Middle Aged ,Ultrasonography, Prenatal ,Cross-Sectional Studies ,Pregnancy ,Reference Values ,Humans ,Female ,Prospective Studies ,Head - Abstract
Maternal height and weight have increased during the past 20 years, as has birthweight. The aim of the present study was to establish new reference charts for gestational age (GA) assessment using fetal biparietal diameter (BPD) and head circumference (HC), and to determine the effect of maternal and fetal factors on age assessment.This was a prospective, cross-sectional study of 650 healthy women with regular menstrual periods and singleton uncomplicated pregnancies, recruited after written consent. BPD (outer-outer) and HC were measured at 10-24 weeks of gestation. We used regression analysis to construct mean curves and assess the effect of maternal and fetal factors on age assessment.BPD and HC were successfully measured in 642 participants. Using BPD and HC before 20 weeks, the new charts gave 3-8 days higher GA assessment than the charts presently in use, and1 day difference compared to other recently established charts. Maternal age, multiparity, fetal gender, breech position and shape of fetal head affect GA estimation by 1-2 days when using BPD (p = 0.0001-0.02). Only maternal age and fetal gender affected GA estimation when using HC (/= 1 day, p = 0.001).Our new charts for assessing gestational age based on fetal head biometry are notably different from charts presently in use. Maternal and especially fetal factors affect gestational age assessment when using BPD, but less so for the HC method, which is suggested as the more robust method.
- Published
- 2004
34. Twin-twin transfusion syndrome treated with serial amniocenteses
- Author
-
Synnøve Lian, Johnsen, Susanne, Albrechtsen, and Jouko, Pirhonen
- Subjects
Adult ,Male ,Norway ,Pregnancy ,Amniocentesis ,Infant, Newborn ,Pregnancy Outcome ,Humans ,Female ,Gestational Age ,Fetofetal Transfusion ,Twins, Monozygotic ,Retrospective Studies - Abstract
To evaluate the treatment and neonatal outcome in pregnancies complicated by twin-twin transfusion syndrome (TTS).Twenty-four women with TTS were identified in the period 1993-99 among 34477 deliveries. We include a retrospective chart review of all twins with TTS.The overall incidence of TTS was 4.75% of all twin pregnancies. The mean gestational age at the time of diagnosing TTS was 23 weeks (range 17.6-38), and the mean gestational age at delivery was 34.6 weeks (range 23.1-38.3). Therapeutic amniocenteses was performed in 21 women. The total volume drained varied from 0.4 to 32.31 with a mean of 2.3 l. Overall perinatal mortality in TTS was 35.4%, as nine donor twins and eight recipient twins died. The main causes for mortality were intrauterine death and prematurity.Twin-twin transfusion syndrome is a severe complication in monochorionic diamniotic twin pregnancies, with high perinatal mortality and morbidity even though amnioreduction prolonged the pregnancies leading to better neonatal outcome.
- Published
- 2004
35. [Medical abortion--the first Norwegian experiences]
- Author
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Ole Erik, Iversen, Grete, Midbøe, Synnøve Lian, Johnsen, Grete, Augestad, Ingrid, Økland, Harald, Helland, Sverre, Strray-Pedersen, and Line, Bjørge
- Subjects
Adult ,Abortifacient Agents, Nonsteroidal ,Mifepristone ,Pregnancy Trimester, First ,Adolescent ,Pregnancy ,Abortifacient Agents, Steroidal ,Humans ,Abortion, Induced ,Female ,Misoprostol - Abstract
Medical abortion was first introduced in Norway in April 1998. The aim of this study is to assess the efficacy, side effects and acceptability of medical abortion with mifepristone and vaginally administered misoprostol in a Norwegian population.The study included the first consecutive 226 women with gestational age of63 days who requested non-surgical abortion in the first year at the first Norwegian hospital using this regime. All women received a single dose of mifepristone 600 mg orally followed by 800 microgram of misoprostol vaginally after 48 hours. Complications were the principal outcome measure. We also took note of side effects such as abdominal pain and bleeding and inquired about how acceptable the treatment was for the women concerned.95 % of the women had an uncomplicated termination of their pregnancies. The side effects were few and tolerable and the method's acceptability high.The combination of mifepristone and vaginally administered misoprostol is effective and safe, has few side effects, and is well accepted by Norwegian women.
- Published
- 2003
36. OC18.02: High-amplitude inspiratory movement in the fetus obstructs the inferior vena cava (IVC) enhancing upper body gas transport
- Author
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Torvid Kiserud, Synnøve Lian Johnsen, and M. K. Nyberg
- Subjects
Fetus ,Radiological and Ultrasound Technology ,High amplitude ,Upper body ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Anatomy ,Inferior vena cava ,Reproductive Medicine ,medicine.vein ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2010
37. Reply
- Author
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Synnøve Lian Johnsen, Svein Rasmussen, Tom Wilsgaard, Rita Sollien, and Torvid Kiserud
- Subjects
Obstetrics and Gynecology ,General Medicine - Published
- 2006
38. OC22.04: Fetal breathing movements increase venous drainage through the superior vena cava
- Author
-
Torvid Kiserud, Synnøve Lian Johnsen, Svein Rasmussen, and M. K. Nyberg
- Subjects
Reproductive Medicine ,Radiological and Ultrasound Technology ,business.industry ,Fetal breathing movements ,Superior vena cava ,Anesthesia ,Obstetrics and Gynecology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Venous drainage ,General Medicine ,business - Published
- 2011
39. OP20.01: Fetal breathing increases umbilical blood flow after the second trimester
- Author
-
M. K. Nyberg, Synnøve Lian Johnsen, and Torvid Kiserud
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Umbilical blood ,Obstetrics and Gynecology ,General Medicine ,Reproductive Medicine ,Second trimester ,Internal medicine ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Fetal breathing ,business - Published
- 2008
40. OP08.04: Fetal age assessment based on ultrasound in the second trimester and the effect of ethnic morphometric differences in Cameroon
- Author
-
Synnøve Lian Johnsen, Torvid Kiserud, Svein Rasmussen, and D. Salpou
- Subjects
Gynecology ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Ethnic group ,Obstetrics and Gynecology ,General Medicine ,Fetal age ,Reproductive Medicine ,Second trimester ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2007
41. P13.05: Accuracy of second-trimester fetal head circumference and biparietal diameter for predicting time of spontaneous birth
- Author
-
Torvid Kiserud, Svein Rasmussen, Rita Sollien, and Synnøve Lian Johnsen
- Subjects
medicine.medical_specialty ,Biparietal diameter ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,Circumference ,Reproductive Medicine ,Second trimester ,Medicine ,Radiology, Nuclear Medicine and imaging ,Fetal head ,business - Published
- 2006
42. P13.06: The effect of second-trimester fetal morphometry on duration of pregnancy
- Author
-
Torvid Kiserud, Rita Sollien, Svein Rasmussen, and Synnøve Lian Johnsen
- Subjects
Pregnancy ,medicine.medical_specialty ,Fetus ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Reproductive Medicine ,Duration (music) ,Second trimester ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2006
43. P14.12: Longitudinal reference charts for growth of the fetal head, abdomen and femur
- Author
-
Torvid Kiserud, Synnøve Lian Johnsen, Svein Rasmussen, and Rita Sollien
- Subjects
Percentile ,medicine.medical_specialty ,Pregnancy ,Longitudinal study ,Radiological and Ultrasound Technology ,Cephalic index ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,medicine ,Abdomen ,Gestation ,Radiology, Nuclear Medicine and imaging ,Fetal head ,Femur ,business - Abstract
Objectives: The aims of the present study were to establish improved reference charts for growth of the fetal head, abdomen and femur, and to determine the effect of fetal and maternal factors. Study design: This prospective longitudinal study included 650 low-risk pregnancies. Outer–outer biparietal diameter (BPD), head circumference (HC), mean abdominal diameter (MAD), abdominal circumference (AC) and femur length (FL) were measured by ultrasound, and the statistical analysis was based on regression analysis and multilevel modeling. Results: Reference percentiles for the growth of MAD, AC and FL showed continuous growth in gestational week 10–40, while BPD and HC showed a slightly blunted growth toward the end of pregnancy. FL was the only variable that was not influenced by gender. There was a significant negative association between breech presentation and all five biometrical variables, while maternal weight was positively associated with all five variables. Cephalic index significantly influenced BPD and HC. Maternal height had a positive effect on BPD, HC, AC and FL, and parity had a positive effect on MAD and AC, while smoking influenced negatively HC, MAD, and FL. Terms for calculating conditional reference values and customisation for individualised growth assessment are presented. Conclusions: New reference charts for the growth of fetal head, abdomen and femur are suggested for assessing fetal size and growth, and can be adjusted for maternal and fetal factors to suite individual pregnancies. # 2005 Published by Elsevier Ireland Ltd.
- Published
- 2004
44. P184: New charts for gestational age assessment based on fetal head biometry; effect of maternal and fetal factors
- Author
-
Svein Rasmussen, Rita Sollien, Torvid Kiserud, and Synnøve Lian Johnsen
- Subjects
Crown-rump length ,medicine.medical_specialty ,Fetus ,Radiological and Ultrasound Technology ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Ballard Maturational Assessment ,Reproductive Medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Fetal head ,business - Published
- 2003
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