pinecone/core-2020-05-10-deduplication huggingface dataset:
Left ventricular function and systemic arterial properties in normal and preeclamptic pregnancy

List of papers. The papers are removed from the thesis due to copyright restrictions.<br><br>

Paper I 
Estensen ME, Beitnes JO, Grindheim G, Aaberge L, Smiseth OA, Henriksen T, Aakhus S.
Altered left ventricular function during normal pregnancy.
Ultrasound Obstet Gynecol. 2012 Sep 24. [Epub ahead of print]
<a href="http://dx.doi.org/10.1002/uog.12296">doi:10.1002/uog.12296</a><br><br>

Paper II 
Estensen ME, Grindheim G, Remme EW, Swillens A, Smiseth OA, Segers P, Henriksen T, Aakhus S. 
Systemic arterial response and ventriculo-arterial interaction during normal pregnancy.
Am J Hypertens 2012; 25:672-7
<a href="http://dx.doi.org/10.1038/ajh.2012.29">doi:10.1038/ajh.2012.29</a><br><br>

Paper III 
Grindheim G, Estensen ME, Langesaeter E, Rosseland LA, Toska K.
Changes in blood pressure during healthy pregnancy: a longitudinal cohort study.
J Hypertens 2012; 30:342-50
<a href="http://dx.doi.org/10.1097/HJH.0b013e32834f0b1c">doi:10.1097/HJH.0b013e32834f0b1c</a><br><br>

Paper IV 
Estensen ME, Remme EW, Grindheim G, Smiseth OA, Segers P, Henriksen T, Aakhus S.
Increased arterial stiffness in preeclamptic pregnancy at term, and early and late postpartum. A combined echocardiographic and tonometric study.
Am J Hypertens 2013; First published online: January 7, 2013
<a href="http://dx.doi.org/10.1093/ajh/hps067">doi:10.1093/ajh/hps067</a
Fetal cardiac function in recipient twins undergoing fetoscopic laser ablation of placental anastomoses for Stage IV twin-twin transfusion syndrome

Objective Cardiac dysfunction is common in the recipient fetus of twin-twin transfusion syndrome (TTTS). In this study, we aimed to document the severity of fetal cardiac dysfunction in Stage IV TTTS (fetal hydrops) and assess evolution of cardiac function longitudinally after fetoscopic laser surgery. Methods: We reviewed obstetric ultrasound examination data, pre- and postoperative echocardiograms and neonatal outcomes for 22 cases of Stage IV TTTS undergoing fetoscopic laser ablation of placental anastomoses between 1998 and 2011. Myocardial performance index, atrioventricular valve flow patterns, ventricular shortening fraction, ventricular hypertrophy, outflow tract obstruction and venous Doppler waveforms were assessed. Results Nineteen fetuses (86.4%) had ascites, eight (36.4%) had pleural effusions, nine (40.9%) had a pericardial effusion and 12 (54.5%) had subcutaneous edema at presentation. Preoperatively, cardiac function was grossly abnormal in all. Eight fetuses (36.4%) had functional pulmonary atresia and one (4.5%) had functional aortic atresia. Seventy-seven percent of recipient fetuses survived until birth. Postoperative echocardiographic follow-up (mean, 26 days) showed that indices of fetal cardiac function improved considerably, but never completely normalized. Six of the eight fetuses with functional pulmonary atresia (75.0%), as well as the fetus with functional aortic atresia, survived to birth. In all cases, the functional atresia resolved within 48 h of laser ablation therapy and none had structural valve anomalies at birth. All fetal effusions resolved after the laser. Conclusions: Fetoscopic laser ablation of placental anastomoses reverses cardiac dysfunction and valvulopathy, even in the most severe cases of TTTS. However, recovery takes longer than in early stage disease. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd
Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium

Objective To evaluate the role of transvaginal power
Doppler sonography to discriminate between benign
and malignant endometrial conditions in women presenting
with postmenopausal bleeding and thickened
endometrium at baseline sonography.
Methods Ninety-one postmenopausal women (median
age, 58 years; range, 47–83 years) presenting with uterine
bleeding and a thickened endometrium (≥5-mm doublelayer
endometrial thickness) on transvaginal sonography
were included in this prospective study. Endometrial
blood flow distribution was assessed in all patients by
power Doppler immediately after B-mode transvaginal
sonography. Three different vascular patterns were
defined: Pattern A: multiple-vessel pattern, Pattern B:
single-vessel pattern and Pattern C: scattered-vessel
pattern. Histological diagnoses were obtained in all cases.
No patient taking tamoxifen citrate or receiving hormone
replacement therapy was included.
Results Histological diagnoses were as follows: endometrial
cancer: 33 (36%), endometrial polyp: 37 (41%),
endometrial hyperplasia: 14 (15%), endometrial cystic
atrophy: 7 (8%). Blood flow was found in 97%, 92%,
79% and 85% of cases of carcinoma, polyp, hyperplasia
and endometrial cystic atrophy, respectively. A total of
81.3% of vascularized endometrial cancers showed Pattern
A, 97.1% of vascularized polyps exhibited Pattern B
and 72.7% of vascularized hyperplasias showed Pattern
C. Sensitivity and specificity for endometrial cancer were
78.8% and 100%. For endometrial polyp these respective
values were 89.2% and 87% and for hyperplasia they
were 57.1% and 88.3%.
Conclusions Transvaginal power Doppler blood flow
mapping is useful to differentiate benign from malignant
endometrial pathology in women presenting with postmenopausal
bleeding and thickened endometrium at baseline
sonography
Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: A consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group

The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd
Omega-3 supplementation during pregnancy to prevent recurrent intrauterine growth restriction: Systematic review and meta-analysis of randomized controlled trials

OBJECTIVE:\ud
To evaluate the efficacy of omega-3 supplementation during pregnancy in preventing intrauterine growth restriction (IUGR) in women with apparently uncomplicated singleton pregnancy and previous IUGR pregnancy.\ud
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METHODS:\ud
For this systematic review, the research protocol was designed a priori. Searches were performed in electronic databases for studies published from inception of each database to December 2014. A combination of search terms was used including 'fish oil', 'long chain polyunsaturated fatty acids', 'intrauterine growth restriction', 'small for gestational age' and 'omega-3'. We included all randomized controlled trials (RCTs) of women with an uncomplicated singleton pregnancy and a prior IUGR pregnancy who were randomized to receive prophylactic treatment with omega-3 supplementation or either placebo or no treatment (control). Trials that included women with multiple gestations and those with only biochemical outcomes available were excluded. Pooled estimates were based on relative risk (RR) with 95% CI. Primary outcome was incidence of IUGR as defined in the RCTs.\ud
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RESULTS:\ud
Three RCTs including 575 women with uncomplicated singleton pregnancy with prior IUGR were analyzed. Women who received omega-3 supplementation during pregnancy had the same incidence of IUGR, defined as estimated fetal weight < 5(th) or < 3(rd) centiles, as had controls (22.8% vs 20.2%, respectively; RR, 1.13 (95% CI, 0.83-1.54)). Compared to controls, women who received omega-3 supplementation delivered later (mean difference, 1.4 (95% CI, 1.28-1.63) weeks), had a longer latency (mean difference, 2 (95% CI, 1.73-2.08) weeks), had a similar incidence of perinatal death (2.1% vs 3.3%, respectively; RR, 0.60 (95% CI, 0.15-2.42)) and similar birth weight (mean difference, 50 g (95% CI, -26 to 246 g)).\ud
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CONCLUSIONS:\ud
Omega-3 supplementation during pregnancy does not prevent recurrence of IUGR in women with uncomplicated singleton pregnancy and a previous IUGR pregnancy
IONA test for first-trimester detection of trisomies 21, 18 and 13

OBJECTIVE: To assess the potential performance of screening for fetal trisomies 21, 18 and 13 by cell-free DNA (cfDNA) analysis of maternal blood using the IONA® test.\ud
METHODS:\ud
This was a nested case-control study of cfDNA analysis of maternal plasma using the IONA test. Samples were obtained at 11-13 weeks' gestation, before chorionic villus sampling, from 201 euploid pregnancies, 35 with trisomy 21, four with trisomy 18 and two with trisomy 13. Laboratory personnel were blinded to the fetal karyotype.\ud
RESULTS:\ud
Probability scores for trisomies 21, 18 and 13 were given for 241/242 samples analyzed. No probability score was provided for one (0.5%) euploid pregnancy because of low fetal fraction. In all 35 cases of trisomy 21 the probability score for trisomy 21 was > 95% and the scores for trisomies 18 and 13 were ≤ 0.0001%. In all four cases of trisomy 18, the probability score for trisomy 18 was > 77% and the scores for trisomies 21 and 13 were ≤ 0.0001%. In the two cases of trisomy 13, the probability score for trisomy 13 was > 59% and the scores for trisomies 21 and 18 were ≤ 0.0001%. In the 200 euploid pregnancies with a test result, the probability score was < 0.08% for trisomy 21, < 0.001% for trisomy 18 and < 0.002% for trisomy 13. Therefore, the IONA test detected 100% of all three trisomies, with a false-positive rate of 0%.\ud
CONCLUSION:\ud
The IONA test successfully differentiated all cases of trisomies 21, 18 and 13 from euploid pregnancies
Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG: development and validation of a two-step triage protocol.

A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two-step triage protocol based on presenting serum progesterone (step 1) and hCG ratio two days later (step 2) to select PUL at high-risk of ectopic pregnancy (EP).Cohort study of 2753 PUL (301 EP), involving a secondary analysis of prospectively and consecutively collected PUL at two London-based university teaching hospitals. Using a chronological split we used 1449 PUL for development and 1304 for validation. We aimed to select PUL as low-risk with high confidence (high negative predictive value, NPV) while classifying most EP as high-risk (high sensitivity). The first triage step selects low-risk PUL at presentation using a serum progesterone threshold. The remaining PUL are triaged using a novel logistic regression risk model based on hCG ratio and initial serum progesterone (second step), defining low-risk as an estimated EP risk <5%.On validation, initial serum progesterone ≤2nmol/l (step 1) selected 16.1% PUL as low-risk. Second step classification with the risk model M6P  selected an additional 46.0% of all PUL as low-risk. Overall, the two-step protocol classified 62.1% of PUL as low-risk, with an NPV of 98.6% and a sensitivity of 92.0%. When the risk model was used in isolation (i.e. without the first step), 60.5% of PUL were classified as low-risk with 99.1% NPV and 94.9% sensitivity.The two-step protocol can efficiently classify PUL into being at high or low risk of complications
Ultrasound-based gestational-age estimation in late pregnancy

This project was supported by a generous grant from the Bill & Melinda Gates Foundation to the University of Oxford.Objectives . Accurate gestational age (GA) estimation, preferably by ultrasound measurement of fetal crown rump length before 14 weeks’ gestation, is an important component of high-quality antenatal care. The objective was to determine how GA can best be estimated by fetal ultrasound for women who present for the first time late in pregnancy with uncertain or unknown menstrual dates. Methods. INTERGROWTH-21st was a large, prospective, multicentre, population-based project performed in eight geographically defined urban populations. One of its principal components, the Fetal Growth Longitudinal Study (FGLS), aimed to develop international fetal growth standards. Each participant had certain menstrual dates confirmed by first trimester ultrasound. Fetal head circumference (HC), biparietal diameter (BPD), occipitofrontal diameter (OFD), abdominal circumference (AC) and femur length (FL) were measured every 5 weeks from 14 weeks’ gestation until birth. For each participant, a single, randomly selected ultrasound examination was used to explore all candidate biometric variables and permutations to build models to predict GA. Regression equations were ranked based upon minimization of the mean prediction error, goodness of fit and model complexity. An automated machine learning algorithm, the Genetic Algorithm, was adapted to evaluate >64,000 potential polynomial equations as predictors. Results . Of the 4607 eligible women, 4321 (94%) had a pregnancy without major complications and delivered a live singleton without congenital malformations. After other exclusions (missing measurements in GA window and outliers), the final sample comprised 4229 women. Two skeletal measures, HC and FL, produced the best GA prediction, given by the equation loge(GA) = 0.03243 x (loge(HC))2 + 0.001644 x FL x loge(HC) + 3.813.  When FL is not available, the best equation based on HC alone is loge(GA) = 0.05970 x (loge(HC))2 + 0.000000006409 x (HC)3 + 3.3258.  The estimated uncertainty of GA prediction (half width 95% interval) was 6-7 days at 14 weeks’ gestation, 12-14 days at 26 weeks’ gestation, and > 14 days in the third trimester. The addition of FL to HC leads to improved prediction intervals over just using HC, but no further improvement in prediction is afforded by adding AC, BPD or OFD. Equations that included other measurements (BPD, OFD and AC) did not perform better. Conclusions . Among women initiating antenatal care late in pregnancy a single set of ultrasound measurements combining HC and FL in the second trimester can be used to estimate GA with reasonable accuracy. We recommend this tool for underserved populations but considerable efforts should be implemented to improve early initiation of antenatal care worldwide.Publisher PDFPeer reviewe
Clinical utility of non-invasive prenatal testing in pregnancies with ultrasound anomalies

Contains fulltext :
                  174531.pdf (publisher's version ) (Open Access)OBJECTIVE: To evaluate the application of non-invasive prenatal testing (NIPT) as an alternative to invasive diagnostic prenatal testing in pregnancies with abnormal ultrasound findings. METHODS: This was a retrospective analysis of 251 singleton and multiple pregnancies at high risk for fetal chromosomal abnormality based on findings at sonographic examination, in which NIPT was performed as a first-tier genetic test. NIPT was performed by massively parallel sequencing of cell-free DNA in maternal plasma, allowing genome-wide detection of whole-chromosome, as well as partial, autosomal aneuploidy. Sex chromosomes were not analyzed, according to the current protocol in Dutch laboratories. RESULTS: NIPT was performed at a median gestational age of 20 weeks, indicated by the presence of multiple congenital anomalies (n = 13), isolated structural anomalies (n = 57), increased nuchal translucency >/= 3.5 mm (n = 58), soft markers (n = 73), growth restriction (n = 40) and other anomalies (n = 10). NIPT results were normal in 224 (89.2%) pregnancies, inconclusive in one (0.4%) and abnormal in 26 (10.4%). Most genetic aberrations detected by NIPT were common whole-chromosome aneuploidies: trisomy 21 (n = 13), trisomy 18 (n = 6) and trisomy 13 (n = 3). Four further NIPT results were abnormal; one was suspected of being confined placental mosaicism and one was of maternal origin. In those with normal NIPT results, sonographic follow-up or examination of the newborn indicated the need for diagnostic genetic testing in 33/224 (14.7%) pregnancies. Clinically relevant genetic aberrations were revealed in 7/224 (3.1%) cases, two of which were whole-chromosome aneuploidies: trisomy 13 and monosomy X. As sex chromosomal aberrations are not included in NIPT analysis, the latter cannot be considered a false-negative result. Other discordant findings were subchromosomal aberrations (< 20 megabases, n = 2) and monogenic aberrations (n = 3). CONCLUSIONS: NIPT should not be recommended for genetic evaluation of the etiology of ultrasound anomalies, as both resolution and sensitivity, or negative predictive value, are inferior to those of conventional karyotyping and microarray analysis. Nonetheless, some pregnant women consider NIPT to be an acceptable alternative to invasive diagnostic testing. (c) 2016 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology
The fetal cerebroplacental ratio in pregnancies complicated by gestational diabetes mellitus

To assess the relationship between the cerebroplacental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM).This was a retrospective cohort study of women with a non-anomalous singleton pregnancy diagnosed with GDM who delivered at Mater Mothers\u27 Hospital between 2007 and 2015. CPR was measured in 1089 cases between 34 + 0 and 36 + 6 weeks\u27 gestation. CPR values were compared between groups categorized according to GDM treatment (by diet, oral hypoglycemic agent (OHA) or insulin). The association between CPR and intrapartum and perinatal outcomes was evaluated.No difference in CPR was observed between treatment groups. Fetuses with CPR < 10 centile were significantly more likely to have adverse composite perinatal outcome (odds ratio (OR) = 2.93 (95% CI, 1.95-4.40)), preterm delivery and low birth weight than fetuses with CPR ≥ 10 centile (all P < 0.001). These associations were present regardless of the type of GDM treatment. Fetuses of women with insulin-controlled GDM had poorer neonatal outcomes than did fetuses of women treated with OHA or dietary control alone. The risk of adverse outcome was significantly increased in the insulin-treated group (OR = 1.75 (95% CI, 1.34-2.28); P < 0.001), which also had higher rates of preterm delivery and higher birth weight.Regardless of the type of treatment, a low CPR is associated with poorer neonatal outcome in women with GDM. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data

Cervical length screening by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous preterm birth (PTB) in symptomatic singleton pregnancy with threatened preterm labor (PTL). The aim of this review and meta-analysis of individual participant data was to evaluate the effect of knowledge of the TVS cervical length (CL) in preventing PTB in singleton pregnancies presenting with threatened PTL.\ud
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METHODS:\ud
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and the Cochrane Complementary Medicine Field's Trials Register (May 2016) and reference lists of retrieved studies. Selection criteria included randomized controlled trials of singleton gestations with threatened PTL randomized to management based mainly on CL screening (intervention group), or CL screening with no knowledge of results or no CL screening (control group). Participants included women with singleton gestations at 23 + 0 to 36 + 6 weeks with threatened PTL. We contacted corresponding authors of included trials to request access to the data and perform a meta-analysis of individual participant data. Data provided by the investigators were merged into a master database constructed specifically for the review. The primary outcome was PTB < 37 weeks. Summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% CI.\ud
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RESULTS:\ud
Three trials including a total of 287 singleton gestations with threatened PTL between 24 + 0 and 35 + 6 weeks were included in the meta-analysis, of which 145 were randomized to CL screening with knowledge of results and 142 to no knowledge of CL. Compared with the control group, women who were randomized to the known CL group had a significantly lower rate of PTB < 37 weeks (22.1% vs 34.5%; RR, 0.64 (95% CI, 0.44-0.94); three trials; 287 participants) and a later gestational age at delivery (MD, 0.64 (95% CI, 0.03-1.25) weeks; MD, 4.48 (95% CI, 1.18-8.98) days; three trials; 287 participants). All other outcomes for which there were available data were similar in the two groups.\ud
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CONCLUSIONS:\ud
There is a significant association between knowledge of TVS CL and lower incidence of PTB and later gestational age at delivery in symptomatic singleton gestations with threatened PTL. Given that in the meta-analysis we found a significant 36% reduction in the primary outcome, but other outcomes were mostly statistically similar, further study needs to be undertaken to understand better whether the predictive characteristics of CL screening by TVS can be translated into better clinical management and therefore better outcomes and under what circumstances