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Combined ultrasound and biochemistry for risk evaluation in the first trimester: the Stockholm experience of a new web-based system.

https://arctichealth.org/en/permalink/ahliterature131601
Source
Acta Obstet Gynecol Scand. 2012 Jan;91(1):34-8
Publication Type
Article
Date
Jan-2012
Author
Peter Conner
Magnus Westgren
Anna Marsk
Sven Gustafsson
Marius Kublickas
Author Affiliation
Obstetrics and Gynecology Karolinska University Hospital Ultragyn, Danderyds Hospital Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden. peter.conner@karolinska.se
Source
Acta Obstet Gynecol Scand. 2012 Jan;91(1):34-8
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Biological Markers - blood
Chorionic Gonadotropin, beta Subunit, Human - blood
Chromosome Disorders - blood - diagnosis - ultrasonography
Chromosomes, Human, Pair 13 - ultrasonography
Chromosomes, Human, Pair 18
Down Syndrome - blood - diagnosis - ultrasonography
Female
Humans
Incidence
Internet
Middle Aged
Nuchal Translucency Measurement
Pregnancy-Associated Plasma Protein-A - metabolism
Prospective Studies
Registries
Risk assessment
Sensitivity and specificity
Software
Sweden - epidemiology
Trisomy - diagnosis
Young Adult
Abstract
To evaluate the performance of a new first trimester web-based software for the detection of chromosomal anomalies using a combination of ultrasound and biochemistry.
Registry-based cohort study.
Ultrasound units in the Stockholm region.
20 710 women with singleton pregnancies were examined at 11(+0) to 13(+6) weeks' gestational age during a three-year period 2006-2009.
The risks for trisomy 21, 13 and 18 were calculated using a combination of maternal age, serum markers and nuchal translucency. Individual risk estimates were calculated and then reported to a web-based system using a new algorithm based on likelihood ratios of each marker derived from Gaussian distributions in normal and affected pregnancies.
The impact on rates of invasive testing and the incidence of children born with Down's syndrome after implementing the method.
Approximately a third of all pregnant women in the region were examined with the combined test. The detection and test positive rates for Down's syndrome was 90 and 6.8%, respectively. Invasive testing among pregnant women decreased from 15 to 8% after introducing the method but the incidence of children born with Down's syndrome did not decrease during the study period.
The new web-based software is an effective method for the detection of trisomy 21 with similar performance compared to other programs. However, it needs to be offered to all pregnant women to have an impact on the incidence of Down's syndrome.
PubMed ID
21895611 View in PubMed
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Education in obstetrical ultrasound--an important factor for increasing the prenatal detection of congenital heart disease.

https://arctichealth.org/en/permalink/ahliterature115303
Source
Acta Obstet Gynecol Scand. 2013 Jul;92(7):804-8
Publication Type
Article
Date
Jul-2013
Author
Nina Asplin
Annika Dellgren
Peter Conner
Author Affiliation
Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
Source
Acta Obstet Gynecol Scand. 2013 Jul;92(7):804-8
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Adult
Clinical Competence
Education, Nursing, Graduate
Female
Heart Defects, Congenital - ultrasonography
Humans
Midwifery - education
Norway
Pregnancy
Retrospective Studies
Sweden
Ultrasonography, Prenatal
Abstract
To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease.
Tertiary care center.
Experienced and less experienced midwives performing ultrasound scans.
Number of fetuses and live-born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound.
The prenatal detection rate of complex congenital heart malformations.
The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p
PubMed ID
23521227 View in PubMed
Less detail

First trimester contingent testing with either nuchal translucency or cell-free DNA. Cost efficiency and the role of ultrasound dating.

https://arctichealth.org/en/permalink/ahliterature262543
Source
Acta Obstet Gynecol Scand. 2015 Apr;94(4):368-75
Publication Type
Article
Date
Apr-2015
Author
Peter Conner
Sven Gustafsson
Marius Kublickas
Source
Acta Obstet Gynecol Scand. 2015 Apr;94(4):368-75
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Adult
Aneuploidy
Biological Markers - blood
Cell-Free System
Chromosome Disorders - diagnosis - economics - genetics
Cost-Benefit Analysis
DNA - analysis
False Positive Reactions
Female
Genetic markers
Gestational Age
Humans
Maternal Serum Screening Tests - economics
Nuchal Translucency Measurement - economics
Pregnancy
Pregnancy Trimester, First - blood - genetics
Registries
Retrospective Studies
Risk assessment
Sweden
Abstract
To evaluate the performance and cost efficacy of different first-trimester contingent screening strategies based on an initial analysis of biochemical markers.
Retrospective study.
Swedish National Quality Register for prenatal diagnosis.
35,780 women with singleton pregnancies.
Serum values from first trimester biochemistry were re-analyzed in a contingent approach. For risks between 1:40 and 1:1000, risk estimates from nuchal translucency measurements were added and outcomes were compared using either a final cut-off risk of 1:200 to proceed with invasive testing or offering non-invasive prenatal testing. In a subgroup of 12,836 women with regular menstrual cycles the same analyses were performed using data on the last menstrual period for determining gestational age. The costs of detecting one case of aneuploidy were compared.
Comparison of screening strategies.
The detection rate was the same (87%) in the contingent group as in complete combined screening, with only 41% requiring a nuchal translucency scan. As an alternative, offering non-invasive prenatal testing to the intermediate risk group would result in a detection rate of 98%, but the cost to detect one case of trisomy 21 would be 83% higher than the cost associated with traditional combined screening.
First trimester examination using a contingent approach will achieve similar results compared with full combined screening. Non-invasive prenatal testing will not be cost-effective when a high proportion of pregnancies need further testing.
PubMed ID
25581307 View in PubMed
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Outcome in 212 anti-Ro/SSA-positive pregnancies and population-based incidence of congenital heart block.

https://arctichealth.org/en/permalink/ahliterature271981
Source
Acta Obstet Gynecol Scand. 2016 Jan;95(1):98-105
Publication Type
Article
Date
Jan-2016
Author
Amanda Skog
Linda Lagnefeldt
Peter Conner
Marie Wahren-Herlenius
Sven-Erik Sonesson
Source
Acta Obstet Gynecol Scand. 2016 Jan;95(1):98-105
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Adult
Antibodies, Antinuclear - blood
Atrioventricular Block - congenital - epidemiology
Cesarean Section - statistics & numerical data
Female
Fetal Growth Retardation - epidemiology
Humans
Incidence
Lupus Erythematosus, Systemic - epidemiology - immunology
Pregnancy
Premature Birth - epidemiology
Prevalence
Prospective Studies
Sjogren's Syndrome - epidemiology - immunology
Sweden - epidemiology
Abstract
We investigated the effects of maternal autoimmune disease and fetal congenital heart block (CHB) on pregnancy outcomes in anti-Ro/SSA-positive women and assessed the population-based incidence of isolated CHB.
One hundred and ninety nine anti-Ro/SSA-positive pregnancies were prospectively followed at our center (2000-2013). Seven fetuses developed atrioventricular block (AVB) II-III. In this period, another 13 anti-Ro/SSA-positive pregnancies were referred for fetal bradycardia, subsequently diagnosed with AVB II-III. Cesarean section rates, gestational age, body measurements at birth, and the incidence of CHB in these 212 pregnancies were analyzed in relation to fetal atrioventricular conduction and maternal diagnosis and compared with data from the Medical Birth Registry on 352,104 pregnancies in the Stockholm County.
The prevalence of maternal systemic lupus erythematosus (SLE) and primary Sjögren's syndrome and the outcomes at birth were similar in normal conduction and AVB I cases. Only 1/20 AVB II-III cases (0/7 in the surveillance group) had a mother diagnosed with SLE, compared with 73/192 in cases with normal conduction or AVB I. Excluding cases with AVB II-III, SLE mothers more frequently delivered by cesarean section (31% vs. 20%, p
PubMed ID
26411741 View in PubMed
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Prenatal diagnosis in Sweden 2011 to 2013-a register-based study.

https://arctichealth.org/en/permalink/ahliterature287305
Source
BMC Pregnancy Childbirth. 2016 11 22;16(1):365
Publication Type
Article
Date
11-22-2016
Author
Kerstin Petersson
Marie Lindkvist
Margareta Persson
Peter Conner
Annika Åhman
Ingrid Mogren
Source
BMC Pregnancy Childbirth. 2016 11 22;16(1):365
Date
11-22-2016
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Educational Status
Female
Humans
Maternal Age
Patient Acceptance of Health Care - statistics & numerical data
Pregnancy
Pregnancy outcome
Prenatal Diagnosis - methods - utilization
Registries
Retrospective Studies
Sweden
Abstract
Prenatal diagnosis involves methods used in early pregnancy as either screening tests or diagnostic methods. The aims of the study were to i) investigate guidelines on prenatal diagnosis in the counties of Sweden, ii) investigate uptake of prenatal diagnosis, and iii) background characteristics and pregnancy outcomes in relation to different prenatal diagnostic methods.
A retrospective cross-sectional study using data from the Swedish Pregnancy Register 2011 to 2013 (284,789 pregnancies) was performed. Additionally, guidelines on prenatal diagnosis were collected. Biostatistical and epidemiological analyses were performed including calculation of odds ratios (OR) and their 95% confidence intervals in univariate and multivariate logistic regression analyses.
The national uptake of routine ultrasound examination, Combined Ultrasound and Biochemical test (CUB), Amniocentesis (AC) and Chorionic Villus Sampling (CVS) were 97.6, 33.0, 2.6 and 1.1%, respectively. From 2012, 6/21 counties offered CUB test to all pregnant women, nine counties at specific indications, and five counties did not offer CUB at all. Advanced maternal age demonstrated the highest impact on uptake of prenatal diagnosis. Further, university educational level in relation to lower educational level was associated with an increased likelihood of undergoing CUB (OR 2.30, 95% CI 2.26-2.35), AC (OR 1.54, 95% CI 1.46-1.63) and CVS (OR 2.68, 95% CI 2.44-2.93).
Offers of prenatal diagnosis varied considerably between counties resulting in unequal access to prenatal diagnosis for pregnant women. The intentions of the Swedish Health and Medical Services Act stating equal care for all, was thus not fulfilled.
Notes
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PubMed ID
27876014 View in PubMed
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Study for Improving Maternal Pregnancy And Child ouTcomes (IMPACT): a study protocol for a Swedish prospective multicentre cohort study.

https://arctichealth.org/en/permalink/ahliterature311268
Source
BMJ Open. 2020 09 23; 10(9):e033851
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
09-23-2020
Author
Lina Bergman
Anna Sandström
Bo Jacobsson
Stefan Hansson
Peter Lindgren
Anders Larsson
Henrik Imberg
Peter Conner
Marius Kublickas
Ylva Carlsson
Anna-Karin Wikström
Author Affiliation
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Source
BMJ Open. 2020 09 23; 10(9):e033851
Date
09-23-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Child
Female
Humans
Infant, Newborn
Language
Multicenter Studies as Topic
Pregnancy
Pregnancy Outcome - epidemiology
Prospective Studies
Sweden - epidemiology
Abstract
First-trimester pregnancy risk evaluation facilitates individualised antenatal care, as well as application of preventive strategies for pre-eclampsia or birth of a small for gestational age infant. A range of early intervention strategies in pregnancies identified as high risk at the end of the first trimester has been shown to decrease the risk of preterm pre-eclampsia (
PubMed ID
32967865 View in PubMed
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The Swedish Pregnancy Register - for quality of care improvement and research.

https://arctichealth.org/en/permalink/ahliterature295730
Source
Acta Obstet Gynecol Scand. 2018 Apr; 97(4):466-476
Publication Type
Journal Article
Date
Apr-2018
Author
Olof Stephansson
Kerstin Petersson
Camilla Björk
Peter Conner
Anna-Karin Wikström
Author Affiliation
Clinical Epidemiology Unit, Department of Medicine - Solna, Karolinska Institute, Stockholm, Sweden.
Source
Acta Obstet Gynecol Scand. 2018 Apr; 97(4):466-476
Date
Apr-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Delivery, Obstetric - standards
Female
Humans
Infant, Newborn
Postnatal Care - standards
Pregnancy
Pregnancy outcome
Prenatal Care - standards
Quality Improvement
Registries
Sweden
Abstract
The objective of this study was to present the Swedish Pregnancy Register and to explore regional differences in maternal characteristics, antenatal care, first trimester combined screening and delivery outcomes in Sweden.
The Pregnancy Register (www.graviditetsregistret.se) collects data on pregnancy and childbirth, starting at the first visit to antenatal care and ending at the follow-up visit to the antenatal care, which usually occurs at around 8-16 weeks postpartum. The majority of data is collected directly from the electronic medical records. The Register includes demographic, reproductive and maternal health data, as well information on prenatal diagnostics, and pregnancy outcome for the mother and the newborn.
Today the Register covers more than 90% of all deliveries in Sweden, with the aim to include all deliveries within 2018. The care providers can visualize quality measures over time and compare results with other clinics, regionally and nationally by creating reports on an aggregated level or using case-mix adjusted Dash Boards in real time. Detailed data can be extracted after ethical approval for research. In this report, we showed regional differences in patient characteristics, antenatal care, fetal diagnosis and delivery outcomes in Sweden.
Our report indicates that quality in antenatal and delivery care in Sweden varies between regions, which warrants further actions. The Swedish Pregnancy Register is a new and valuable resource for benchmarking, quality improvement and research in pregnancy, fetal diagnosis and delivery.
Notes
Cites: BMC Health Serv Res. 2014 Aug 30;14:364 PMID 25175811
Cites: BMJ. 2008 Nov 27;337:a2547 PMID 19039015
Cites: Acta Obstet Gynecol Scand. 2009;88(6):635-8, 7p following 638 PMID 19330568
Cites: Ultrasound Obstet Gynecol. 2008 Jun;31(6):618-24 PMID 18461550
Cites: Acta Obstet Gynecol Scand. 2015 Apr;94(4):368-75 PMID 25581307
Cites: Acta Obstet Gynecol Scand. 2008;87(11):1202-12 PMID 18951207
Cites: Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):199-205 PMID 8572006
Cites: BMC Health Serv Res. 2014 Dec 10;14:613 PMID 25491418
Cites: BMC Pregnancy Childbirth. 2016 Mar 07;16:49 PMID 26951777
Cites: Eur J Epidemiol. 2009;24(11):659-67 PMID 19504049
PubMed ID
29172245 View in PubMed
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7 records – page 1 of 1.