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  • 1.
    Akhter, Tansim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Marita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Naessén, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Thicknesses of individual layers of artery wall indicate increased cardiovascular risk in severe pre-eclampsia2014In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 43, no 6, p. 675-680Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Pre-eclampsia, especially severe pre-eclampsia, is associated with an increased risk of cardiovascular disease later in life. However, ultrasound assessments of the common carotid artery intima-media thickness (CCA-IMT) do not convincingly demonstrate this. The aim of this study was to assess whether the individual thickness of the CCA intima and media layers and calculation of intima/media ratio (I/M) indicate an increased cardiovascular risk in women with previous severe pre-eclampsia.

    METHODS: The thicknesses of the CCA intima and media layers were obtained by non-invasive high-frequency ultrasound (22 MHz) in 42 women with previous severe pre-eclampsia and 44 women with previous normal pregnancies. A thick intima, thin media and high I/M are signs of a less healthy artery wall.

    RESULTS: Women with previous severe pre-eclampsia had a thicker CCA intima and a higher I/M than women with previous normal pregnancies, also after adjustment for mean arterial pressure, body mass index and CCA-IMT (all p < 0.0001). CCA-IMT did not differ significantly between the groups. In receiver operating characteristic curve analysis, intima thickness and I/M clearly discriminated between women with and without previous pre-eclampsia (c value about 0.95), whereas CCA-IMT did not (c = 0.52).

    CONCLUSIONS: Estimation of the individual CCA intima and media layers using high-frequency ultrasound and calculation of the I/M clearly demonstrated the well known increased cardiovascular risk in women with pre-eclampsia, whereas CCA-IMT did not. This method appears preferable to measuring CCA-IMT for imaging arterial effects and the increased cardiovascular risk in women with previous severe pre-eclampsia.

  • 2.
    Akhter, Tansim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Gynecological endocrinology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Larsson, Marita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Naessén, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Gynecological endocrinology.
    Association between angiogenic factors and signs of arterial aging in women with pre-eclampsia2017In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 50, p. 93-99Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Pre-eclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) later in life. In PE there is a substantial increase in levels of the anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt1) and decreased levels of the pro-angiogenic factor placental growth factor (PlGF). Elevated levels of sFlt1 are also found in individuals with CVD. The aims of this study were to assess sFlt1, PlGF and the sFlt1/PlGF ratio and their correlation with signs of arterial aging by measuring common carotid artery (CCA) intima and media thicknesses and their ratio (I/M ratio) in women with and without PE.

    METHODS: Serum sFlt1 and PlGF levels were measured using commercially available enzyme-linked immunosorbent assay kits, and CCA intima and media thicknesses were estimated using high-frequency (22 MHz) ultrasonography in 55 women at PE diagnosis and 64 women with normal pregnancies at a similar gestational age, with reassessment one year postpartum. A thick intima, thin media and a high I/M ratio indicate a less healthy arterial wall.

    RESULTS: During pregnancy, higher levels of sFlt1, lower levels of PlGF and thicker intima, thinner media and higher I/M ratios were found in women with PE vs. controls (all p < 0.0001). Further, sFlt1 and the sFlt1/PlGF ratio were positively correlated with intima thickness and I/M ratio (all p < 0.0001), but negatively correlated with media thickness (p = 0.002 and 0.03, respectively). About one year postpartum, levels of sFlt1 and the sFlt1/PlGF ratio had decreased in both groups, but compared with controls women in the PE group still had higher levels (p = 0.001 and 0.02, respectively). Further, sFlt1 levels and the sFlt1/PlGF ratio were still positively correlated with intima thickness and I/M ratio.

    CONCLUSIONS: Higher sFlt1 levels and sFlt1/PlGF ratios in women with PE were positively associated with signs of arterial aging during pregnancy. About one year postpartum sFlt1 levels and the sFlt1/PlGF ratios were still higher in the PE group, and also associated with the degree of arterial aging.

  • 3.
    Bjarnegård, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Morsing, E
    Lund University, Sweden .
    Cinthio, M
    Lund University, Sweden .
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Brodszki, J
    Lund University, Sweden .
    Cardiovascular function in adulthood following intrauterine growth restriction with abnormal fetal blood flow2013In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 41, no 2, p. 177-184Article in journal (Refereed)
    Abstract [en]

    Objectives To examine whether intrauterine growth restriction (IUGR) is associated with increased cardiovascular risk later in life. Methods We examined 19 young adults (aged 2225 years) who were born at term after IUGR, along with 18 controls. All had been examined previously with fetal Doppler, and in the present follow-up with echocardiography, carotid echo-tracking ultrasound, applanation tonometry, blood pressure and laser Doppler, in order to characterize their cardiac and vascular geometry and/or function. Results The diameter of the ascending aorta and the left ventricular diameter were smaller in the IUGR group, but only ascending aortic diameter remained significantly smaller after adjustment for body surface area (Pandlt;0.05). The aortic pressure augmentation index was higher in the IUGR group (Pandlt;0.05). The common carotid artery diameter, intimamedia thickness and distensibility as well as left ventricular mass and function were similar in the two groups. IUGR status was found to be an independent predictor of ascending aortic diameter. Conclusions IUGR due to placental dysfunction seems to contribute to the higher systolic blood pressure augmentation and the smaller aortic dimensions that are observed in adults more than 20 years later, with possible negative consequences for future left ventricular performance due to increased aortic impedance.

  • 4. Carlsson, L. Höglund
    et al.
    Saltvedt, S.
    Anderlid, B. -M.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Gillberg, C.
    Westgren, M.
    Fernell, E.
    Prenatal ultrasound and childhood autism: long-term follow-up after a randomized controlled trial of first- vs second-trimester ultrasound2016In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 48, no 3, p. 285-288Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze whether the frequency of autism spectrum disorder (ASD) in a cohort of Swedish children differs between those exposed to ultrasound in the 12th week and those exposed to ultrasound in the 18th week of gestation.

    Methods: The study cohort consisted of approximately 30 000 children born between 1999 and 2003 to mothers who had been randomized to a prenatal ultrasound examination at either 12 or 18weeks' gestation as part of the framework for a study on nuchal translucency screening. The outcome measure in the present study was the rate of ASD diagnoses among the children. Information on ASD diagnoses was based on data from the Swedish social insurance agency concerning childcare allowance granted for ASD.

    Results: Between 1999 and 2003, a total of 14 726 children were born to women who underwent a 12-week ultrasound examination and 14 596 to women who underwent an 18-week ultrasound examination. Of these, 181 (1.2%) and 176 (1.2%) children, respectively, had been diagnosed with ASD. There was no difference in ASD frequency between the early and late ultrasound groups.

    Conclusions: Women subjected to at least one prenatal ultrasound examination at either 12 or 18weeks' gestation had children with similar rates of ASD. However, this result reflects routine care 10-15 years ago in Sweden. Today, higher intensity ultrasound scans are performed more frequently, at earlier stages during pregnancy and for non-medical purposes, implying longer exposure time for the fetus. This change in the use of ultrasound necessitates further follow-up study of the possible effects that high exposure to ultrasound during the gestational period has on the developing brain.

  • 5.
    Elmstedt, Nina
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering.
    Lind, Britta
    KTH, School of Technology and Health (STH), Medical Engineering.
    Ferm-Widlund, K.
    Westgren, M.
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical Engineering.
    Temporal frequency requirements for tissue velocity imaging of the fetal heart2011In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 38, no 4, p. 413-417Article in journal (Refereed)
    Abstract [en]

    Objectives The high velocity and short duration of myocardial motion requires a high sampling rate to obtain adequate temporal resolution; this issue becomes even more important when taking into consideration the high fetal heart rate. In this study we have established optimal sampling requirements for assessing the duration of various cardiac cycle events and myocardial velocities of the fetal heart using color-coded tissue velocity imaging (TVI). Methods Recordings from 30 fetuses were acquired at an initial frame rate of 180-273 frames/s. All TVI recordings were performed from an apical four-chamber view and stored as cineloops of five to 10 consecutive cardiac cycles for subsequent offline analysis using software enabling a reduction in frame rate. Different components of the myocardial velocity curve, obtained from the basal part of the ventricular septum, were measured at the initial frame rate and compared with their equivalents at gradually decreased frame rates. Results As acquisition frame rate was reduced, there was a marked increase in deviation from the initial values, resulting in an underestimation of all systolic and diastolic velocities. For the measured durations, there was a clear tendency to underestimate isovolumetric contraction and relaxation, and a clear tendency to overestimate ventricular ejection and diastolic E-wave and A-wave. An acceptable <= 5% deviation from the value obtained at the highest frame rate corresponded to measurements obtained at above 150-200 frames/s. Conclusions A high sampling rate of at least 200 frames/s is necessary for adequate reconstruction of TVI data for the fetal heart. Frame rates that are too low result in considerable loss of temporal and velocity information.

  • 6.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Waldenström, Ulla
    Karolinska Institutet.
    Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample2008In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 32, no 1, p. 15-22Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focused specifically on reasons for women not having a positive experience. METHOD: Of 4600 eligible Swedish-speaking women, 3061 were recruited to the study in early pregnancy, during three 1-week periods spread evenly over 1 year (1999-2000), and these women completed a questionnaire at a mean of 16 weeks' gestation. A follow-up questionnaire at 2 months after delivery was completed by 2730 women. The representativeness of the sample was assessed by comparison with the total Swedish birth cohort of 1999. RESULTS: The most prominent expectation about the up-coming scan was confirmation that the baby was well, followed by confirmation that the pregnancy was real. Detailed information, such as date of delivery and sex of the baby, was mentioned less often, and very few wrote about the examination as an exciting and joyful experience. After the birth, a large majority was satisfied with information about why (88%) and how (87%) the examination was performed, but only 58% said they had received sufficient information about possible risks. 94% had a positive experience of the scan, and those who had not had more ambivalent feelings about their pregnancy. Women with negative feelings about the scan were more often single and of non-Swedish background, and emotional problems were more common in this group. CONCLUSION: Women's expectations of the routine second-trimester scan differ from those of caregivers, focusing on general reassurance rather than specific information. Level of satisfaction with the scan was high, but information given about risks could be improved. Women with ambivalent or negative feelings about pregnancy may have difficulties enjoying the examination.

  • 7.
    Herling, L.
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Johnson, Jonas
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems. Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Ferm-Widlund, K.
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Bergholm, F.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Elmstedt, N.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Lindgren, P.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Sonesson, S. -E
    Acharya, G.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden.;UiT Arctic Univ Norway, Dept Clin Med, Womens Hlth & Perinatol Res Grp, Tromso, Norway..
    Westgren, M.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Automated analysis of fetal cardiac function using color tissue Doppler imaging in second half of normal pregnancy2019In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 53, no 3, p. 348-357Article in journal (Refereed)
    Abstract [en]

    Objectives Color tissue Doppler imaging (cTDI) is a promising tool for the assessment of fetal cardiac function. However, the analysis of myocardial velocity traces is cumbersome and time-consuming, limiting its application in clinical practice. The aim of this study was to evaluate fetal cardiac function during the second half of pregnancy and to develop reference ranges using an automated method to analyze cTDI recordings from a cardiac four-chamber view. Methods This was a cross-sectional study including 201 normal singleton pregnancies between 18 and 42weeks of gestation. During fetal echocardiography, a four-chamber view of the heart was visualized and cTDI was performed. Regions of interest were positioned at the level of the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls of the fetal heart, to obtain myocardial velocity traces that were analyzed offline using the automated algorithm. Peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm) and rapid ventricular filling, i. e. early diastole (Em), as well as the Em/Am ratio, mechanical cardiac time intervals and myocardial performance index (cMPI) were evaluated, and gestational age-specific reference ranges were constructed. Results At 18 weeks of gestation, the peak myocardial velocities, presented as fitted mean with 95% CI, were: LV Am, 3.39 (3.09-3.70) cm/s; LV Sm, 1.62 (1.46-1.79) cm/s; LV Em, 1.95 (1.75-2.15) cm/s; septal Am, 3.07 (2.80-3.36) cm/s; septal Sm, 1.93 (1.81-2.06) cm/s; septal Em, 2.57 (2.32-2.84) cm/s; RV Am, 4.89 (4.59-5.20) cm/s; RV Sm, 2.31 (2.16-2.46) cm/s; and RV Em, 2.94 (2.69-3.21) cm/s. At 42weeks of gestation, the peak myocardial velocities had increased to: LV Am, 4.25 (3.87-4.65) cm/s; LV Sm, 3.53 (3.19-3.89) cm/s; LV Em, 4.55 (4.18-4.94) cm/s; septal Am, 4.49 (4.17-4.82) cm/s; septal Sm, 3.36 (3.17-3.55) cm/s; septal Em, 3.76 (3.51-4.03) cm/s; RV Am, 6.52 (6.09-6.96) cm/s; RV Sm, 4.95 (4.59-5.32) cm/s; and RV Em, 5.42 (4.99-5.88) cm/s. The mechanical cardiac time intervals generally remained more stable throughout the second half of pregnancy, although, with increased gestational age, there was an increase in duration of septal and RV atrial contraction, LV pre-ejection and septal and RV ventricular ejection, while there was a decrease in duration of septal postejection. Regression equations used for the construction of gestational age-specific reference ranges for peak myocardial velocities, Em/Am ratios, mechanical cardiac time intervals and cMPI are presented. Conclusion Peak myocardial velocities increase with gestational age, while the mechanical time intervals remain more stable throughout the second half of pregnancy. Using an automated method to analyze cTDI-derived myocardial velocity traces, it was possible to construct reference ranges, which could be used in distinguishing between normal and abnormal fetal cardiac function.

  • 8.
    Herling, L.
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden.
    Ferm-Widlund, K.
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Bergholm, Fredrik
    KTH, School of Technology and Health (STH), Medical Engineering.
    Lindgren, P.
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Sonesson, S. -E
    Acharya, G.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden.;UiT Arctic Univ Norway, Dept Clin Med, Womens Hlth & Perinatol Res Grp, Tromso, Norway..
    Westgren, M.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Ctr Fetal Med, Stockholm, Sweden..
    Automated analysis of fetal cardiac function using color tissue Doppler imaging2018In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 52, no 5, p. 599-608Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the feasibility of automated analysis of fetal myocardial velocity recordings obtained by color tissue Doppler imaging (cTDI). Methods This was a prospective cross-sectional observational study of 107 singleton pregnancies >= 41 weeks of gestation. Myocardial velocity recordings were obtained by cTDI in a long-axis four-chamber view of the fetal heart. Regions of interest were placed in the septum and the right (RV) and left (LV) ventricular walls at the level of the atrioventricular plane. Peak myocardial velocities and mechanical cardiac time intervals were measured both manually and by an automated algorithm and agreement between the two methods was evaluated. Results In total, 321 myocardial velocity traces were analyzed using each method. It was possible to analyze all velocity traces obtained from the LV, RV and septal walls with the automated algorithm, and myocardial velocities and cardiac mechanical time intervals could be measured in 96% of all traces. The same results were obtained when the algorithm was run repeatedly. The myocardial velocities measured using the automated method correlated significantly with those measured manually. The agreement between methods was not consistent and some cTDI parameters had considerable bias and poor precision. Conclusions Automated analysis of myocardial velocity recordings obtained by cTDI was feasible, suggesting that this technique could simplify and facilitate the use of cTDI in the evaluation of fetal cardiac function, both in research and in clinical practice.

  • 9. Kovacevic, A.
    et al.
    Roughton, M.
    Mellander, M.
    Öhman, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Tulzer, G.
    Dangel, J.
    Magee, A. G.
    Mair, R.
    Ghez, O.
    Schmidt, K. G.
    Gardiner, H. M.
    Fetal aortic valvuloplasty: investigating institutional bias in surgical decision-making2014In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 44, no 5, p. 538-544Article in journal (Refereed)
    Abstract [en]

    Objectives Fetal aortic valvuloplasty may prevent the progression of aortic stenosis to hypoplastic left heart syndrome and allow biventricular rather than univentricular postnatal treatment. This study aimed to investigate whether blinded simulation of a multidisciplinary team approach aids interpretation of multicenter data to uncover institutional bias in postnatal decision-making following fetal cardiac intervention for aortic stenosis. Methods The study included 109 cases of prenatally diagnosed aortic stenosis from 13 European countries, of which 32 had undergone fetal cardiac intervention. The multidisciplinary team, blinded to fetal cardiac intervention, institutional location and postnatal treatment, retrospectively assigned a surgical pathway (biventricular or univentricular) based on a review of recorded postnatal imaging and clinical characteristics. The team's decisions were the numerical consensus of silent voting, with case review when a decision was split. Funnel plots showing concordance between the multidisciplinary team and the local team's surgical choice (first pathway) and with outcome (final pathway) were created. Results In 105 cases the multidisciplinary team reached a consensus decision regarding the surgical pathway, with no decision in four cases because the available imaging records were inadequate. Blinded multidisciplinary team consensus for the first pathway matched the decision of the surgical center in 93/105 (89%) cases, with no difference in agreement between those that had undergone successful fetal cardiac intervention (n= 32) and no (n= 74) or unsuccessful (n= 3) valvuloplasty (no fetal cardiac intervention) (kappa = 0.73 (95% CI, 0.38-1.00) vs 0.74 (95% CI, 0.51-0.96)). However, funnel plots comparing multidisciplinary team individual decisions with those of the local teams displayed more discordance (meaning biventricular-univentricular conversion) for the final surgical pathway following fetal cardiac intervention than they did for cases without such intervention (36/74 vs 34/130; P = 0.002), and identified one outlying center. Conclusions The use of a blinded multidisciplinary team to simulate decision-making and presentation of data in funnel plots may assist in the interpretation of data submitted to multicenter studies and permit the identification of outliers for further investigation. In the case of aortic stenosis, a high level of agreement was observed between the multidisciplinary team and the surgical centers, but one outlying center was identified.

  • 10.
    Marusik, C
    et al.
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Frykholm, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Ericson, Katharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical and experimental pathology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI)2017In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 49, no 3, p. 410-412Article in journal (Refereed)
  • 11.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Postpartum Ultrasound2012In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 6, no 1, p. 76-92Article in journal (Refereed)
  • 12.
    Mulic-Lutvica, Ajlana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ultrasound finding of an echogenic mass in women with secondary postpartum hemorrhage is associated with retained placental tissue2006In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 28, no 3, p. 312-319Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe sonographic findings associated with retained placental tissue in patients with secondary postpartum hemorrhage, and to compare these findings with those of women with a normal puerperium. Methods: This was a prospective observational study of 79 women with secondary postpartum hemorrhage. Ultrasound examinations were performed on the day the patients presented with clinical symptoms and were scheduled for postpartum days 1, 3, 7, 14, 28 and 56, continuing until uterine surgical evacuation was performed or until the bleeding stopped. The maximum anteroposterior (AP) diameters of the uterus and uterine cavity were measured and morphological findings in the cavity were recorded. The findings were compared with previously published results from a normal population. Results: The patients were divided into two groups. Group 1 (n = 18) underwent surgery and Group 2 (n = 61) was treated conservatively. Sonography revealed an echogenic mass in the uterine cavity in 17 patients from Group 1, and in 14 of these patients histology confirmed placental tissue. The AP diameter of the uterine cavity was above the 90 th percentile in all but two of the 18 Group 1 patients. In 18 patients from Group 2 the cavity was empty and in 43 a mixed-echo pattern was found. The uterine cavity was wider compared with the controls, but the values largely overlapped. Conclusion: This report supports the opinion that the sonographic finding of an echogenic mass in the uterine cavity in women with secondary postpartum hemorrhage is associated with retained placental tissue.

  • 13.
    Sohlberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Weis, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    MRI estimated placental perfusion in fetal growth assessment2015In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 46, no 6, p. 700-705Article in journal (Refereed)
    Abstract [en]

    Objective

    This study aimed to evaluate placental perfusion fraction estimated by magnetic resonance imaging (MRI) in vivo as a marker of placental function.

    Methods

    The study population included 35 pregnant women, of whom 13 had preeclampsia, examined at gestational weeks 22 to 40. Each woman underwent, within a 24 hour period: a MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction); venous blood sampling; and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. We compared the perfusion fraction in pregnancies with and without fetal growth restriction and estimated correlations between the perfusion fraction and ultrasound estimates and plasma markers with linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of preeclampsia (p < 0.05) and therefore we included an interaction term between preeclampsia and the covariates in the models.

    Results

    The median placental perfusion fraction in pregnancies with and without fetal growth restriction was 21% and 32%, respectively (p = 0.005). The correlations between the placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (p-values 0.002 to 0.0001). The highest coefficient of determination (R2= 0.56) for placental perfusion fraction was found for a model including pulsatility index in ductus venosus, plasma level of sFlt1, estimated fetal weight and presence of preeclampsia.

    Conclusion

    The placental perfusion fraction has potential to contribute to the clinical assessment in cases of placental insufficiency.

  • 14.
    Stålberg, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haglund, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hultman, Christina M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Lambe, Mats
    Kieler, Helle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Prenatal ultrasound exposure and children’s school performance at age 15-16; follow-up of a randomised controlled trial2009In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 34, no 3, p. 297-303Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the association between prenatal ultrasound exposure and school performance at 15-16 years of age. Methods The study population consisted of children born to women who participated in a randomized controlled trial on the second-trimester ultrasound examination in Sweden from 1985 to 1987. Information about the children's grades when graduating from primary school and information on socioeconomic factors was obtained from Swedish nationwide registers. Comparisons were made using linear and logistic regression analyses according to randomization to ultrasound, ultrasound exposure in the second trimester and ultrasound exposure at an), time during pregnancy. Boys and girls were analyzed separately. Results Of the 4756 singleton children from the randomized trial, we identified 4458 (94%) in the National School Register. There were no statistically significant differences in school performance for boys or girls according to randomization or exposure to ultrasound in the second trimester. Compared to those who were unexposed, boys exposed to ultrasound at least once at any time during fetal life bad a tendency towards lower mean school grades in general (-4.39 points; 95% CI, -9.59 to 0.81. (max possible, 320) points) and in physical education (-0.45 points; 95% CI, -0.91 to 0.01 (max possible, 20) points), but the differences did not reach significance. Conclusion In general, routine ultrasound examination in the second trimester bad no effect on overall school performance in teenagers.

  • 15.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Re: Placental magnetic resonance imaging T2*measurements in normal pregnancies and in those complicated by fetal growth restriction. M. Sinding, D. A. Peters, J. B. Frokjaer, O. B. Christiansen, A. Petersen, N. Uldbjerg and A. Sorensen. Ultrasound Obstet Gynecol 2016; 47: 748-754.2016In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 47, no 6, p. 673-673Article in journal (Other academic)
  • 16.
    Zeisler, H.
    et al.
    Med Univ Vienna, Dept Obstet & Gynecol, Vienna, Austria.
    Llurba, E.
    Univ Autonoma Barcelona, Vall dHebron Univ Hosp, Barcelona, Spain.
    Chantraine, F. J.
    Univ Liege, CHR Citadelle, Liege, Belgium.
    Vatish, M.
    Univ Oxford, Oxford, England.
    Staff, A. C.
    Oslo Univ Hosp, Oslo, Norway;Univ Oslo, Oslo, Norway.
    Sennstrom, M.
    Karolinska Univ Hosp, Stockholm, Sweden.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive biology.
    Brennecke, S. P.
    Univ Melbourne, Dept Obstet & Gynaecol, Melbourne, Vic, Australia;Royal Womens Hosp, Melbourne, Vic, Australia.
    Stepan, H.
    Univ Leipzig, Leipzig, Germany.
    Allegranza, D.
    Roche Diagnost Int Ltd, Rotkreuz, Switzerland.
    Schoedl, M.
    Roche Diagnost GmbH, Penzberg, Germany.
    Grill, S.
    Roche Diagnost GmbH, Penzberg, Germany.
    Hund, M.
    Roche Diagnost Int Ltd, Rotkreuz, Switzerland.
    Verlohren, S.
    Charite, Berlin, Germany.
    Soluble fms-like tyrosine kinase-1 to placental growth factor ratio: ruling out pre-eclampsia for up to 4weeks and value of retesting2019In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 53, no 3, p. 367-375Article in journal (Refereed)
    Abstract [en]

    Objectives

    The soluble fms-like tyrosine kinase-1 ( sFlt-1) to placental growth factor ( PlGF) ratio is generally elevated some time before and at the clinical onset of pre-eclampsia. The PROGNOSIS study validated a sFlt-1/PlGF ratio cut-off of = 38 to rule out the onset of pre-eclampsia within 1week of testing in women with suspected disease. The aim of this study was to assess the predictive value of the sFlt-1/PlGF ratio to rule out the onset of pre-eclampsia for up to 4 weeks, and to assess the value of repeat measurements.

    Methods

    This was an exploratory post-hoc analysis of data from the PROGNOSIS study performed in pregnant women aged = 18 years with suspected pre-eclampsia, who were at 24+ 0 to 36+ 6weeks' gestation at their first clinic visit. Serum samples were collected at the first visit and weekly thereafter. sFlt-1 and PlGF levels were measured using Elecsys (R) sFlt-1 and PlGF immunoassays. Whether the sFlt-1/PlGF ratio cut-off of = 38 used to rule out the onset of pre-eclampsia within 1week could predict the absence of pre-eclampsia 2, 3, and 4 weeks post-baseline was assessed. The value of repeat sFlt-1/PlGF testing was assessed by examining the difference in sFlt-1/PlGF ratio 2 and 3 weeks after the first measurement in women with, and those without, pre-eclampsia or adverse fetal outcome.

    Results

    On analysis of 550 women, sFlt-1/PlGF ratio = 38 ruled out the onset of pre-eclampsia 2 and 3weeks post-baseline with high negative predictive values (NPV) of 97.9% and 95.7%, respectively. The onset of pre-eclampsia within 4weeks was ruled out with a high NPV (94.3%) and high sensitivity and specificity (66.2% and 83.1%, respectively). Compared with women who did not develop pre-eclampsia, those who developed pre-eclampsia had significantly larger median increases in sFlt-1/PlGF ratio at 2 weeks (., 31.22 vs 1.45; P< 0.001) and at 3 weeks (., 48.97 vs 2.39; P< 0.001) after their initial visit. Women who developed pre-eclampsia and/or adverse fetal outcome compared with those who did not had a significantly greater median increase in sFlt-1/PlGF ratio over the same period (., 21.22 vs 1.40; P< 0.001 at 2weeks;., 34.95 vs 2.30; P< 0.001 at 3weeks).

    Conclusion

    The Elecsys (R) immunoassay sFlt-1/PlGF ratio can help to rule out the onset of pre-eclampsia for 4 weeks in women with suspected pre-eclampsia.

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