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Randers, Denmark

Glavind J.,Aarhus University Hospital | Kindberg S.F.,Aarhus University Hospital | Uldbjerg N.,Aarhus University Hospital | Khalil M.,Kolding Hospital | And 6 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2013

Objectives To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes. Design Randomised controlled multicentre open-label trial. Setting Seven Danish tertiary hospitals from March 2009 to June 2011. Population Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section. Methods Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days). Main outcome measures The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events. Results Among women scheduled for elective caesarean section at 38+3 weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39+3 weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups. Conclusions This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation. © 2013 RCOG. Source

Glavind J.,Regional Hospital of Randers | Uldbjerg N.,Aarhus University Hospital
Current Opinion in Obstetrics and Gynecology | Year: 2015

Purpose of review The purpose of this article is to critically review the existing literature with regard to neonatal and maternal outcomes after elective cesarean delivery at 38 completed weeks versus 39 completed weeks of gestation. Recent findings Recent observational studies have consolidated previous findings of an increased risk of neonatal composite morbidity, respiratory morbidity, and neonatal admission with elective cesarean delivery at 38 compared with 39 weeks of gestation. In opposition, results from the first randomized trial were recently reported in which there was no significant difference in the risk of neonatal admission with elective cesarean delivery at the two gestational weeks. In the mothers, the risk of adverse outcomes is similar with elective cesarean delivery at 38 or 39 weeks. Though evidence of long-term adverse effects of early-term delivery (primarily spontaneous and vaginally) is accumulating, no data exist to elucidate whether these findings apply to children electively delivered by cesarean section. Summary Neonatal but not maternal adverse events are more frequent with elective cesarean delivery performed at 38 than 39 weeks' gestation. The difference, however, may be significantly smaller than previously anticipated. Further prospective studies, including investigations with focus on the impact of labor onset prior to cesarean delivery, are warranted. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Jensen M.S.,Regional Hospital of Randers
Epidemiology | Year: 2014

BACKGROUND:: Prenatal exposure to phthalates may pose a threat to human male reproduction. However, additional knowledge about the in vivo effect in humans is needed, and reported associations with genital abnormalities are inconclusive. We aimed to study prenatal di(2-ethylhexyl) phthalate (DEHP) and diisononyl phthalate (DiNP) exposure in relation to cryptorchidism, hypospadias, and human fetal Leydig cell function.METHODS:: We studied 270 cryptorchidism cases, 75 hypospadias cases, and 300 controls. Second-trimester amniotic fluid samples were available from a Danish pregnancy-screening biobank (n = 25,105) covering 1980–1996. We assayed metabolites of DEHP and DiNP (n = 645) and steroid hormones (n = 545) by mass spectrometry. We assayed insulin-like factor 3 by immunoassay (n = 475) and analyzed data using linear or logistic regression.RESULTS:: Mono(2-ethyl-5-carboxypentyl) phthalate (5cx-MEPP, DEHP metabolite) was not consistently associated with cryptorchidism or hypospadias. However, we observed an 18% higher (95% confidence interval [CI] = 5%–33%) testosterone level, and a 41% lower (−56% to −21%) insulin-like factor 3 level in the highest 5cx-MEPP tertile compared with the lowest. Mono(4-methyl-7-carboxyheptyl) phthalate (7cx-MMeHP, DiNP metabolite) showed elevated odds ratio point estimates for having cryptorchidism (odds ratio = 1.28 [95% CI = 0.80 to 2.01]) and hypospadias (1.69 [0.78 to 3.67]), but was not consistently associated with the steroid hormones or insulin-like factor 3.CONCLUSIONS:: Data on the DEHP metabolite indicate possible interference with human male fetal gonadal function. Considering the DiNP metabolite, we cannot exclude (nor statistically confirm) an association with hypospadias and, less strongly, with cryptorchidism. © 2014 by Lippincott Williams & Wilkins, Inc Source

Jensen L.F.,University of Aarhus | Pedersen A.F.,University of Aarhus | Bech B.H.,University of Aarhus | Andersen B.,Regional Hospital of Randers | Vedsted P.,University of Aarhus
Breast | Year: 2016

Background: Organised breast cancer screening is currently one of the best strategies for early-stage breast cancer detection. However, early detection has proven challenging for women with psychiatric disease. This study aims to investigate psychiatric morbidity and non-participation in breast cancer screening. Methods: We conducted an observational cohort study including women invited to the first organised screening round in the Central Denmark Region. Data on psychiatric diagnosis, psychoactive prescription medicine and consultation with private psychiatrists were obtained from Danish registries and assessed for a period of up to 10 years before the screening date. Results: The cohort comprised 144,264 women whereof 33.0% were registered with an indication of psychiatric morbidity. We found elevated non-participation propensity among women with a psychiatric diagnosis especially for women with schizophrenia and substance abuse. Also milder psychiatric morbidity was associated with higher non-participation likelihood as women who had redeemed psychoactive prescription medicine or have had minimum one consultation with a private psychiatrist were more likely not to participate. Finally, we found that the chronicity of psychiatric morbidity was associated with non-participation and that woman who had a psychiatric morbidity defined as 'persistent' had higher likelihood of non-participation than women with recently active morbidity or inactive psychiatric morbidity. Conclusion: This study showed a strong association between psychiatric morbidity and an increased likelihood of non-participation in breast cancer screening in a health care system with universal and tax-funded health services. This knowledge may inform interventions targeting women with psychiatric morbidity as they have poorer breast cancer prognosis. © 2015 Elsevier Ltd. Source

Adelborg K.,Aarhus University Hospital | Adelborg K.,University of Aarhus | Al-Mashhadi R.H.,Regional Hospital of Randers | Nielsen L.H.,Regional Hospital of Randers | And 3 more authors.
Anaesthesia | Year: 2014

Forty surf lifeguards attempted to ventilate a manikin through one out of three supraglottic airways inserted in random order: the Portex® Soft Seal®; the Intersurgical® i-gel™; and the Ambu® AuraOnce™. We recorded the time to ventilate and the proportion of inflations that were successful, without and then with concurrent chest compressions. The mean (SD) time to ventilate with the Soft Seal, i-gel and AuraOnce was 35.2 (7.2)s, 15.6 (3.3)s and 35.1 (8.5) s, respectively, p < 0.0001. Concurrent chest compression prolonged the time to ventilate by 5.0 (1.3-8.1)%, p = 0.0072. The rate of successful ventilations through the Soft Seal (100%) was more than through the AuraOnce (92%), p < 0.0001, neither of which was different from the i-gel (97%). The mean (SD) tidal volumes through the Soft Seal, i-gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively. Most lifeguards (85%) preferred the i-gel. Ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards. © 2014 The Association of Anaesthetists of Great Britain and Ireland. Source

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