BackgroundPrenatal screening of pregnant women in Sweden has improved the detection of major congenital heart defects (CHD). The aim was to explore parental experiences and need for information following a prenatal diagnosis of CHD.MethodsSemi-structured interviews conducted with six fathers and five mothers to seven prenatally diagnosed children. Data were analyzed through content analysis.ResultsThree themes and 9 categories emerged. Theme 1, Grasping the facts today while reflecting on the future, containing five categories: Difficulties sorting out information when in emotional chaos; Respectful information regarding termination of pregnancy; Early information is crucial; Understanding the facts regarding the anomaly; Preparing for the future. Theme 2, Personal contact with medical specialists who give honest and trustworthy information is valued, containing two categories: Trust in information received from medical specialists and Truth and honesty is valued. Theme 3, An overwhelming amount of information on the Internet, containing two categories: Difficulties in finding relevant information and Easy to focus on cases with a poor outcome when searching the Internet.ConclusionEarly and honest information in line with individual preferences is crucial to support the decisional process regarding whether to continue or terminate the pregnancy. The use of illustrations is recommended, as a complement to oral information, as it increases comprehension and satisfaction with obtained information. Furthermore, the overwhelming amount of information on the Internet calls for compilation of easily accessible and reliable information sources via the Internet.

Objective To compare the rate of prenatal diagnosis of heart malformations between two policies of screening for heart malformations.Design Randomised controlled trial.Setting Six university hospitals, two district general hospitals.Sample A total of 39 572 unselected pregnancies randomised to either policy.Methods The 12-week policy implied one routine scan at 12 weeks including measurement of nuchal translucency (NT), and the 18-week policy implied one routine scan at 18 weeks. Fetal anatomy was scrutinised using the same check-list in both groups, and in both groups, indications for fetal echocardiography were ultrasound findings of any fetal anomaly, including abnormal fourchamber view, or other risk factors for heart malformation. In the 12-week scan group, NT ‡3.5 mm was also an indication for fetal echocardiography.Main outcome measure Prenatal diagnosis of major congenital heart malformation.Results In the 12-week scan group, 7 (11%) of 61 major heart malformations were prenatally diagnosed versus 9 (15%) of 60 in the 18-week scan group (P = 0.60). In four (6.6%) women in the 12-week scan group, the routine scan was the starting point for investigations resulting in a prenatal diagnosis versus in 9 (15%) women in the 18-week scan group (P = 0.15). The diagnosis was made £22 weeks in 5% (3/61) of the cases in the 12-week scan group versus in 15% (9/60) in the 18-week scan group (P = 0.08).Conclusions The prenatal detection rate of major heart malformations was low with both policies. The 18-week scan policy seemed to be superior to the 12-week scan policy, although the differences in prenatal detection rates were not statistically significant.

ObjectiveTo explore the need for information and what information was actually received following prenatal diagnosis of a congenital heart defect, in a country where termination of pregnancy beyond 22 weeks of gestation is not easily possible because of legal constraints.MethodsTwenty‐six Swedish‐speaking pregnant women (n = 14) and partners (n = 12) were consecutively recruited for semi‐structured telephone interviews following the prenatal diagnosis of a congenital heart defect. Data were analyzed using content analysis.ResultsAlthough high satisfaction with the specialist information was described, the information was considered overwhelming and complex. Objective, honest, and detailed information about multiple subjects were needed, delivered repeatedly, and supplemented by written information/illustrations. Eighteen respondents had used the Internet to search for information and identified issues involving searching difficulties, low quality, and that it was too complex, insufficient, or unspecific. Those who terminated their pregnancy criticized that there was a lack of information about termination of pregnancy, both from health professionals and online sources, resulting in unanswered questions and unpreparedness.ConclusionIndividuals faced with a prenatal diagnosis of a congenital heart defect need individualized and repeated information. These needs are not all adequately met, as individuals are satisfied with the specialist consultation but left with unanswered questions regarding pregnancy termination. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern, 2012, Annals of the Rheumatic Diseases, (71) Methods. The influence of fetal gender, maternal age, parity and time of birth on heart block development was analyzed in 145 families including Ro/La-positive (n= 190) and Ro/Lanegative (n=165) pregnancies.Results. We observed a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was however significantly higher than in pregnancies resulting in babies without heart block (p<0.01). Further, seasonal timing of pregnancy influenced the outcome. Gestational susceptibility-weeks 18-24 occurring during January-March correlated with a higher proportion of heart block pregnancies and lower vitamin D levels, and a corresponding higher proportion of children with heart block born in the summer (p<0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies.Conclusion. This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for congenital heart block development in Ro/La positive pregnancy. These observations indicate that the risk can be modified, and will be important for counseling when a pregnancy is considered. 4Congenital complete heart block without cardiac malformation is a rare disease, affecting 1 in 15,000 to 20,000 births in the general population. An association with the presence of maternal autoantibodies to Ro/SSA and/or La/SSB is however well established [1,2], and the risk of complete congenital heart block is 1-2% in Ro/SSA-positive pregnancies [3][4][5][6]. Furthermore, the reported risk of giving birth to a second child with complete heart block for anti-Ro/SSA positive mothers ranges from 12 to 20% [7][8][9], despite the persistence of the maternal autoantibodies [10].This indicates that additional factors are critical for establishing the heart block. Fetal genetic susceptibility has been suggested as a potential risk factor [11,12], and polymorphisms in the gene encoding TGFβ have been implicated in the development of heart block [13,14]. Variations in the intrauterine environment between pregnancies have also been suggested to contribute to the penetrance of the disease. Maternal disease severity has been investigated as such a potential risk factor, but was not found to contribute to the development of congenital heart block [15].Given the rarity of congenital heart block occurrence in the general population, it is difficult to investigate potential risk factors associated with the disease. In particular, very little information is available on the influence of maternal age and parity on pregnancy outcome in anti-Ro/La positive mothers. In an effort to address these questions in a reasonable cohort we identified heart ...

The objective of the study was to investigate the antigen specificity and occurrence of individual autoantibodies in mothers of children diagnosed with atrioventricular (AV) block in a nation-wide setting. Patients with AV block detected before 15 years of age were identified using national quality registries as well as a network of pediatric and adult cardiologists and rheumatologists at the six university hospitals in Sweden. Patients with gross heart malformations, surgically or infectiously induced blocks were excluded. Blood samples were obtained from the mothers and maternal autoantibody profile, including the occurrence of antibodies against Ro52, Ro60, La, SmB, SmD, RNP-70k, RNP-A, RNP-C, CENP-C, Scl-70, Jo-1, ribosomal RNP and histones was investigated in 193 mothers of children with AV block by immunoblotting and ELISA. Autoantibody reactivity was detected in 48% (93/193) of the mothers of children with AV block. In autoantibody-positive mothers, the vast majority, 95% (88/93), had antibodies against Ro52, while 63% (59/93) had autoantibodies to Ro60 and 58% (54/93) had autoantibodies to La. In addition, 13% (12/93) of the autoantibody-positive mothers had antibodies to other investigated antigens besides Ro52, Ro60 and La, and of these anti-histone antibodies were most commonly represented, detected in 8% (7/93) of the mothers. In conclusion, this Swedish population-based study confirms that maternal autoantibodies may associate with heart block in the child. Further, our data demonstrate a dominant role of Ro52 antibodies in association with AV block.Funding Agencies|KIRCNET (Karolinska Institutet Circulation and Respiratory Research Network)||Magn Bergvalls Foundation||Jerringfoundation||Stiftelsen Samariten||Karolinska Institute||Royal Swedish Academy of Sciences||Swedish Research Council||Goran Gustafsson Foundation||Torsten and Ragnar Soderberg Foundation||King Gustaf the V:th 80-year foundation||Swedish Foundation for Strategic Research||Heart-Lung Foundation||Swedish Rheumatism Association|

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SYNOPSIS IN INTERLINGUAUN QUANTITATIVE STUDIO MICRORADIOGRAPHIC DE INCIPIENTE CARIE ADAMANTIN.-Le strato superficial del cariose adamante studiate habeva perdite approximativemente 8 pro cento de su sales mineral. Le valor medie del spissitate del strato superficial esseva 40 gA, e le valor medie de su contento mineral esseva 82,7 pro cento a base del volumine. Le dismineralisation subsuperficial monstrava marcate variationes. Le contento mineral le plus basse esseva 28,9 pro cento a base del volumine, e iste alte grado de dismineralisation esseva trovate in un lesion de un profundor de 300 A sin ruptura del superficie.Quantitative microradiography has been used only to a limited extent for studying dental hard tissues. Thewlis' and Angmar, Carlstrdm, and Glas' have used the technique for studying normal human enamel, but to our knowledge no quantitative microradiographic investigation of carious enamel has been published. Semiquantitative data have been published, and the results have then usually been presented graphically with densitometric tracings, giving a view of the degree of decalcification.3"6 The semiquantitative technique is a valuable tool for detecting variations in the degree of mineralization in a hard tissue, but it can only give relative data. Insufficient literature and the need for more detailed information about the degree of decalcification in dental caries can be regarded as the background of the present investigation. It is believed that the quantitative microradiographic technique can be of value for throwing light on the pathogenesis of dental caries. Materials and MethodsThe material consisted of eleven premolars from individuals 10-15 years of age. The teeth, which were extracted on orthodontic indications, exhibited early approximal enamel caries and were otherwise intact, without signs of developmental disturbances. In nine cases the lesion consisted only of a white, opaque spot without cavitation; in the remaining two cases there existed a shallow cavitv in the center of the white spot. After fixation in absolute alcohol the teeth were serially sectioned longitudinally with a diamond wheel without prior embedding. The cutting direction was perpendicular to the carious surface, and the interval between two adjoining sections in each series was 300 ,. The number of sections of each lesion depended on its width and varied between five and fourteen. The sections were ground planoparallel and polished, the final thickness being 70-80 y. From each serialsectioned tooth the section with the deepest part of the lesion was chosen for microradiographic examination.The thickness of the ground sections was measured in the following way. Each section was divided with a diamond wheel parallel to the direction of the enamel prisms through the deepest part of the carious lesion and perpendicular to the ground surfaces of the section. The section was then viewed in a microscope with a X50 lens and with the cut surface of the section at right angles to the optical axis. The thickness measurement was ...

Objective