Women of childbearing age are often affected with psychotic disorders, requiring the use of antipsychotic medication during pregnancy. In the present study, we prospectively followed the pregnancies of 561 women exposed to second-generation antipsychotic agents (SGAs; study cohort) and compared these to 284 pregnant women exposed to first-generation antipsychotic agents (FGAs; comparison cohort I) and to 1122 pregnant women using drugs known as not harmful to the unborn (comparison cohort II). Subjects were enrolled through the Institute's consultation service. Major malformation rates of SGA exposed were higher compared to comparison cohort II (adjusted odds ratio, 2.17; 95% confidence interval, 1.20-3.91), possibly reflecting a detection bias concerning atrial and ventricular septal defects. Postnatal disorders occurred significantly more often in infants prenatally exposed to SGAs (15.6%) and FGAs (21.6%) compared to 4.2% of comparison cohort II. Cumulative incidences of elective terminations of pregnancy were significantly higher in both the study cohort (17%) and comparison cohort I (21%) compared to comparison cohort II (3%), whereas the rates of spontaneous abortions did not differ. The numbers of stillbirths and neonatal deaths were within the reference range. Preterm birth and low birth weight were more common in infants exposed to FGAs. To conclude, our findings did not reveal a major teratogenic risk for SGAs, making the better studied drugs of this group a treatment option during pregnancy. Because neonates exposed to SGAs or FGAs in the last gestational week are at higher risk of postnatal disorders, delivery should be planned in clinics with neonatal intensive care units.

Thirty-five patients were prospectively examined on average 5.9 and 11.1 months after reconstruction of the anterior cruciate ligament. Eighteen patients were treated postoperatively with a regular physiotherapy (PT) program 2-3 times per week for 30 min, 17 patients with a special, extended, and supervised rehabilitation program 3-5 times per week for 2.5 h. Criteria for exclusion from this study were previous operation or fractures of the affected knee. The bases for the evaluation of the clinical results were the clinical examination, the Lysholm and Tegner scores, KT 1000, angular reproducibility according to Barrett (proprioception), and the figure-of-eight hop test. It appeared that patients treated with extended ambulatory physiotherapy (EAP) gained a significantly higher degree of functionality in the Lysholm score after 5.9 months (p < 0.02) and the Tegner score after 11.1 months (p < 0.05) than patients treated with regular physiotherapy. Patients treated with EAP also displayed better results in the proprioceptive capability test with an angular deviation of 5.8 degrees after 5.9 months compared to 11 degrees in patients receiving regular PT. After 11.1 months, there were no differences in proprioceptive capability between the two groups. Although the EAP patients were faster in the figure-of-eight hop test (0.39 s difference compared to 0.58 s in the PT patients), the results were not statistically significant. In KT 1000 ventral tibial instability was on average 21% lower in the PT patients than in the EAP patients. After 11.1 months, both groups exhibited the same median value of 3 mm. Furthermore, EAP patients were able to return to work after 36.7 days on average, a 35% shorter period than in the case of PT patients (55 days), also of statistical significance (p < 0.02). To conclude, the primarily higher costs of this intensive rehabilitation program are justified by the better functional outcome linked with an earlier return to work.

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