Maternal morbidity and mortality continue to rise, and pre-eclampsia is a major driver of this burden1. Yet the ability to assess underlying pathophysiology before clinical presentation to enable identification of pregnancies at risk remains elusive. Here we demonstrate the ability of plasma cell-free RNA (cfRNA) to reveal patterns of normal pregnancy progression and determine the risk of developing pre-eclampsia months before clinical presentation. Our results centre on comprehensive transcriptome data from eight independent prospectively collected cohorts comprising 1,840 racially diverse pregnancies and retrospective analysis of 2,539 banked plasma samples. The pre-eclampsia data include 524 samples (72 cases and 452 non-cases) from two diverse independent cohorts collected 14.5 weeks (s.d., 4.5 weeks) before delivery. We show that cfRNA signatures from a single blood draw can track pregnancy progression at the placental, maternal and fetal levels and can robustly predict pre-eclampsia, with a sensitivity of 75% and a positive predictive value of 32.3% (s.d., 3%), which is superior to the state-of-the-art method2. cfRNA signatures of normal pregnancy progression and pre-eclampsia are independent of clinical factors, such as maternal age, body mass index and race, which cumulatively account for less than 1% of model variance. Further, the cfRNA signature for pre-eclampsia contains gene features linked to biological processes implicated in the underlying pathophysiology of pre-eclampsia.

A variety of operations for stress incontinence or genital descensus are performed in gynecological department. The purpose of this study was to find out whether these operations influenced the patients' sexual life. In a prospective study of 55 women, all sexually active prior to the operation, various characteristics were evaluated by interview and gynaecological examination, immediately before and 6 months after the operation. We had adviced early resumption of sexual intercourse. Postoperatively, 13 of 55 (24%) patients experienced improvement in their sexual life, 37 of 55 (67%) no change, and 5 of 55 (9%) experienced a deterioration. Improvement often resulted from cessation of urinary incontinence. Deterioration was in all 5 cases due to dyspareunia and all 5 patients underwent a posterior colporrhaphy as part of the operation. We conclude that provided the patients are well-informed the prognosis for sexual life after these operations is good. However, colpoperineoplasty in combination with anterior colporrhaphy might cause dyspareunia in some patients.

Twin gestation is often a hazardous pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Among the serious complications with twins, the twin-twin transfusion syndrome complicates 5–35% of monozygotic twin pregnancies with monochorionic placentation. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. In the following paper we review the literature on the subject and report 6 cases, 5 twins and 1 triplet, that were diagnosed at our department during the period of 1993–1997 and treated conservatively. Only 1 child survived.

Objective To assess outcome in twin pregnancies according to chorionicity. Methods