Abstract. The present study describes the evolution over a 5‐year period of an ultrasonic routine screening programme of a pregnant population with participation of approximately 90 % of the pregnant women. One obvious result obtained in the screening programme is the pronounced improvement of early detection of twins, the incidence now approaching 95 % with the mean gestational age for the detection being 20 (median 19) weeks. Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm (before week 37) from 33 % to 10 %. The perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme. The power of an early measurement of the fetal biparietal diameter (BPD) to predict the date of confinement was high. Of 848 pregnant women with an early BPD measurement (96.5 % were measured before the 21st gestational week), 95 % were delivered spontaneously within 12 days according to the estimates from the BPD, only 1.5 % being delivered later than the 42nd gestational week. The corresponding figures estimated from the last menstrual period was 79.3 % and 11.6 %. The experience gained from the programme recognized BPD for estimate of actual gestational age and the 17th gestational week was for practical reasons chosen for the first ultrasonic examination. As dating of the gestation is an important prerequisite in a screening programme for neural tube defect, the estimate of serum alphafetoprotein (AFP) was conveniently added to the ultrasonic screening programme. When ultrasound is used for exclusion of twins, dead fetuses, and erroneous dates, the percentage of amniocentesis occasioned by raised serum AFP value has hitherto been low (1.3 %). The introduction of ultrasound at our department has enabled us to reduce by 50 % the number of X‐ray examinations of pregnant women. The calculated cost for each examination made by midwives in our programme is Skr. 50:‐ (US $ 11).

A prospective study was performed on the effect of smoking on pregnancy, using information from 6 363 pregnancies with known smoking habits. Of these, 2806 (44%) smoked during pregnancy, and 2731 (97%) of the 2 806 reported that they smoked during the whole pregnancy. The well‐known effect on prematurity rate and mean birth weight was verified in this study. A 50% increase of prematurity rate was registered among smoking women compared with non‐smoking women. The mean birth weight reduction was 170 g among live‐born, non‐malformed children. These effects were found to occur irrespective of other variables studied: maternal age, parity, and whether the pregnancy was wanted. The body length, head circumference, and shoulder circumference were found to be reduced in children born to smoking women. Placental weight was also reduced, but the ratio placental weight over body weight increased with smoking. No effect on the malformation rate was observed, but the series is too small to exclude a teratogenic effect of smoking. Children were followed to 1 year of age. The death risk for a child of a smoking woman was found to be increased to 1.6 times that for a child of a non‐smoking woman. No significant difference in stillbirth rate was found, but an effect was found on neo‐natal death both before and after the age of 1 week, although only among non‐premature children. Among children dying before the age of 1 week, a significant increase in frequency of abruptio placentae was noted. No other specific cause of death was noted. An overall increased risk of spontaneous abortion among smoking women was verified; this was shown to be almost completely due to the association between the fact that the pregnancy was unwanted and smoking. An even higher incidence of smoking was seen among women with induced abortions. Spontaneous abortion is also associated with unwanted pregnancies, perhaps due to the presence of induced abortions among the group recorded as spontaneous abortions. Smoking was shown to be associated only with late spontaneous abortions. If there is an abortifacient effect of smoking, it must be very slight. The decreased rate of preeclamptic complications among smoking women, described by earlier authors, was verified. A similar decrease in frequency of morning sickness was also found. No effect of smoking on the mean Apgar score of surviving, non‐malformed children was seen. The sex ratio among children born to smoking women differed slightly from that born to non‐smoking women, but this difference was not statistically significant.

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