Sturla Eik-Nes: Background
“To a man with a hammer, everything looks like a nail.” --Mark Twain

EIk-Nes et al. 1984, Letters to the Editor, The Lancet: "Ultrasound screening in pregnancy: a randomised controlled trial"
"This prospectively randomised study has demonstrated that the use of ultrasound screening in an area with experience with antenatal ultrasound diagnosis did not cause any increased use of hospital resources; it reduced the perinatal deaths and decreased morbidity. The diagnosis of severe growth retardation in the ultrasound-examined group had significant consequences. Full details of this study will be published elsewhere." (Source: "Ultrasound screening in pregnancy: a randomised controlled trial" Eik-Nes, SH, Okland, O, Aure, JC, and Ulstein, M.  Lancet. 1984; 1: 1347)

Iain Chalmers: "Underreporting Research is Scientific Misconduct"
Following is the Abstract and a separate Description (by Kennedy Institute of Ethics (KIE)) of Iain Chalmers' 1990 JAMA article which makes the point that "uderreporting research is scientific misconduct."

• Abstract
  "Substantial numbers of clinical trials are never reported in print, and among those that are, many are not reported in sufficient detail to enable judgments to be made about the validity of their results. Failure to publish an adequate account of a well-designed clinical trial is a form of scientific misconduct that can lead those caring for patients to make inappropriate treatment decisions. Investigators, research ethics committees, funding bodies, and scientific editors all have responsibilities to reduce underreporting of clinical trials. An extended use of prospective registration of trials at inception, as well as benefiting clinical research in other ways, could help people to play their respective roles in reducing underreporting of clinical trials." (Source: "Underreporting Research is Scientific Misconduct" Iain Chalmers. JAMA: The Journal of the American Medical Association, Vol 263. No.10, 1405-1408. doi:10.1001/jama.1990.03440100121018)
  Description (KIE)
  ​Chalmers discusses two phenomena that he regards as forms of scientific misconduct. The first is the selection of reports for publication on the basis of "positive results" rather than of whether they have been well conceptualized and competently executed. The second is the failure of investigators to publish results with sufficient detail to allow judgments to be made about their validity. Chalmers gives examples of underreporting of research in the field of perinatology, and reports on a survey he and colleagues conducted in an attempt to identify unpublished randomized trials. He discusses ways that the problem of underreporting might be reduced through the efforts of investigators, funding organizations, ethics committees, and journal editors. Chalmers suggests that these efforts could be aided by wider adoption of prospective registration of trials at their inception.  (Source: "Underreporting research is scientific misconduct." Chalmers I, National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford, England.. JAMA. 1990 Mar 9;263(10):1405-8.) [Note: KIE = Kennedy Institute of Ethics]
• "SCIENTIFIC misconduct is commonly conceptualized as deliberate falsification of data—a sin of commission—but sins of omission may be even more important." (Source: Ibid., p. 1405)
• "Selective underreporting of research is almost certainly more widespread and more likely to have adverse consequences for patients than the publication of deliberately falsified data." (Source: "Underreporting Research is Scientific Misconduct" Iain Chalmers. JAMA: The Journal of the American Medical Association, Vol 263. No.10, 1405-1408, p. 1405. doi:10.1001/jama.1990.03440100121018)
• "Adequate reporting of clinical trials is required for both scientific and ethical reasons. Failure to publish "disappointing" or "uninteresting" research results, or failure to report results in sufficient detail, may either lead patients to receive ineffective or dangerous forms of care or result in a delay in recognizing that other forms of care are beneficial. Neither of these consequences is in the interests of patients. In addition, failure to provide adequate, publicly available reports of the results of clinical trials does an injustice to the patients who have participated in them, as well as to others who have collaborated with the investigators and those who have provided funds or other resources." (Source: Ibid., p. 1405-1406)
• "EXAMPLES OF THE CONSEQUENCES OF UNDERREPORTING CLINICAL TRIALS"
  (...)
  The second example from the perinatal field concerns the unresolved question as to whether routine (as opposed to selective) ultrasonography is justified in every pregnancy. 9 Controlled comparisons of routine and selective ultrasonography have shown that routine ultrasonography is associated with a lower incidence of induction of labor in pregnancies deemed to be "postterm," but the published trials have not been large enough to assess whether this effect is associated with any reduction in the frequency of substantive adverse outcomes of pregnancy."
  
  The confusion in this field is compounded by the fact that one large trial of routine ultrasonography, conducted nearly 10 years ago, remains unpublished. 10 If the results of this trial show beneficial effects of routine ultrasonography, this would be important evidence on which to base current policy; if no benefits are demonstrated, this might reflect either technical inadequacies of the ultrasound equipment (or its application) during the era in which the trial was conducted, or the fact that routine ultrasonography has nothing important to offer over selective use of the technology. Either way, a full report of the results of the trial has current relevance.
• Assessment of the effects of routine ultrasonography in pregnancy is also bedeviled by inadequate published reports of relevant trials. The only randomized trial to suggest that routine ultrasonography has any beneficial effects on substantive outcomes of pregnancy is that conducted in Àlesund, Norway, by Eik-Nes and colleagues in 1979 and 1980. This potentially important trial has never been fully reported in a scientific journal. The reports that are available are contradictory in a very important respect. The only readily available account of the trial, published as a letter to the editor in The Lancet," states that women allocated to routine ultrasonography were compared with controls who "were not examined routinely but could be referred for ultrasound examination on a clinical indication." This description is at odds with an account of the trial presented to and published by the National Institutes of Health some months earlier. In that report Eik-Nes and Okland12 state that, "The pregnant population was randomized either to have routine ultrasound examination twice in pregnancy or not to have ultrasound at all [my emphasis].... The control group with no ultrasound went through routine pregnancy care as had been done before ultrasound was introduced at the hospital. All the problems in connection with the pregnancy were solved without the use of ultrasound."
• This inconsistency between the only two reports of this trial is clearly of great importance in any attempt to answer the still inadequately addressed question of whether routine ultrasonography is preferable to selective ultrasonography (as opposed to withholding ultrasonography completely). Again, substantial health service resources are involved, and, furthermore, there is no basis for assuming that routine ultrasonography is innocuous."
• "DIFFICULTIES IN CORRECTING THE PROBLEM OF UNDERREPORTING AFTER THE EVENT
  The two perinatal examples cited above were selected to illustrate how inadequate reporting of clinical research can jeopardize the formulation of well-founded clinical policies. Because of this effect, underreporting operates against the interests of patients, not to mention those who fund health services, including the public. In collaboration with many colleagues, I have been involved in a systematic attempt to evaluate the effects of the various elements of care offered to women during pregnancy and childbirth. Using a variety of methods that have been reported in detail elsewhere,13 we have tried to reduce the problems that can result from the kind of inadequate reporting of clinical research illustrated above." (Source: "Underreporting Research is Scientific Misconduct" Iain Chalmers. JAMA: The Journal of the American Medical Association, Vol 263. No.10, 1405-1408. doi:10.1001/jama.1990.03440100121018)

"From politics to ethics - obstetric ultrasound in the 1980s and 90s"
​Included below is an excerpt from the 2008 article "From politics to ethics - obstetric ultrasound in the 1980s and 90s" by Lise Kvande in Tidsskrift for Den norske legeforening and an excerpt from Lise Kvande's 2008 NTNU PhD Thesis. Both excerpts serve to introduce relevant research ethics and medical ethics background information regarding Sturla H. Eik-Nes, head of the NCFM eSnurra Group.

• "Discussions on this issue, and whether midwives or doctors should be in charge of the routine investigations were started, but only took off in full in 1984. The recommendation from the so-called Bakketeig selection on perinatal care was presented and the selection was negative for screening (12). The reason for this assessment was one randomized controlled study from Trondheim was about to conclude that screening was expensive and had limited clinical usefulness (13). One corresponding study in Ålesund which was the first to publish contradictory conclusions, which did not add weight to the selection (14). The disadvantage of the study from Ålesund was that it had been published only as a reader post [letter to the Editor] for several years. The basic material was not sufficiently presented so that one could have full confidence in the conclusions."
  "Diskusjonar om dette spørsmålet, og ma om det var jordmødrer eller legar som burde stå for rutineundersøkingane, var i gang, men tok av for fullt først i 1984. Innstillinga frå det såkalla Bakketeig-utvalet om perinatalomsorgen vart lagt fram, og utvalet var negativt til screening ( 12 ). Til grunn for denne vurderinga låg ma ein randomisert kontrollert studie frå Trondheim, som var i ferd med å konkludere med at screening var kostbart og hadde avgrensa klinisk nytteverdi ( 13). Ein tilsvarande studie i Ålesund, som var først ute med å publisere motsette konklusjonar, vart ikkje tillagt vekt av utvalet ( 14 ). Ulempen med studien frå Ålesund var at han i fleire år berre var publisert som eit lesarinnlegg. Grunnlagsmaterialet var såleis ikkje tilstrekkeleg presentert til at ein kunne ha full tillit til konklusjonane." (Source: "Frå politikk til etikk – obstetrisk ultralyd i 1980- og 90-åra" ("From politics to ethics - obstetric ultrasound in the 1980s and 90s") Lise Kvande. Tidsskr Nor Legeforen 2008; 128: 2855-9) [Note: Lise Kvande's 2008 NTNU PhD Thesis titled: "Bilete av svangerskap –bilete av foster: Ultralyd-diagnostikk i norsk svangerskapsomsorg 1970–1995" provides an in-depth history of ultrasound in antenatal care and Sturla H. Eik-Nes. For what it's worth, there are 2,033 occurrences of the word "ultralyd" ("ultrasound") and 421 occurrences of the name "Eik-Nes" in the 320 pages of Lise Kvande's 2008 NTNU PhD Thesis.] [Citations: 12. Noregs offentlege utgreiingar. Perinatal omsorg i Norge. Helsearbeid blant svangre og fødende kvinner samt nyfødte barn. NOU 1984: 17.; 13. Bakketeig LS, Jacobsen G, Brodtkorb CJ et al. Randomised controlled trial of ultrasonographic screening in pregnancy. Lancet 1984; 2: 207–11. 14. Eik-Nes SH, Økland O, Aure JC et al. Ultrasound screening in pregnancy: A randomised controlled trial. Lancet 1984; 1: 1347.] 
• "This news was followed up one month later. "Injuries can be healed before birth," reported Aftenposten on the frontpage, and followed up with an article about how ultrasound could prevent fetal injuries and lead to surgical procedures on sick fetuses. 17 Professor Eik-Nes was photographed with a newborn on his arm, and concluded that ethical objections to ultrasound diagnostics were incorrect and based on lack of knowledge. "I would actually say so strongly that it would be ethically irresponsible not to allow pregnant women to undergo this form of investigation," said Eik-Nes and showed that about two percent of all newborns had one form of deviation or another. He immediately received a reply from four, female doctors who alleged he committed professional seduction and promised more than the technology could deliver. 18 They reported Eik-Nes to the Norwegian Medical Association's Board of Medical Ethics for this statement, which later agreed that this was unfortunate wording (a point of view Eik-Nes had also submitted to the council). "
  "Dette nyhendet vart følgt opp ein månad seinare. ”Skader kan leges før fødsel,” rapporterte Aftenposten på framsida, og følgde opp med ein artikkel om korleis ultralydsjekk kunne hindre fosterskadar og føre til kirurgiske inngrep på sjuke foster.17 Professor Eik-Nes var fotografert med ein nyfødd på armen, og han slo fast at etiske innvendingar mot ultralyd-diagnostikk var feil og bygde på manglande viten. "Jeg vil faktisk si det så sterkt at det ville være etisk uansvarlig ikke å la gravide gjennomgå denne formen for undersøkelse,” sa Eik-Nes og viste til at om lag to prosent av alle nyfødde hadde ei eller anna form for avvik. Han fekk straks svar frå fire kvinnelege legar, som meinte han dreiv med fagleg forføring og lovde meir enn teknologien kunne halde.18 Dei meldte Eik-Nes inn for Den norske lægeforenings Råd for legeetikk for denne utsegna, som seinare sa seg samd i at dette var uheldige formuleringar (eit synspunkt som Eik-Nes også hadde framført for rådet)." (Source: Lise Kvande's 2008 NTNU PhD Thesis p., 231-233. "Bilete av svangerskap – bilete av foster: Ultralyd-diagnostikk i norsk svangerskapsomsorg 1970–1995" ("Image of pregnancy - image of fetus: Ultrasound diagnostics in Norwegian pregnancy care 1970–1995") Trondheim, April 2008. ISBN 978-82-471-8060-0 (elektr. utg.))

​​​Ole Olsen's Letter in The Lancet Regarding Sturla Eik-Nes & Scientific Misconduct:
Included below is Correspondence published 28 April 2001 to The Lancet from Ole Olsen, a statistician and senior researcher at the Nordic Cochrane Center in Denmark, regarding Sturla H. Eik-Nes and Scientific Misconduct, with a specific reference to bending policy-relevant science with respect to the reassessment of ultrasound screening policy in Denmark. This adds to the background information provided in the excerpt from Lise Kvande's 2008 article: "From politics to ethics - obstetric ultrasound in the 1980s and 90s" and her 2008 NTNU PhD Thesis "Bilete av svangerskap – bilete av foster: Ultralyd-diagnostikk i norsk svangerskapsomsorg 1970–1995"

• "Correction of data delayed for 16 years"
  "Sir
  In a letter in The Lancet in 1984, Sturla Eik-Nes and colleagues 1 reported a beneficial effect of routine ultrasonography in pregnant women. In an editorial in the same year, 2 it was noted, however, that the study was hard to assess properly since it had not been published in detail, and in 1990, in a report on scientific misconduct, the trial was mentioned as an example of a selectively reported trial. 3 However, no detailed report was published subsequently, and when the value of ultrasonographic screening was reassessed in Denmark in the mid-1990s, the validity and status of the letter was still unclear.
  
  Eik-Nes has resisted strong pressure to publish the trial in full. In 1990, the regional research ethics committee reacted to the report on scientific misconduct and called for proper publication. In 1994, the Norwegian Minister for Health made an inquiry to the medical school, and the dean asked an independent researcher to reanalyse the data and participate in the preparation of a final report, which was ready for publication in 1995. In 1998, The Nordic Cochrane Centre wrote to Eik-Nes and the dean but received no answer. That centre brought the case to the attention of the Council on Scientific Dishonesty (NUVU) at the Norwegian Research Council later the same year. Within 1 month of NUVU accepting the case and contacting Eik-Nes, a full manuscript was submitted. We informed NUVU that a statement on potential conflict of interest in the full paper would be relevant, but such a statement was not included. The report has now been published. 4
  
  All four subconclusions in the letter were promising, but in the full report these conclusions were not sustained. Furthermore, in their letter Eik-Nes and colleagues stated that the groups did not differ for baseline risk factors, including smoking, but in the full paper there was a significant excess of smokers in the control group which creates a bias in favour of the intervention.
  
  If medicine is going to be evidence based rather than authority based, the published reports must be sound. If doubt is raised and results cannot be verified, the report should be formally retracted. Pioneers should not feel tempted to publish misleading data and unsubstantiated conclusions in a letter in a high-impact journal, use the publication for their own purposes, and delay full publication for many years without running the risk of having their letter retracted. I suggest that Eik-Nes and colleagues' original letter be formally retracted and tagged as such in Medline."
  
  "References
  1. Eik-Nes, SH, Okland, O, Aure, JC, and Ulstein, M. Ultrasound screening in pregnancy: a randomised controlled trial. Lancet. 1984; 1: 1347
  
  2. Editorial. Diagnostic ultrasound in pregnancy. Lancet. 1984; 2: 201–202
  
  3. Chalmers, I. Underreporting research is scientific misconduct. JAMA. 1990; 263: 1405–1408
  
  4. Eik-Nes, SH, Salvesen, KA, Okland, O, and Vatten, LJ. Routine ultrasound fetal examination in pregnancy: the ‘Alesund’ randomized controlled trial. Ultrasound. Obstet Gynecol. 2000; 15: 473–478"
  (Source: "Correction of data delayed for 16 years" Ole Olsen. The Lancet Volume 357, No. 9265, p1360, 28 April 2001. DOI: https://doi.org/10.1016/S0140-6736(00)04478-0.   Also, see PDF with Author's reply)

Sturla Eik-Nes' Reply to Ole Olsen's Letter Regarding Scientific Misconduct, Published in The Lancet:
Included below is the "Author's reply Correspondence" from Sturla H. Eik-Nes to The Lancet regarding Ole Olsen's Correspondence "Correction of data delayed for 16 years". This was published 28 April 2001.

• "Author's reply to: Correction of data delayed for 16 years"
  "Sir—It is quite correct that the our letter was used as an example of a selectively reported trial by Chalmers and colleagues. The issues with the study were, however, an unfortunate combination of computer registration difficulties on an old computer, practical difficulties related to the main investigator moving to a different university soon after publication, the establishment of a national centre in fetal medicine, and adequate reason to believe that the data ought to be completely rechecked and cross checked before a full publication was prepared. The need for reanalysis was appropriately reported. 1
  
  Ole Olsen and colleagues have promoted full publication of the data. The necessary checking and rechecking of the data was done at a pace accordant with the working conditions of the main investigator, and the data were published last year, as Olsen cites, in a state we believe to be completely correct. The study was one of the first randomised controlled trials to address the routine use of ultrasound; the publication of reliable data, even if late, was therefore thought more important than publication itself. In this case, assurance of reliability unfortunately took a long time, but does this warrant a label of misconduct?
  
  There was not an excess of smokers among the controls compared with the screened participants, as Olsen claims. If any bias were caused by smoking; then it is in favour of the controls.
  
  Olsen informs the readers of The Lancet that he brought the case to the attention of the NUVU in Norway. The council spent 1·5 years checking the data and interviewing the investigators and others involved. In conclusion, the council criticised me for late full publication, which I think is fair. They find no grounds to retract the letter, based on a comparison of the letter and the full publication, and a thorough assessment of the total publication process. We wonder why Ole Olsen, who instigated the NUVU investigation and has been fully informed of its outcome, has chosen to mention the investigation without including this outcome. The omitting of these results is misinformation.
  
  The complete data from the Alesund and Trondheim studies are now available for assessment.1, 2, 3,4, 5 I believe this series of reports, all published in high-ranking journals, is of importance for the analysis of the routine use of ultrasound."
  
  References
  1. Salvesen, KÅ, Bakketeig, LS, Eik-Nes, SH, Undheim, JO, and Økland, O. Routine ultrasonography in utero and school performance at age 8–9 years. Lancet. 1992; 339: 85–89
  
  2. Salvesen, KÅ, Vatten, LJ, Jacobsen, G et al. Routine ultrasonography in utero and subsequent vision and hearing at primary school age. Ultrasound Obstet Gynecol. 1992; 2: 243–247
  
  3. Salvesen, KÅ, Vatten, LJ, Eik-Nes, SH, Hugdahl, K, and Bakketeig, LS. Routine ultrasonsography in utero and subsequent handedness and neurological development. BMJ. 1993; 307: 159–164
  
  4. Salvesen, KA, Jacobsen, G, Vatten, LJ, Eik-Nes, SH, and Bakketeig, LS. Routine ultrasonography in utero and subsequent growth during childhood. Ultrasound Obstet Gynecol. 1993; 3: 6–10
  
  5. Bakketeig, LS, Eik-Nes, SH, Jacobsen, G et al. Randomised controlled trial of ultrasonographic screening in pregnancy. Lancet. 1984; 2: 207–211
  (Source: "Author's reply to: Correction of data delayed for 16 years" Sturla H. Eik-Nes. The Lancet Volume 357, No. 9265, p1360–1361, 28 April 2001    DOI: https://doi.org/10.1016/S0140-6736(00)04479-2.   Also, see PDF)

"Eik-Nes is accused of cheating"
Included below is the 10 May 2001 Adresseavisen article titled "Eik-Nes is accused of cheating" ("Eik-Nes beskyldes for juks") which includes content from Ole Olsen. This article was published 12 days after publication of Ole Olsen's letter to The Lancet on 28 April 2001.

• Eik-Nes is accused of cheating
  Eik-Nes beskyldes for juks
  
  A Danish statistician accuses professor Sturla Eik-Nes of the Regional Hospital in Trondheim of cheating and accuses him of balancing on the verge of scientific dishonesty.
  En dansk statistiker beskylder professor Sturla Eik-Nes ved Regionsykehuset i Trondheim for juks og anklager ham for å balansere på kanten av vitenskapelig uredelighet.
  
  "It's very unfortunate if researchers can publish misleading data in employment magazines and use it to promote their own career. It should have consequences if a researcher is unable to answer when doubts are raised about his results," says Statistics and Senior Researcher Ole Olsen for Danish Dagens Medicin.
  - Det er svært uheldig hvis forskere kan publisere misvisende data i ansette magasiner og bruke det til å fremme egen karriere. Det bør få konsekvenser hvis en forsker ikke er i stand til å svare for seg når det reiser tvil om hans resultater, sier statistikeren og seniorforskeren Ole Olsen til det danske Dagens Medicin. 
  
  The background is a letter to the editor Eik-Nes got published in the renowned journal The Lancet in early 1984. Through a comprehensive survey, Eik-Nes had revealed several benefits of giving women routine ultrasound in the 18th and 32nd week of pregnancy.
  Bakgrunnen er et leserinnlegg Eik-Nes fikk publisert i det anerkjente tidsskriftet The Lancet så tidlig som i 1984. Gjennom en omfattende undersøkelse hadde Eik-Nes avdekket flere fordeler ved å gi kvinner rutinemessig ultralyd i 18. og 32. svangerskapsuke. 
  
  The results showed that women who received routine ultrasound gave birth to fewer dead children and fewer children needed admission. At the same time it was shown that routine surveys did not lead to increased health care costs. Eik-Nes and his research colleagues promised in the article to come back with a detailed explanation of the survey. 
  Resultatene viste at kvinner som fikk rutinemessig ultralyd fødte færre døde barn og færre barn hadde behov for innleggelse. Samtidig ble det vist til at rutineundersøkelser ikke medførte økte utgifter for helsevesenet. Eik-Nes og hans forskerkolleger lovte i artikkelen å komme tilbake med en detaljert redegjørelse for undersøkelsen.
  
  "Only after 16 years was it possible to pressure the Norwegian researchers to publish the final results, and they give a completely different picture. They do not show a decrease in mortality, and the number of children is not mentioned in the article. In terms of consumption of resources, the survey now shows that it has increased in the group routinely scanned," says Ole Olsen. He is a senior researcher at the Nordic Cochrane Center in Denmark.
  - Først etter 16 år har det lyktes å presse de norske forskerne til å offentliggjøre de endelige resultatene, og de gir et helt annet bilde. De viser ikke nedgang i dødeligheten, og antall innleggelse av barna nevnes ikke i artikkelen. Når det gjelder forbruk av ressurser, viser undersøkelsen nå at den har økt i gruppen som rutinemessig ble skannet, sier Ole Olsen. Han er til daglig seniorforsker ved Det Nordiske Cochrane-senteret i Danmark. 
  
  Sturla Eik-Nes thinks there is no big difference between the letter to the editor in 1984 and the article now published in the Journal of Ultrasound in Obstetrics and Gynecology. But he regrets that it has taken so long.
  Sturla Eik-Nes mener det ikke er stor forskjell på innlegget i 1984 og artikkelen som nå er publisert i tidsskriftet Journal of Ultrasound in Obstetrics and Gynegogoy. Men han beklager at det har tatt så lang tid. 
  
  "This is due, among other things, to an unfortunate combination of data registration problems and the fact that I have changed jobs along the way. I've been very busy, and eventually the project became a "child of pain" which had to be done," says the RiT professor to Dagens Medicin.
  - Det skyldes blant annet en uheldig kombinasjon av problemer med dataregistreringen, og at jeg har byttet jobb underveis. Jeg har hatt det svært travelt, og etter hvert ble prosjektet et ”smertens barn” som måtte gjøres ferdig, sier RiT-professoren til Dagens Medicin. 
  
  Sturla Eik-Nes is head of the National Center for Fetal Medicine at the Regional Hospital in Trondheim and became president of the International Society of Ultrasound in Obstetrics and Gynecology in 1998. He has, among other things, received the Ian Donald Gold Medal, which is the highest achievement to receive in the field of ultrasound work in obstetrics and gynecology.
  Sturla Eik-Nes er leder av Nasjonalt Senter for Fostermedisin ved Regionsykehuset i Trondheim og ble i 1998 president for Verdensforbundet for ultralyd og kvinnesykdommer og fødselshjelp. Han har blant annet mottatt Ian Donald Gold Medal, som er den høyeste utmerkelse å få innen arbeid med ultralyd i gynekologi og fødselsmedisin. (Source: "Eik-Nes is accused of cheating" ("Eik-Nes beskyldes for juks" ) Adresseavisen, Published: 10.05.2001 11:16, Last updated: 24.04.2012 11:39)

Outcomes Reporting Bias
A 2004 study confirmed the problem of selective reporting of outcomes, empirically. "Our study had 3 goals: (1) to determine the prevalence of incomplete outcome reporting in published reports of randomized trials; (2) to assess the association between outcome reporting and statistical significance; and (3) to evaluate the consistency between primary outcomes specified in trial protocols and those defined in the published articles."

• "Abstract
  Context  Selective reporting of outcomes within published studies based on the nature or direction of their results has been widely suspected, but direct evidence of such bias is currently limited to case reports.
  Objective  To study empirically the extent and nature of outcome reporting bias in a cohort of randomized trials.
  (...)
  Conclusions  The reporting of trial outcomes is not only frequently incomplete but also biased and inconsistent with protocols. Published articles, as well as reviews that incorporate them, may therefore be unreliable and overestimate the benefits of an intervention. To ensure transparency, planned trials should be registered and protocols should be made publicly available prior to trial completion." (Source: "Empirical Evidence for Selective Reporting of Outcomes in Randomized Trials Comparison of Protocols to Published Articles" An-Wen Chan, MD, DPhil; Asbjørn Hróbjartsson, MD, PhD; Mette T. Haahr, BSc; Peter C. Gøtzsche, MD, DrMedSci; Douglas G. Altman, DSc. JAMA. 2004;291(20):2457-2465. doi:10.1001/jama.291.20.2457P)

---

 "CHEATING: How researchers are cheating and why it's not so dangerous ..." (2011) by Erik Tunstad
"JUKS: Hvordan forskere svindler og hvorfor det ikke er så farlig ..." (2011) by Erik Tunstad

Included below is an extended excerpt from Erik Tunstad's book that discusses the research misconduct issues (bending policy-relevant science) relative to the incredible 16-year gap between the date Sturla H. Eik-Nes prematurely published selected results from a 1984 ultrasound study and the date the actual study was published. Specifically, after intense pressure, Eik-Nes et al. finally relented and "Routine ultrasound fetal examination in pregnancy: the ‘Alesund’ randomized controlled trial" was published by Ultrasound in Obstetrics & Gynecology (UOG) in 2000. It is interesting to note Sturla H. Eik-Nes was President of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) (1998-2002) at the time.

• "In the early 1990s, I interviewed two researchers at NTNU in Trondheim. A little into in the conversation, the atmosphere became more intimate, they leaned forward, their voices lowered - and then came the story of Sturla Eik-Nes:
  "Tidlig på 1990-tallet gjorde jeg et intervju med to forskere på NTNU i Trondheim. Et stykke ut i samtalen ble stemningen mer intim, de lente seg fremover, senket stemmene - og så kom historien om Sturla Eik-Nes:
  
  It started in Ålesund in 1979, when Eik-Nes examined the possible benefit of ultrasound testing of all pregnant women - not only in cases where there was suspicion that something was wrong during pregnancy.
  Det startet i Ålesund i 1979, da Eik-Nes undersøkte en eventuell nytte av å foreta ultralydundersøkelse av alle gravide - altså ikke bare i de tilfellene man hadde mistanke om at noe var galt under svangerskapet.
  
  Eik-Nes meant his research showed that it is a good idea to offer ultrasound to all pregnant women, something he expressed in an informal article - not a scientific publication - in The Lancet in 1984. The problem was that Eik-Nes then did not write anything more about the case, at least he never published any scientific article.
  Eik-Nes mente forskningen hans viste at det er en god idé å tilby ultralyd til alle gravide, noe han ga uttrykk for i en uformell artikkel - altså ikke en vitenskapelig publikasjon - i The Lancet i 1984. Problemet var at Eik-Nes deretter ikke skrev noe mer om saken, i hvert fall publiserte han aldri noen vitenskapelig artikkel.
  
  This is a fraud, my sources said. And they were not alone in thinking so: Eik-Nes had already been accused of fraudulent research in 1990 on the front page of JAMA, Journal of the American Medical Association. It was the famous social worker, Iain Chalmers who argued that the lack of published research results is to be considered research misconduct.
  Dette er svindel, sa mine kilder. Og de var ikke alene om å mene det: Eik-Nes hadde allerede i 1990 vært beskyldt for uredelig forskning på forsiden av JAMA, Journal of the American Medical Association. Det var den kjente samfunnsmedisineren Iain Chalmers som her argumenterte for at manglende publisering av forskningsresultater er å regne som fusk i forskning. 
  
  He might have been right about it, but where did he get the case from? And why?
  Den hadde han kanskje rett i, men hvor hadde han fått saken fra? Og hvorfor?
  
  The review of the Eik-Nes and Ålesund survey could have had a killing effect, and Eik-Nes and those who agreed with him could have lost the battle for ultrasound. The discussion about the cost and benefit of ultrasound screening was the big, hot potato in the ultrasound environment in the early 1980s, and continued well into 1990s. It was at one point that Eik-Nes began to receive threatening letters and nightly phone calls. 
  Omtalen av Eik-Nes og Ålesundundersøkelsen kunne fått drepende effekt, og Eik-N es og de som var enige med ham kunne ha tapt kampen om ultralyd. Diskusjonen rundt kostnad og nytte ved ultralydscreening var den store, varme poteten i ultralydmiljøet tidlig på 1980-tallet, og den fortsatte godt ut på 1990-tallet. Den var på et tidspunkt så het at Eik-Nes begynte å motta trusselbrev og nattlige telefoner. 
  
  The JAMA article got the Regional Research Ethics Committee for Medicine to call Eik-Nes onto the carpet - where he was strongly encouraged to Complete the work: Put out a scientific article.
  JAMA-artikkelen fikk Den regionale forskningsetiske komiteen for medisin til å kalle Eik-Nes inn på teppet - hvor han ble sterkt oppfordret til å ferdigstille arbeidet: Få ut en vitenskapelig artikkel.
  
  However, the case did not get any high profile. The journal Nota Bene mentioned it, and there were articles in Aftenposten. Adresseavisa and the Nation, who could tell that undocumented research gave rise to ultrasound in Norway, but nobody screamed about Norway's honor.
  Saken fikk likevel ingen høy profil. Tidsskriftet NotaBene omtalte den, og det ble artikler i blant annet Aftenposten. Adresseavisa og Nationen, som kunne fortelle at Udokumentert forskning ga gjennomslag for ultralyd i Norge. men ingen skrek opp om Norges ære.
  
  Perhaps because the fraud is neither obvious nor perhaps as gross as in the Sudbø case? Eik-Nes had conducted a survey. He had not made it up. The only thing he had done wrong. was that he had mentioned the results publicly, without a formal scientific publication to back it up. This appears as a technical detail for outsiders - far from suitable for newspapers front pages.
  Kanskje fordi svindelen verken er så opplagt eller eventuelt så grov som i tilfellet Sudbø? Eik-Nes hadde utført en undersøkelse. han hadde ikke diktet den opp. Det eneste han hadde gjort feil. var at han hadde omtalt resultatene offentlig, uten en formell vitenskapelig publikasjon i ryggen. Slikt fremstår som en teknisk detalj for utenforstående - langt fra egnet for avisenes førstesider.
  
  The case swung back and forth over several years before it was finally laid to rest in 2000. Eik-Nes then published - finally - the scientific article he presumably should have published 16 years earlier. At the same time as Norway Research Council's Committee for Evaluation of Research Misconduct, NUVU, after two years' assessment presented its final report. It concluded that the long time that had elapsed from advance review to final publication was the longest made - contrary to good research practice - but the committee would not call it fraudulent.
  Saken svingte frem og tilbake over flere år, før den ble lagt endelig til ro i 2000. Eik-Nes publiserte da - endelig - den vitenskapelige artikkelen han antagelig burde ha publisert 16 år tidligere. samtidig som Norges forskningsråds Utvalg for vurdering av uredelighet i forskning, NUVU, etter to års vurdering la frem sin sluttrapport. Den konkluderte med at den lange tiden som hadde gått fra forhåndsomtale til endelig publisering var i lengste laget - i strid med god forskningspraksis - men utvalget ville ikke kalle det uredelig.
  
  Why did he not publish? He himself said that it was due to a short period of time. This seems credible when we see what the man has done of both research and administrative work through life. Nevertheless, why did he write in The Lancet in 1984? Perhaps for the same reason as one or more of his opponents found it opportune to accuse him of dishonesty a few years later: An attempt to influence the ultrasound case.
  Hvorfor publiserte han ikke? Han sier selv at det skyldtes tidsnød. Det virker troverdig, når vi ser hva mannen har utrettet av både forskning og administrativt arbeid gjennom livet. Likevel: Hvorfor skrev han da i The Lancet i 1984? Kanskje av samme grunn som en eller flere av hans motstandere fant det opportunt å anklage ham for uredelighet noen år senere: Et forsøk på å påvirke ultralydsakens gang.
  
  Eik-Nes and his sentences won this match. But there was an attempt to stop him through an accusation of scientific misconduct. This could have stopped him. Although the case did not create Sudboesque tremors in the public, both parliamentarians and health ministers were involved: In the new year 1994, then Minister of Health, Werner Christie, had to explain to the Storting about the "Eik-Nes case"  as he had asked the regional committee for medical research ethics to take it up again because it represented a deviation from Norwegian rules on research publishing.
  Eik-Nes og hans meningsfeller vant denne kampen. Men han ble forsøkt stoppet gjennom en anklage om vitenskapelig uredelighet. Denne kunne ha stanset ham. Selv om saken ikke skapte sudbøske rystelser i allmennheten, var både storting og helseminister involvert: På nyåret 1994 måtte daværende helseminister Werner Christie forklare seg for Stortinget om «Eik-Nes-saken», som han hadde bedt den regionale komiteen for medisinsk forskningsetikk ta opp igjen, fordi den representerte et avvik fra norske regler om forskningspublisering.
  
  Neither Eik-Nes nor his unknown opponents acted correctly in this case. Opponents less correct than Eik-Nes, we can say in retrospect. Both parties fought a research-political struggle, one willing to attack a researcher's most important asset - credibility - and thus put the fraud card on the table."
  ​Verken Eik-Nes eller hans ukjente motstandere opptrådte helt korrekt i denne saken. Motstanderne mindre korrekt enn Eik-Nes, kan vi si i ettertid. Begge parter kjempet en forskningspolitisk kamp, den ene var villig til å angripe en forskers kanskje viktigste eiendel - troverdigheten - og dermed kom svindelkortet på bordet."

Eik-Nes & Conclusions Regarding Epidemiology for Obstetric Ultrasound​

• "Non–Right-Handedness
  The first report of a possible link between prenatal exposure to ultrasound and subsequent non–right-handedness in insonated children was published in 1993 by Salvesen et al. [Salvesen KA, Vatten LJ, Eik-Nes SH, Bakketeig LS] 29 The acoustic outputs of the ultrasound instrumentation used are thought to have been around 1mW/cm^2. The authors stressed in their analysis that the association was “only barely significant at the 5% level, and the possibility of a chance finding should be kept in mind.” Unknown confounding factors may have been present. The authors recommended that no clinical conclusions be made. When looking further at their data, as a response to a letter to the editor, they described that the association was restricted to boys. 30 A second group of researchers (which included Salvesen, the main author of the first study, but with the new study performed in Sweden as opposed to Norway) published similar findings of a statistically significant association between ultrasound exposure in utero and non–right-handedness in boys. 5 The fact that similar findings appear to be present in 2 different populations seems to add weight to the proposed finding. In 1999, Salvesen and Eik-Nes 10 published a meta-analysis of these 2 studies and of previously unreported results. No difference was found in general, but a mild difference was present when analyzing boys separately. A word of caution is needed: the use of the term meta-analysis is somewhat of a misnomer. Only 2 studies were included. It is generally accepted that a meta-analysis should include at least 6 studies. Four comparisons were reported: (1) an intention-to-treat analysis, comparing those randomly assigned to receive ultrasound versus those in the nonultrasound group; (2) a further analysis of the above, limited to male infants; (3) a comparison of those who were actually scanned versus those who were not, thus breaking the original randomization of each trial; and (4) the analysis in comparison 3 limited to male infants. When analyzing the results, a small increase in non–right-handedness appeared to be present in male infants, but if one adjusts for sex subgroups, wider CIs should be used (97.5% versus 95%), and the OR 1 should be included in the CI, therefore making the difference not statistically significant. Other important points to consider: the studies by Kieler et al 5,31 were population based and observational rather than randomized and controlled, as was the study by Salvesen et al. 29 Furthermore the authors stretched their findings to describe non–right-handedness as brain damage. No valid mechanistic explanation can explain the findings. We conclude that, although there may be a small increase in the incidence of non–right-handedness in male infants, there is not enough evidence to infer a direct effect on brain structure or function or even that non–right-handedness is an adverse effect." (Source: "Conclusions Regarding Epidemiology for Obstetric Ultrasound" Jacques S. Abramowicz, MD, J. Brian Fowlkes, PhD, Andrea C. Skelly, PhD, MPH, Melvin E. Stratmeyer, PhD, Marvin C. Ziskin, MD.  American Institute of Ultrasound in Medicine (aium) • J Ultrasound Med 2008; 27:637–644 • 0278-4297/08 p. 639-640) [Note: The 2 studies which comprised the 2-study 'meta-analysis' referenced in the excerpt above include: 5. Kieler H, Axelsson O, Haglund B, Nilsson S, Salvesen KA. Routine ultrasound screening in pregnancy and the children’s subsequent handedness. Early Hum Dev 1998;50:233–245; 29. Salvesen KA, Vatten LJ, Eik-Ness SH, Bakketeig LS. Routine ultrasonography in utero and subsequent handedness and neurological development. BMJ 1993; 307:159–164.]

For additional information on obstetric ultrasound and non-right handedness see...

• 2002 "Literature review by the ISUOG Bioeffects and Safety Committee"
• 2002 "Ultrasound and left-handedness: a sinister association?"
• 2011 "Ultrasound in pregnancy and non-right handedness: meta-analysis of randomized trials"

...for which select excerpts are included below, respectively.

• "It is very difficult, if not impossible to formulate a hypothesis to explain this stated effect of ultrasound. Non-right handedness has been attributed to hypoxia-induced changes. The major bioeffects of ultrasound (tissue warming and cavitation) cannot easily, if at all, be related to such changes. The authors use terms such a ‘lesions’ and ‘brain injury’ but these are pure speculations and unnecessarily alarmist." (Source:  "Literature review by the ISUOG Bioeffects and Safety Committee" J.S. ABRAMOWICZ, G. KOSSOFF, K. MARSˇÁL and G. TER HAAR. Ultrasound Obstet Gynecol 2002; 19: 318–319.)
• "I have personally been involved in this debate for almost 10 years, and quite intensively so during the last couple of months. I have discussed with experts in epidemiology, laterality research and physics, and people involved with experimental studies. My personal opinion is that although a statistically significant association has been found in a subgroup analysis of the randomised controlled trials, there is not enough evidence to believe that there is a causal association." (Source: Editorial "Ultrasound and left-handedness: a sinister association?" K. Å. SALVESEN. National Center for Fetal Medicine, St. Olav University Hospital of Trondheim, N-7006 Trondheim, Norway. Ultrasound Obstet Gynecol 2002; 19: 217–221.)​
• "In conclusion, there is a weak statistically significant association between ultrasound screening and being non-right handed, but this does not mean that there must be a causal relationship. The current biological understanding of handedness is limited and partly contradictory of the epidemiological evidence. We will have to live with uncertainty regarding ultrasound safety in the years to come." (Source: "Ultrasound in pregnancy and non-right handedness: meta-analysis of randomized trials" K. A. SALVESEN, (National Center for Fetal Medicine, St. Olav University Hospital of Trondheim and Department of Laboratory Medicine, Women’s and Child Health, Norwegian University of Science and Technology, Trondheim, Norway) Ultrasound Obstet Gynecol 2011; 38: 267–271. p. 271)​

Eik-Nes: Bending Science in 2002 Dagens Medisin
Dagens Medisin's Editorial regarding "a major Norwegian study"
The 2002 Editorial "Risikabelt å overse mors termin" ("Risky to ignore mother's term") in Dagens Medisin identified important issue relating to "a major Norwegian study" which identified adverse outcomes resulting from misclassification of gestational age and term due to reliance on suboptimal, unilateral, ultrasound-based pregnancy dating. This 2002 Dagens Medisin Editorial is included below in its entirety in both English and Norwegian (English translation via Google Translate with edits). Unfortunately, the main issue discussed within this 2002 Editorial (below, emphasis added) is the same harms-causing issue of suboptimal, unilateral ultrasound-based pregnancy dating exposed and discussed within LailasCase.com, 16-years later.

• "Risky to ignore mother's term"
  "Pregnant women's own information about the term must be taken seriously, states a major Norwegian study. - If the ultrasound examination shifts the term two weeks or more, women should be closely monitored. They are at higher risk of various complications, says chief doctor Jakob Nakling. Annually this applies to approximately 4000 women."
  Published: 2002-10-10 00.00 Written by: The Editors
  "Risikabelt å overse mors termin"
  "Gravides egne opplysninger om termin må tas alvorlig, fastslår en stor norsk studie. - Hvis ultralydundersøkelse forskyver terminen to uker eller mer, bør kvinnene følges nøye opp. De har høyere risiko for ulike komplikasjoner, sier overlege Jakob Nakling. Årlig gjelder dette cirka 4000 kvinner."
  Publisert: 2002-10-10 00.00 Skrevet av: Redaktionen

• " LILLEHAMMER: About seven percent of pregnant women experience that their term is shifted two weeks or more after ultrasound examination. It shows data from the ultrasound examinations of approximately 16,000 pregnant women in Oppland.
  Must apologize  We have looked at the meaning of the term shift for the fetus. It turns out that this group is quite special. The morbidity is higher and there is greater risk of perinatal mortality before, during or immediately after birth," said Jakob Nakling. He has been chief doctor at Oppland Central Hospital at Lillehammer and is currently a special adviser to Helse Øst. The study is funded by the Research Council of Norway, and he was a PhD Fellow at the Norwegian University of Science and Technology in Trondheim from 2000 to 2001. We who do ultrasound have been very assertive: "We can best find the term." We must apologize and give redress to women because we have been arrogant and conceited, says chief doctor Nakling."
  " LILLEHAMMER: Om lag syv prosent av gravide kvinner opplever at terminen deres forskyves to uker eller mer etter ultralydundersøkelse. Det viser data fra ultralydundersøkelse av ca 16.000 gravide kvinner i Oppland.
  - Må unnskylde - Vi har sett på hvilken betydning terminforskyvning har for fosteret. Det viser seg at denne gruppen er ganske spesiell. Sykeligheten er høyere,  , under eller rett etter fødsel, sier Jakob Nakling. Han har vært overlege ved Oppland sentralsykehus på Lillehammer og er for tiden spesialrådgiver i Helse Øst. Studien er finansiert av Norges Forskningsråd, og han var doktorgradsstipendiat ved Norges teknisk-naturvitenskapelige universitet i Trondheim fra 2000 til 2001. - Vi som driver med ultralyd, har vært veldig påståelige: «Vi klarer best å finne terminen». Vi må gi kvinnene unnskyldning og oppreisning for at vi har vært arrogante og overlegne, mener overlege Nakling."
• " More risk factors  The study shows that in pregnancies where the term was shifted more than 14 days, there was a significantly higher risk of:
       - premature birth; before 37 pregnancy weeks
       - giving birth to a child under 2,500 grams
       - giving birth to a child thinner than normal
       - perinatal mortality; that the fetus dies before, during or after birth.
  The number of vacuum and forceps recoveries was higher in the group with shifted term, while the number of cesarean sections was equal. Apgar scores and the number transferred to the newborn department were also similar. "Premature birth, growth retardation and low birth weight are three important factors that affect the risk of increased morbidity and mortality in the newborn child," points out Nakling. Women with uncertain menstrual data were omitted from the study. The analyses have taken into account factors such as smoking, maternity age and parity. About 20 percent were excluded from the original data source.
  "Flere risikofaktorer  Studien viser at i svangerskap hvor terminen ble forskjøvet mer enn 14 dager, var det en signifikant høyere risiko for: - å føde for tidlig; før 37 svangerskapsuke
       - å føde et barn under 2.500 gram
       - å føde et barn som er tynnere enn det normale
       - perinatal mortalitet; at fosteret dør før, under eller etter fødsel.
  Antall vakuum- og tangforløsninger var høyere i gruppen med forskjøvet termin, mens antall keisersnitt var likt. Apgar-skåre og antallet som ble overført til nyfødtavdeling, var også likt. - For tidlig fødsel, veksthemming og lav fødselsvekt er tre viktige faktorer som påvirker risiko for økt sykdom og død hos det nyfødte barnet, påpeker Nakling. Kvinner med usikre menstruasjonsdata var utelatt fra studien. I analysene er det tatt hensyn til faktorer som røyking, mors alder og paritet. Om lag 20 prosent er ekskludert fra det opprinnelige datamaterialet."
• "Should be followed carefully  The effects already occur when the deviation between the term of the pregnancy and the ultrasound period is plus-minus four days. The effect is increasing with increasing deviations. - When the difference is more than 14 days, we must respond. This is risk eviction that will be followed up closely. We can do blood flow measurement to see if the kid gets enough nutrition in the uterus. With ultrasound we can measure whether the fetus grows as it should. Nakling says that a subgroup with a different term is not exposed to the same risk factors; women who have used birth control pills up to 6 months before fertilization. - They are more likely to ovulate later, and therefore get term offset more often. For them, deviation is not dangerous."  [Note: An ovulation test, if available and not obviated from medical evidence, can confirm time of ovulation.]
  "Bør følges nøye  Effektene inntrer allerede når avviket mellom den gravides termin og ultralydterminen er pluss-minus fire dager. Effekten stiger med økende avvik. - Når forskjellen er mer enn 14 dager, må vi reagere. Dette er risikosvangerskap som skal følges nøye opp. Vi kan foreta blodstrømsmåling for å se om ungen får nok næring i livmoren. Med ultralyd kan vi måle om fosteret vokser som det skal. Nakling sier at en undergruppe med avvikende termin ikke er utsatt for de samme risikofaktorene; kvinner som har brukt p-piller inntil 6 måneder før befruktning. - De har større sannsynlighet for eggløsningsforskyvning, og får derfor forskjøvet termin oftere. For dem er ikke avviket farlig."
• Routine ultrasound
  According to Nakling, the results are good arguments for routine ultrasound testing. - Then we can take this group up and follow it up better. He believes this can make it easier to place pregnant in the right place in a decentralized birthplace. "We do not recommend this group to give birth at the nursery or the ABC clinic, because there is a higher risk of something happening during the birth," he says. The results are published in Acta Obstetricia et Gynecologica Scandinavica. Associate Professor Bjørn Backe at NTU has been a supervisor.
  "Rutinemessig ultralyd  I følge Nakling er resultatene gode argumenter for rutinemessig ultralydundersøkelse. - Da kan vi ta inn denne gruppen og følge den bedre opp. Han mener dette kan gjøre det lettere å plassere rett gravid på riktig plass i et desentralisert fødselstilbud. - Vi vil ikke anbefale denne gruppen å føde ved fødestue eller ABC-klinikk, for det er høyere risiko for at noe skjer under fødselen, sier han. Resultatene er publisert i Acta Obstetricia et Gynecologica Scandinavica. Førsteamanuensis Bjørn Backe ved NTU har vært veileder."
• - Confirms previous findings - This study is very valuable. It is large, from a good population and confirms the trend we have seen in earlier studies. This is said by Sturla Eik-Nes at the National Center for Fetal Medicine in Trondheim. There, Katarina Tunón examined the same problem in her doctorate in 1999. "In both studies, we can conclude that among women who are postponed for more than 14 days, there is a prevalence of malformations, syndromes and growth problems - but this applies to very few," he emphasizes.
  More sources - Is it important to take the mother's term seriously? - Yes, it's always important. Good medicine is always based on information from several sources. If we only use mother's information about the last menstrual period, we can not find these cases. With only ultrasound we can not find them either. Eik-Nes says Nakling's work is another study that shows that it is possible to isolate a group with increased incidence of ultrasound problems.
  The material number  The conclusion from Tunon's study was that the material number had to be increased. Now the group in Trondheim expands the basis of her approx. 15,000 to about 40,000. "We will look at the same phenomenon and want to reduce the number of those who need intense monitoring. Then we must have a better number base," says Sturla Eik-Nes. 
  "- Bekrefter tidligere funn - Denne studien er veldig verdifull. Den er stor, fra en god populasjon og bekrefter det vi har sett trenden av i tidligere studier. Dette sier Sturla Eik-Nes ved Nasjonalt senter for fostermedisin i Trondheim. Der undersøkte Katarina Tunón den samme problemstillingen i sin doktorgrad i 1999. - I begge studiene kan vi konkludere at blant kvinner som får utsatt termin mer enn 14 dager, er det overhyppighet av malformasjoner, syndromer og vekstproblemer - men dette gjelder ytterst få, understreker han.
  Flere kilder - Er det viktig å ta mors termin på alvor? - Ja, det er alltid viktig. God medisin bygger alltid på informasjon fra flere kilder. Hvis vi bare bruker mors opplysninger om siste menstruasjon, finner vi ikke disse kasus. Med bare ultralyd finner vi dem heller ikke. Eik-Nes sier Naklings arbeid er nok en studie som viser at det er mulig å isolere en gruppe med økt forekomst av problemer ved hjelp av ultralyd.
  Tallmaterialet Konklusjonen fra Tunóns studie var at tallmaterialet måtte økes. Nå utvider gruppen i Trondheim grunnlaget fra hennes ca. 15.000 til om lag 40.000. - Vi vil se på det samme fenomenet og ønsker å redusere tallet på dem som trenger intens overvåking. Da må vi ha et bedre tallgrunnlag, påpeker Sturla Eik-Nes." 
• "We should perform an extra check - The study is great and reminds us that we should take extra control when the term is shifted more than two weeks, "says Torbjørn Moe Eggebø. Torbjørn Moe Eggebø is a section chief at the obstetrics clinic at Sentral Hospital in Rogaland. Most people who experience the term displacement have later ovulation than expected and healthy fetuses. [Note: An ovulation test, if available and not obviated from medical evidence, can confirm time of ovulation.]
  Will change practice  Eggebø is not surprised by displacements of two weeks - or more in some cases - are linked to risk of complications. - It's as expected. The term is determined on the basis of size measurements. If the fetus is growth restricted when we do it [ultrasound measurement], it [gestational age & term] will be shifted. Normally we do only one measurement. In my eyes, we should make an extra check of the women where the term is shifted more than two weeks. We have talked for a long time about this, but did not take it seriously. "After this study, I definitely decided that we will do it," he adds."
• "- Vi bør utføre en ekstra kontroll - Studien er flott og minner oss om at vi bør ta en ekstra kontroll når terminen forskyves mer enn to uker, sier Torbjørn Moe Eggebø. Torbjørn Moe Eggebø er seksjonsoverlege ved fødepoliklinikken på Sentralsjukehuset i Rogaland. De fleste som opplever at terminen forskyves, har senere eggløsning enn antatt og friske fostre.
  Vil endre praksis  Eggebø overraskes ikke av at forskyvninger på to uker - eller mer i noen tilfeller - er knyttet til risiko for komplikasjoner. - Det er som forventet. Terminen fastsettes på grunnlag av størrelsesmålinger. Hvis fosteret er veksthemmet når vi gjør det, vil den forskyves. Normalt foretar vi bare én måling. I mine øyne bør vi foreta en ekstra kontroll av kvinnene der terminen forskyves mer enn to uker. Vi har snakket lenge om dette, men ikke tatt det alvorlig. - Etter denne studien har jeg definitivt bestemt at vi skal gjøre det, legger han til."
  [Note: Torbjørn Moe Eggebøe replaced Sturla H. Eik-Nes as the head or section chief (seksjonsoverlege) of National Center for Fetal Medicine in 2013, However, neither Eik-Nes nor Eggebøe ever implemented that which they stated was needed and that which they stated they would implement in their 2002 cooperation with the Dagens Medisin Editorial "Risikabelt å overse mors termin" ("Risky to ignore mother's term'). Why?]
• "- Listen to the woman! "This is an important work," says section chief Tore Henriksen at the birth department at Rikshospitalet. He does not want to comment on the study in detail, but supports Nakling that women's own information must be taken seriously. - Ultrasound is a good aid for determining the term, but it should not be used blindly. In practice, I always listen to what the woman says; Not very rarely, she is right. Henriksen is not surprised that some risk factors are more frequent in women where the term is shifted by two weeks or more and stresses that it is important to be careful with this group."
  "- Lytt til kvinnen! - Dette er et viktig arbeid, fastslår seksjonsoverlege Tore Henriksen ved fødeseksjonen på Rikshospitalet. Han vil ikke kommentere studien i detalj, men støtter Nakling i at kvinners egne opplysninger må tas på alvor. - Ultralyd er et godt hjelpemiddel for å bestemme termin, men det skal ikke brukes blindt. I praksis hører jeg alltid på hva kvinnen sier; ikke helt sjelden har hun rett. Henriksen overraskes ikke over at enkelte risikofaktorer er hyppigere hos kvinner hvor terminen forskyves med to uker eller mer, og understreker at det er viktig å være påpasselig med denne gruppen."
• "Impact must be investigated  Torvid Kiserud, Chief of Section for Fetal Medicine at Haukeland Hospital is not surprised at the results, but believes they coincide with other research. - Further studies are required, but it is advisable to pay particular attention to pregnancies where the ultrasound term is significantly different from the certain menstrual term. Which category of small fetuses we should aim at identifying, their management and the benefit of such strategy are still in need of scientific documentation."
  "Konsekvenser må utredes  Heller ikke overlege Torvid Kiserud ved Seksjon for fostermedisin på Haukeland sykehus er overrasket over resultatene, men mener de sammenfaller med annen forskning. - Det trengs videre studier, men det er anbefalelsesverdig å følge spesielt med på svangerskap der ultralydterminen er vesentlig forskjellig fra sikker menstruasjontermin. Detaljene i hvilken gruppe av de små vi vil identifisere, hvilke konsekvenser vi skal ta av det og hvilken nytte slik omsorg har, må fortsatt utredes."
• Affordable and necessary  "It is commendable to undertake such a reassessment of new measures - in particular, that it is done outside the university hospitals. The findings are not very surprising when the deviation is greater than two weeks, says Professor Ole-Erik Iversen at the Women's Clinic at Haukeland University Hospital. Iversen says the scientific evidence was limited when routine ultrasound for pregnant women was introduced. At two Norwegian consensus conferences, it has been established that the method is so well incorporated that it is unacceptable to remove it, even if the scientific evidence of the medical benefits have not been totally convincing."
  "Prisverdig og nødvendig  - Det er prisverdig å foreta slik ettervurdering av nye tiltak - spesielt at det gjøres utenfor universitetssykehusene. Selve funnene er ikke veldig overraskende når avviket er større enn to uker, sier professor Ole-Erik Iversen ved Kvinneklinikken på Haukeland universitetssykehus. Iversen sier den vitenskapelige dokumentasjonen var begrenset da rutinemessig ultralyd for gravide ble innført. Ved to norske konsensuskonferanser er det slått fast at metoden er så godt innarbeidet at det er uaktuelt å ta den vekk, selv om vitenskapelig dokumentasjon av medisinsk nytte ikke har vært helt overbevisende."
• Byproduct for clinical work  - Nakling and Backe have further characterized the routine use of ultrasound and highlight the side effects of the method. This is relevant to a healthcare system that uses significant resources every year on 60,000 routine ultrasound examinations of pregnant women, says the Professor in Bergen. Iversen also points out that scientists make observations as a byproduct for clinical work. In Oppland, a good database was created early to systematise ultrasound findings.
  "Biprodukt til klinisk arbeid  - Nakling og Bakke [sic] har karakterisert rutinebruk av ultralyd ytterligere og belyser bivirkningene ved metoden. Dette er relevant for et helsevesen som årlig bruker betydelige ressurser på 60.000 rutinemessige ultralydundersøkelser av gravide, sier professoren i Bergen. Iversen poengterer også at forskerne får frem observasjonene som et biprodukt til klinisk arbeid. I Oppland ble det tidlig opprettet god database for å systematisere ultralydfunn." 
• "Research as a side effect  - Many different doctors and midwives perform ultrasound examinations. Nevertheless, Nakling and Backe find interesting results. Ultrasound is overall better than the alternative, but it does not apply to everyone, says Iversen. - The researchers have documented an adverse event in the ultrasound determination of the term when displaced more than 14 days. It is negative for the method, but positive because you can take precautions for these women. The question becomes how intensive and resourcefully they will be followed up. This must be discussed further among the experts, says Ole-Erik Iversen. Origin: Today's Medicine 17/02 Hilde Kari Nylund"
  "Forskning som bivirkning  - Mange ulike leger, og jordmødre, utfører ultralydundersøkelser. Likevel finner Nakling og Bakke [sic] interessante resultater. Ultralyd er totalt sett bedre enn alternativet, men det gjelder ikke for alle, sier Iversen. - Forskerne har dokumentert en bivirkning ved ultralydbestemmelse av fødselstermin; når den forskyves mer enn 14 dager. Det er negativt for metoden, men positivt ved at man kan ta forholdsregler for disse kvinnene. Spørsmålet blir hvor intensivt og ressurskrevende de skal følges opp. Dette må diskuteres videre blant ekspertene, sier Ole-Erik Iversen. Opphav: Dagens Medisin 17/02 Hilde Kari Nylund"

The "major Norwegian study" which was covered in the "Risky to ignore mother's term" ("Risikabelt å overse mors termin") Editorial in Dagens Medisin is the 2002 study included as Paper I within Jakob Nakling's 2008 NTNU PhD Thesis: "Results and consequences of routine ultrasound screening in pregnancy - A geographic based population study"  .

• Nakling's Paper I: "Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination" Nakling J, Backe B. Acta Obstet Gynecol Scand, 2002; 81: 846-51.
  
  Aim: "To assess the obstetric outcome when the interval between the estimated date of delivery by last menstrual period and the estimated date of delivery by second trimester ultrasound exceeds 14 days
  
  Abstract Conclusion: "Fetuses that are smaller than expected at the mid‐second trimester ultrasound corresponding to a discrepancy of more than 14 days have an increased risk for adverse obstetric outcome."

Interestingly, this seminal 2002 "major Norwegian study"  by Nakling & Backe completely contradicted the 2 similar 1999 studies, Paper III and Paper IV, included within Katarina Tunón's 1999 NTNU PhD Thesis: "Ultrasound Prediction of Gestational Age"

1. Tunón's Paper III: "Fetal outcome when the ultrasound estimate of the day of delivery is more than 14 days later than the last menstrual period estimate"  K. Tunón, S. H. Eik-Nes and P. Grøttum. Ultrasound Obstet Gynecol 1999;14:17–22.
   
    Abstract: Conclusion: "There was no indication of any adverse consequence of the routine scan and change of estimated day of delivery among 15 000 pregnancies in a non-selected population." (p. 17)
   
   
2. Tunón's Paper IV: "Fetal outcome in pregnancies defined as post-term according to the last menstrual period estimate, but not according to the ultrasound estimate" K. Tunón, S. H. Eik-Nes and P. Grøttum. Ultrasound Obstet Gynecol 1999;14:12–16.
   
   Abstract Conclusion: "The effect of ultrasound in changing the estimated day of delivery to a later date leading to pregnancies becoming post-term according to the last menstrual period estimate but not according to the ultrasound estimate does not have any adverse consequences for the fetal outcome. However, there seems to be an increased risk for adverse consequences for pregnancies that are post-term according to the ultrasound estimate.  (p. 12)

Moreover, Stula H. Eik-Nes grossly misrepresented the conclusions of Katarina Tunón's 1999 NTNU PhD Thesis when he stated the following:

• "Confirms previous findings - This study is very valuable. It is large, from a good population and confirms what we have seen as the trend of earlier studies. This is what Sturla Eik-Nes said at the National Center for Fetal Medicine in Trondheim. There, Katarina Tunón examined the same problem in her doctorate in 1999. "In both studies, we can conclude that among women who are postponed for more than 14 days, there is a prevalence of malformations, syndromes and growth problems - but this applies to very few," he emphasizes."
  "Bekrefter tidligere funn - Denne studien er veldig verdifull. Den er stor, fra en god populasjon og bekrefter det vi har sett trenden av i tidligere studier. Dette sier Sturla Eik-Nes ved Nasjonalt senter for fostermedisin i Trondheim. Der undersøkte Katarina Tunón den samme problemstillingen i sin doktorgrad i 1999. - I begge studiene kan vi konkludere at blant kvinner som får utsatt termin mer enn 14 dager, er det overhyppighet av malformasjoner, syndromer og vekstproblemer - men dette gjelder ytterst få, understreker han."
  
  
• "More sources - Is it important to take the mother's term seriously? - Yes, it's always important. Good medicine is always based on information from several sources. If we only use mother's information about the last menstrual period, we cannot find these cases. With only ultrasound we cannot find them either. Eik-Nes says Nakling's work is another study that shows that it is possible to isolate a group with increased incidence of problems, with the help of ultrasound."
  "Flere kilder - Er det viktig å ta mors termin på alvor? - Ja, det er alltid viktig. God medisin bygger alltid på informasjon fra flere kilder. Hvis vi bare bruker mors opplysninger om siste menstruasjon, finner vi ikke disse kasus. Med bare ultralyd finner vi dem heller ikke. Eik-Nes sier Naklings arbeid er nok en studie som viser at det er mulig å isolere en gruppe med økt forekomst av problemer ved hjelp av ultralyd."
  [Note: In the 2002 Dagens Medisin Editorial: "Risikabelt å overse mors termin", Eik-Nes could not have been more clear about his belief in, and support of, obstetric & fetal medicine "based on information from several sources."  One can only wonder what changed Sturla H. Eik-Nes' thinking so radically that he worked to ensure NCFM eSnurra Group's unilateral, ultrasound-based pregnancy-dating "method" was selected as the implementation vehicle for Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's unilateral, ultrasound-based pregnancy-dating "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) with a government-mandated protocol of evidence-obviated medicine; a protocol which is proven to cause increased medical risks, critical medical mistakes and grievous medical harms (including perinatal death), unnecessarily, for some of Norway's women and their fetuses/babies.]
• "Material number - The conclusion from Tunón's study was that the material number had to be increased. Now the group in Trondheim expands the basis of her approx. 15,000 to about 40,000. "We will look at the same phenomenon and want to reduce the number of those who need intense monitoring. Then we must have a better number base,"  says Sturla Eik-Nes.
  "Tallmaterialet  Konklusjonen fra Tunóns studie var at tallmaterialet måtte økes. Nå utvider gruppen i Trondheim grunnlaget fra hennes ca. 15.000 til om lag 40.000. - Vi vil se på det samme fenomenet og ønsker å redusere tallet på dem som trenger intens overvåking. Da må vi ha et bedre tallgrunnlag, påpeker Sturla Eik-Nes."

Katarina Tunón's 1999 NTNU PhD Thesis
Included below are the stated overall aims and conclusions of the 5 studies' included within Katarina Tunón's 1999 NTNU PhD Thesis.

• AIMS OF THE STUDIES: "The overall purpose of these studies from a large scale dataset was to evaluate if the ultrasound method could be recommended for the estimation of the day of delivery to be used in all pregnancies as routine procedure" (p. 30).
• [Note: It was not possible for NCFM Snurra to estimate day of delivery since the NCFM Snurra models only predicted/estimated gestational age. The day of delivery was calculated from the NCFM Snurra prediction/estimation of gestational age using the equivalent of Naegele's rule. NCFM Snurra/eSnurra Group conflate the prediction/estimation of EDD and the prediction/estimation of gestational age as a conflate-to-obfuscate strategy for bending policy-relevant science. To further make this point, simply compare how "AIMS OF THE STUDIES" section above with the "SUMMARY: Conclusions" below with respect to "estimation of the day of delivery" and "estimation of gestational age".]
• Results: Using an ultrasound evaluation to change the estimated day of delivery to a date more than fourteen days later than the day of delivery as estimated in accordance with the last menstrual period, did not influence the risk of spontaneous abortion, perinatal death, Apgar score < 7 after 5 minutes or transfer to the neonatal intensive care unit. There was a difference of three days in the prediction of day of delivery between the two groups groups, i.e. the infants in the study group were born 3 days earlier than estimated. There was a greater number of infants with a birth weight below 2 500 g in the study group, but no difference between the groups in the number of infants with a birth weight < 2 SD below the mean according to the ultrasound estimate (Paper III). (Source: Katarina Tunón's 1999 NTNU PhD Thesis, p. 10)​
• SUMMARY: Conclusions: "In comparison with the last menstrual period, the ultrasonic measurement of the biparietal diameter is the superior method for the estimation of the day of delivery. The accuracy of the method is influenced by gender, parity, maternal age, and the experience of the operator, but these differences are small and of no clinical importance. There is no indication of any adverse consequence of the routine scan and change of estimated day of delivery. There is no indication of any increase in adverse fetal outcome for fetuses defined as post-term according to the last menstrual period estimate but not according to the ultrasound estimate. Assessment of gestational age; from the time of IVF, and from measurements of CRL or BPD in pregnancies conceived after in vitro fertilization shows high agreement between the three methods. This supports the use of ultrasound as a reliable method for estimation of gestational age. The ultrasound method can therefore be recommended as the method of choice for dating pregnancies." (p. 11)
  
  NCFM Snurra Group did not have a model/method to estimate the day of delivery. NCFM Snurra Group calculated the day of delivery from the predicted/estimated gestational age using the equivalent of Naegele's rule. Second, the actual scientific conclusion which should have been stated in Katarina Tunón's 1999 NTNU PhD Thesis is: In comparison with the last menstrual period and the ultrasound measurement of the biparietal diameter, the first-trimester ultrasound measurement of the crown-rump length is the superior ultrasound-based method for the estimation of gestational age. However, this conclusion was unwanted and inconvenient because NCFM Snurra's agenda was to ensure: 1) biparietal diameter was established as the preferred predictor measurement and 2) second-trimester was established as the preferred time for the routine (18-week) ultrasound exam. Consequently, NCFM Snurra Group cloaked their outcomes-driven research with Katarina Tunón's 1999 NTNU PhD Thesis as their means for bending policy-relevant science; and, it is working.]

Clearly, these excerpts (above) from the Main Body of Katarina Tunón's 1999 NTNU PhD Thesis completely contradict the statements made by Sturla H. Eik-Nes regarding Katarina Tunón's 1999 NTNU PhD Thesis:

• "In both studies, we can conclude that among women who are postponed for more than 14 days, there is a prevalence of malformations, syndromes and growth problems - but this applies to very few," he emphasizes."

Katarina Tunón's Paper III
Included below are the purpose and conclusions stated in Paper III of Katarina Tunón's 1999 NTNU PhD Thesis which was published as: "Fetal outcome when the ultrasound estimate of the day of delivery is more than 14 days later than the last menstrual period estimate". 

• Study Purpose: Introduction Section: "The purpose of this study was to evaluate the possibility of an increased risk of adverse fetal outcome and impaired fetal growth when the predicted day of delivery as estimated by ultrasound was more than 14 days later than the predicted day of delivery as estimated by the LMP." (p. 17)
• Abstract: Conclusion: "There was no indication of any adverse consequence of the routine scan and change of estimated day of delivery among 15 000 pregnancies in a non-selected population." (p. 17)
• Discussion Section: "In this study, based on a large, primarily non-selected population of fetuses without anomalies, no indication of adverse fetal outcome was found that could be linked to changing the estimated day of delivery as determined by ultrasound to more than 14 days later than the day of delivery that was in accordance with the LMP." (p. 20) [Note: This was the first paragraph of the "DISCUSSION" section.]
• Discussion Section Conclusion: "In conclusion, there is no indication of any adverse consequence of the routine scan and change of estimated day of delivery among 15 000 pregnancies in a non-selected population. However, further studies are required to explore this phenomenon." (p. 22)  [Note: This was the last paragraph of both the "DISCUSSION" section and the paper/article; the literal bottom line.]

Clearly, these excerpts (above) from Paper III of Katarina Tunón's 1999 NTNU PhD Thesis completely contradict the statement made by Sturla H. Eik-Nes regarding Katarina Tunón's 1999 NTNU PhD Thesis:

• "In both studies, we can conclude that among women who are postponed for more than 14 days, there is a prevalence of malformations, syndromes and growth problems - but this applies to very few," he emphasizes."

Paper III: Bending Science
[Interestingly, Paper III "Fetal outcome when the ultrasound estimate of the day of delivery is more than 14 days later than the last menstrual period estimate" from Katarina Tunón's 1999 NTNU PhD Thesis listed a relative risk of 2.07 (CI 0.93–4.61) of perinatal death as a consequence of the routine scan and change of estimated day of delivery greater than 14-days (Table 1, p. 19), but this important finding was excluded from the conclusions of Paper III. Why?

• Paper III: DISCUSSION Section: "Despite the lack of distinctive pathological findings in the deaths of fetuses in the study group, the estimated relative risk of perinatal death of 2.07 with a confidence interval of 0.93–4.61 should lead to further investigations of the frequency and causes of perinatal mortality in this group of patients. It is possible that the extensive discrepancy in gestational age is a marker for fetuses that might benefit from closer monitoring." 

Okay, go ahead and read that last sentence in the excerpt above, again, in the context of the stated study purpose. Other than being unwanted and inconvenient, why was this important finding excluded from being reported in the conclusions as many other studies have done? This relative risk of 2.07 of perinatal death was a clear indication of an adverse consequence of the routine scan and change of estimated day of delivery. The exclusion of a highly important, data-supported finding of direct relevance to the study hypothesis is bending science and would appear to fall into the category of what Iain Chalmers addressed in his 1990 JAMA article "Underreporting research is scientific misconduct" in which he criticized Sturla H. Eik-Nes.

Also, In the 2002 Editorial in Dagens Medisin, Sturla H. Eik-Nes stated: "The conclusion from Tunón's study was that the material number had to be increased." A need to increase the "material number" was neither stated nor implied as a conclusion in Katarina Tunón's 1999 NTNU PhD Thesis nor in any of the 5 studies/papers included therein.

Katarina Tunón's Paper IV
Included below are the purpose and conclusions stated in Paper IV of Katarina Tunón's 1999 NTNU PhD Thesis which was published as: "Fetal outcome in pregnancies defined as post-term according to the last menstrual period estimate, but not according to the ultrasound estimate".

• Paper IV: Introduction Section: Study Purpose:  "The purpose of this study was to determine whether the risk of adverse fetal outcome was greater for fetuses that were post-term according to the last menstrual period estimate but not according to the ultrasound estimate." (p. 12) 
• Paper IV: Abstract: Conclusion: "The effect of ultrasound in changing the estimated day of delivery to a later date leading to pregnancies becoming post-term according to the last menstrual period estimate but not according to the ultrasound estimate does not have any adverse consequences for the fetal outcome. However, there seems to be an increased risk for adverse consequences for pregnancies that are post-term according to the ultrasound estimate." (p. 12)
• Paper IV: Discussion Section: "There was no indication of any increase in adverse fetal outcome for fetuses defined as post-term according to the last menstrual period estimate but not according to the ultrasound estimate."(p. 15) 
  
  "This study did not suggest that there is any increase in the risk of adverse fetal outcome for fetuses that were post-term according to the last menstrual period estimate but not according to the ultrasound estimate." (p. 15)
• Paper IV: Discussion Section Conclusion: "In conclusion, using ultrasound to correct dates and postpone the estimated day of delivery leads to some pregnancies being defined as post-term according to the last menstrual period estimate but not as post-term according to the ultrasound estimate. However, managing these pregnancies according to the ultrasound estimate does not have any adverse consequence on the fetal outcome." (p. 15)  [Note: This was the last paragraph of both the "DISCUSSION" section and the paper/article; the literal bottom line.]

Also, and clearly, these 3 excerpts (above) from Paper IV of Katarina Tunón's 1999 NTNU PhD Thesis completely contradict the statement made by Sturla H. Eik-Nes regarding Katarina Tunón's 1999 NTNU PhD Thesis:

• "In both studies, we can conclude that among women who are postponed for more than 14 days, there is a prevalence of malformations, syndromes and growth problems - but this applies to very few," he emphasizes."

This contradiction is further complicated by the following:

• Sturla H. Eik-Nes is the principal supervisor of Katarina Tunón's 1999 NTNU PhD Thesis (p. 7)
• Sturla H. Eik-Nes is a coauthor to all 5 papers included in Katarina Tunón's 1999 NTNU PhD Thesis
• Nancy Lea Eik-Nes (Sturla H. Eik-Nes' wife) is acknowledged to have "revised and greatly improved" all of Katarina Tunon's manuscripts for her 1999 NTNU PhD Thesisd (p. 7)
• 4 of the 5 papers, i.e., Papers II - V, included in Katarina Tunón's 1999 NTNU PhD Thesis were published between 1998 and 2000 in Ultrasound Obstetrics & Gynecology (UOG) (also known as The White Journal), the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)
• Sturla H. Eik-Nes was President of ISUOG (1998-2002)

The truth: "Good medicine is always based on information from several sources. If we only use mother's information about the last menstrual period, we can not find these cases. With only ultrasound we can not find them either.

The alternative truth: 1) "In both studies, we can conclude that among women who are postponed for more than 14 days, there is a prevalence of malformations, syndromes and growth problems - but this applies to very few," he emphasizes. 2) "The conclusion from Tunon's study was that the material number had to be increased."