To estimate if an interventional program causes a decrease in the frequency of anal sphincter ruptures. A total of 12,369 vaginal deliveries between 2002 and March 2007 were enrolled in the interventional cohort study. Slowing the... more
To estimate if an interventional program causes a decrease in the frequency of anal sphincter ruptures. A total of 12,369 vaginal deliveries between 2002 and March 2007 were enrolled in the interventional cohort study. Slowing the delivery of the infant's head and instructing the mother not to push while the head is delivered was the intervention. Data were analyzed in relation to occurrence of anal sphincter tears. The proportion of parturients with anal sphincter tears decreased significantly during the study period from 4.03% (285 of 7,069) to 1.17% (42 of 3,577) (P<.001). A similar decrease was observed for instrumental deliveries (from 16.26% to 4.90%; P<.001) and noninstrumental deliveries (from 2.70% to 0.72%; P<.001). Although the number of patients with fourth-degree anal sphincter ruptures from 2002 through 2004 was 10, 13, and 11 per year, respectively, there was just one fourth-degree anal sphincter rupture during the whole study period of 18 months (P<.001). The number of episiotomies increased from 13.9% (980 of 7,069) in the years 2002-2004, to 23.1% during the first 9 months of the intervention (416 of 1,776; P<.001), but decreased to 21.1% (381 of 1,801) during the last 9 months of the intervention. As a result of this intervention the number of anal sphincter ruptures was reduced from 4.03% to 1.17%. II.
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Research Interests: Obstetrics, Medicine, Logistic Regression, Birth Weight, Norway, and 15 morePregnancy, Humans, Female, Adult, Odds ratio, Risk Factors, Parity, Logistic Models, Confidence Interval, Cohort Studies, Episiotomy, Anal Sphincter, Anal Canal, Medical and Health Sciences, and Paediatrics and reproductive medicine
Anal sphincter rupture is a serious complication of a vaginal delivery. A considerable number of women suffer permanent anal incontinence after this type of injury. The incidence of sphincter tears is believed to have increased over... more
Anal sphincter rupture is a serious complication of a vaginal delivery. A considerable number of women suffer permanent anal incontinence after this type of injury. The incidence of sphincter tears is believed to have increased over several decades in Denmark, Norway, Sweden and Finland, but there seem to be significant differences in the incidence rates among these countries. The aim of this study is to compare frequency of anal sphincter tears among the four Nordic countries, and to discuss the possible reasons for the development. Ecological register study. Anal sphincter ruptures are registered as third and fourth degree perineal tears in the national birth and hospital registries in the Nordic countries. Data from these registries were sampled from Denmark, Finland, Norway and Sweden. The incidences of anal sphincter ruptures were calculated as percentages of all vaginal deliveries and caesarean sections were excluded. The test of relative proportions, Chi-square and linear regression modelling were used to study the difference between countries and time trends. The frequency of anal sphincter rupture was significantly higher in three countries, Denmark 3.6%, Norway 4.1% and Sweden 4.2%, compared to Finland 0.6%. The trend was clearly increasing from the early 1970s in all countries. There is a significant difference in the Nordic countries in the incidence of anal sphincter tears and a significant increment in the incidence over three decades. Our hypothesis is that change in the routines during labour may be one reason for this increment. Higher episiotomy frequency in Finland may be one contributing reason. We assume that there has been a change in the conduct of labour during the last decades, and protecting the perineum may have lost its importance in the three Nordic countries, while the classic method of protecting perineum is still in use in Finland.
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PURPOSE The primary aim of this study was to observe the change in obstetric anal sphincter tear rates in instrumental deliveries during one decade. Secondly, the changes in non-instrumental deliveries were followed. METHODS Data from all... more
PURPOSE The primary aim of this study was to observe the change in obstetric anal sphincter tear rates in instrumental deliveries during one decade. Secondly, the changes in non-instrumental deliveries were followed. METHODS Data from all deliveries at Hudiksvall Hospital, Sweden 2010-2011 and 2016-2017 were collected. The change of OASIS rate during instrumental deliveries was the most important. Statistical significances were calculated by using chi-square test, test for relative proportions, and Students t-test, where appropriate. RESULTS The total incidence of OASIS decreased significantly (from 2.54% to 0.73%, p < .001). Even the OASIS rate in instrumental deliveries decreased substantially from 15.1% to 3.0% (p = .002) but the decrease was statistically insignificant in spontaneous deliveries (from 1.22% to 0.60%, p = .065). CONCLUSION Based on the results of our study the manual protection of the perineum reduces the risk of OASIS in instrumental delivery significantly.
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Large for gestational age fetuses, also called macrosomic fetuses, represent a continuing challenge in obstetrics. We review various problems with large for gestational age fetuses. We have performed a literature search, mainly through... more
Large for gestational age fetuses, also called macrosomic fetuses, represent a continuing challenge in obstetrics. We review various problems with large for gestational age fetuses. We have performed a literature search, mainly through the database PubMed (includes the Medline database). The clinical problem is discussed from the primary care provider&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s and the obstetrician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s point of view. Macrosomia is arbitrarily defined as having a fetal weight of above the 90th percentile, a birth weight of above 4000 g or 4500 g, or a birth weight of over +2 standard deviation of the mean birth weight by gestational age. The diagnosis of macrosomia is difficult, both by palpation and symphysis fundus measurement; even with sophisticated sonographic measures. The combination of biparietal diameter, femur length and abdominal circumference appears to be no better than abdominal circumference alone. Based on the literature, labor should not be induced in nondiabetic pregnancies. The best policy is to await spontaneous birth or to induce labor after 42 weeks completion. A great number of cesarean sections have to be performed to avoid a single case of plexus brachialis paresis resulting from a difficult shoulder delivery. Cesarean section should not be considered in nondiabetic pregnancies unless the estimated fetal weight is above 5000 g. In pregnancies complicated by diabetes mellitus there are reasons for selective induction of labor if macrosomia is suspected and for cesarean section if the calculated birth weight is above 4000 g. Each department should have a strategy to handle such a situation because the problem with the difficult shoulder delivery cannot be completely avoided. Different procedures of managing difficult shoulder delivery are described.
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Please cite this paper as: Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case‐control study. BJOG 2012;119:724–730.Objectives To investigate... more
Please cite this paper as: Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case‐control study. BJOG 2012;119:724–730.Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles.Design Case–control study.Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway.Sample Seventy‐four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery.Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.Ma...
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Our purpose was to determine normative data for maternal cerebral blood flow indices. Study design. A prospective longitudinal study. The maternal middle cerebral artery was examined by transcranial Doppler ultrasound in 14 healthy women... more
Our purpose was to determine normative data for maternal cerebral blood flow indices. Study design. A prospective longitudinal study. The maternal middle cerebral artery was examined by transcranial Doppler ultrasound in 14 healthy women before (0-10 months prior to conception) and during pregnancy (at 8, 15, 22, 29, and 36 weeks of gestation), and twice after delivery (at 8 and 24 weeks). Middle cerebral artery blood flow velocities were recorded, and pulsatility index and cerebral perfusion pressure were calculated. Pulsatility index of middle cerebral artery peaked in mid-pregnancy and was constantly increased between 8 and 29 weeks of gestation. The diastolic middle cerebral artery velocity remained fairly constant at about 40 cm/s during the study period, while the systolic velocity peaked at 15 weeks (mean 102 cm/s). Cerebral perfusion pressure dropped to its lowest levels in mid-pregnancy and after delivery.
Research Interests: Values, Medicine, Pregnancy, Humans, Female, and 13 moreNormative, Longitudinal Studies, Transcranial Doppler, Adult, Public health systems and services research, Longitudinal Study, Cerebral Blood Flow, Gestation, Reference Values, Blood Flow Velocity, Middle Cerebral Artery, Cerebral perfusion pressure, and Paediatrics and reproductive medicine
The aim of this study was semiquantitative evaluation of tissue blood flow in the fetal lung before and after administration of betamethasone. This was carried out by means of computer analysis of ultrasound Doppler signals obtained by... more
The aim of this study was semiquantitative evaluation of tissue blood flow in the fetal lung before and after administration of betamethasone. This was carried out by means of computer analysis of ultrasound Doppler signals obtained by the color Doppler energy (CDE) technique. CDE signals were recorded in 20 singleton pregnancies with appropriate growth and imminent preterm delivery between 26 and 33 weeks of gestation. The CDE signal recordings were made before and after intramuscular administration of betamethasone 8 mg/day for 3 days. Fixed preset CDE system control settings for the fetal right lung were used during the examinations. Images from CDE scans were recorded on S-VHS videotape and transmitted for computer analysis of 8-bit images at 256 gray-scale levels. The mean flow signal intensity was recorded for the fetal lung before and after betamethasone administration. Additionally, blood velocity waveforms were measured in the intrapulmonary arteries and veins in the peripheral part of the lung. CDE signals from the fetal lung indicated increased energy values after corticosteroid treatment in 16 cases. In three cases there was no change in CDE signal values, and in one case a fall of the signal value was noted. Blood velocity waveforms from the intrapulmonary arteries showed decreased resistance to flow in 15 cases, increased resistance to flow in four cases and no change in one case. No significant differences in venous blood flow velocities were found. In conclusion, the results suggest that there is an increase in fetal lung blood perfusion after maternal corticosteroid administration.
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SummaryPurpose: Longitudinal prospective study before, during and after normal pregnancy of the effect of short‐term submaximal exercise on maternal oxygen saturation.Methods: Fourteen healthy women were recruited to the study before a... more
SummaryPurpose: Longitudinal prospective study before, during and after normal pregnancy of the effect of short‐term submaximal exercise on maternal oxygen saturation.Methods: Fourteen healthy women were recruited to the study before a planned pregnancy, and were followed seven times during the pregnancy and for up to 6 month after delivery. A submaximal bicycle exercise test with a target heart rate of 85% of the predicted age‐adjusted maximum was performed. Maternal oxygen saturation was continuously recorded using a pulse oximeter.Results: Maternal oxygen saturation at maximum work‐load had increased significantly already at 8 weeks gestation compared with preconception levels, and remained at a significantly higher level until 29 weeks of gestation. Thereafter, the oxygen saturation continued to be higher even at 6 month postpartum. During the exercise test, the lowest saturation was found during the late recovery period, this remained unchanged before, during and after pregnancy.Conclusion: A pregnant woman responds to short‐term exercise by increasing the oxygen saturation until 29 weeks. After that, the saturation level decreases but remains at a higher level even 6 month after delivery compared with preconception levels.
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Sir, We have read with interest the article by Stedenfeldt et al. published in the last edition of BJOG. However, some points need to be addressed. The conclusion seemed to suggest that increased episiotomy length and depth should be... more
Sir, We have read with interest the article by Stedenfeldt et al. published in the last edition of BJOG. However, some points need to be addressed. The conclusion seemed to suggest that increased episiotomy length and depth should be adopted for preventing severe perineal injuries, including obstetric anal sphincter injuries (OASIS). The study findings differ markedly from those reported in randomised trials already summarised in a recent Cochrane Systematic Review, which observed a reduction in the risk of severe perineal trauma among women under a restrictive episiotomy policy (RR 0.67 versus routine episiotomy, 95% CI 0.49–0.91). The Cochrane Review states that the restrictive use of episiotomy seems to improve maternal outcomes without increasing adverse perinatal ones. Moreover, a women-centered, less interventionist model of care for childbearing women has been discussed and gradually implemented worldwide. Within this process, protecting perineal integrity emerges as a major concern, as it is impossible to achieve it when an episiotomy is performed, regardless of its angle, length, or depth. Several studies have investigated antenatal and intrapartum perineal protection strategies, and thus we understand that any study aiming to identify predictive factors for perineal trauma should mandatorily include these techniques, particularly those addressing OASIS. This was a case–control study that enrolled women receiving an episiotomy with or without OASIS. The lack of an adequate control group is an obvious bias of this approach because it is expected that a lower risk of OASIS would be found in women NOT receiving episiotomy. Case–control studies are more prone to bias by nature, but the inclusion of women who had not undergone an episiotomy would at least allow for the comparison of OASIS risk for each modality of episiotomy versus no episiotomy. Additionally, the small sample could overestimate the risk and increase the probability of random error or selection bias (i.e. if women without OASIS more often declined to participate in the study). Furthermore, it is reasonable to argue that the accuracy of episiotomy angle, length and depth assessment would be more reliable if it was conducted immediately after birth, not years later. Another limitation is the lack of control for several potential confounding factors in the multivariate analysis: birth position, fundal pressure, guided pushing, perineal techniques, etc. Although some of these limitations have been disclosed by the authors, we are deeply concerned about the possible misuse of their findings to justify a return to the systematic use of episiotomy. In fact, the abstract has been released in the media and, without an accurate critical appraisal of the full article, readers may interpret that the problem is not the episiotomy per se, but an insufficient length or depth, which is a conclusion that cannot be derived from this study. j
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Hypothesis / aims of study Postpartum anal incontinence (AI), urinary incontinence (UI), and sexual dysfunctions are all distressing health problems that have potentially detrimental effects on the quality of life faced by women.... more
Hypothesis / aims of study Postpartum anal incontinence (AI), urinary incontinence (UI), and sexual dysfunctions are all distressing health problems that have potentially detrimental effects on the quality of life faced by women. Obstetric anal sphincter injuries (OASIS) are responsible for significant morbidity, causing AI in 30 to 50% of the injured women, despite an adequate primary repair. As well, these injuries can lead to both UI and sexual dysfunction (1). Although to a lesser extent, other identified risk factors for pelvic floor dysfunctions include receiving an episiotomy and instrumental delivery (2). We intend to estimate the prevalence of postpartum anal incontinence, urinary incontinence and sexual problems in a case-control study where all women have had only one vaginal birth, and each has undergone an episiotomy. The cases and controls have been matched for instrumental delivery, the episiotomy technique has been assessed and the cases had OASIS.
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Background: Neonatal alloimmune thrombocytopenia (NAIT) is most frequently caused by antibodies against the human platelet antigen (HPA) 1a. The objective of the present study was to identify HPA 1a negative women, and to offer them an... more
Background: Neonatal alloimmune thrombocytopenia (NAIT) is most frequently caused by antibodies against the human platelet antigen (HPA) 1a. The objective of the present study was to identify HPA 1a negative women, and to offer them an intervention program aimed to reduce morbidity and mortality of NAIT. Methods: A total of 100,448 pregnant women were HPA 1 typed. The HPA 1a negative women were screened for anti-HPA 1a, which was quantified when present. Immunized women were referred to a university hospital for clinical follow-up, including ultrasonographic examination of the fetal brain. Caesarean section was performed 2–4 weeks prior to term with platelets from HPA 1bb donors reserved for immediate transfusion if petechiae were present and/or if platelet count was < 35 × 109/L. Results: Of all women typed 2.1% were HPA 1a negative. Anti-HPA 1a was detected in 210 of 1,990 HPA 1a negative women. A total of 170 pregnancies in 154 HPA 1a negative women were managed according to t...
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Purpose The present study aimed to assess the risk of obstetric anal sphincter injuries (OASIS) of a subsequent delivery after the previous OASIS in countries with low (Finland) and high rates (Norway and Sweden) of OASIS. Methods This... more
Purpose The present study aimed to assess the risk of obstetric anal sphincter injuries (OASIS) of a subsequent delivery after the previous OASIS in countries with low (Finland) and high rates (Norway and Sweden) of OASIS. Methods This population-based case–control study included women who experienced OASIS 1997–2002. 26,598 women with OASIS were included from countries with low (Finland) and high (Norway and Sweden) OASIS incidences. Each case was matched with one background-adjusted control without OASIS. A follow-up data, including all subsequent deliveries between 1998 and 2011 were then collected. Statistics significances were calculated using chi-square test, test for relative proportions and Students t test, where appropriate. Results OASIS in the first birth was associated with increased recurrences in subsequent births, 6.9% vs. 1.7% in Norway (p < 0.001); 4.5% vs. 0.7 (p < 0.001) in Sweden; and 2.1% vs. 0.8% in Finland (p = 0.038). In Norway, more than two deliveries...
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The clinical management of intrauterine fetal demise (IUFD) in women with a previous cesarean delivery presents a dilemma for the obstetrician. With the current reluctance of obstetricians to perform vaginal birth after cesarean (VBAC)... more
The clinical management of intrauterine fetal demise (IUFD) in women with a previous cesarean delivery presents a dilemma for the obstetrician. With the current reluctance of obstetricians to perform vaginal birth after cesarean (VBAC) and the paucity of data to counsel women regarding maternal risks, management options are limited by physician's clinical experience and biases. In the setting of fetal demise, maternal safety becomes the primary concern. Medicolegal pressures may prevent physicians from attempting a trial of labor in this situation. In this review we will a focus on frequency of birth with IUFD after cesarean section (CS), we discuss the options (VBAC vs CS), different complications, methods for induction of vaginal birth as well as risk factors of vaginal birth and cesarean delivery.
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PURPOSE The primary aim of this study was to observe the change in obstetric anal sphincter tear rates in instrumental deliveries during one decade. Secondly, the changes in non-instrumental deliveries were followed. METHODS Data from all... more
PURPOSE The primary aim of this study was to observe the change in obstetric anal sphincter tear rates in instrumental deliveries during one decade. Secondly, the changes in non-instrumental deliveries were followed. METHODS Data from all deliveries at Hudiksvall Hospital, Sweden 2010-2011 and 2016-2017 were collected. The change of OASIS rate during instrumental deliveries was the most important. Statistical significances were calculated by using chi-square test, test for relative proportions, and Students t-test, where appropriate. RESULTS The total incidence of OASIS decreased significantly (from 2.54% to 0.73%, p < .001). Even the OASIS rate in instrumental deliveries decreased substantially from 15.1% to 3.0% (p = .002) but the decrease was statistically insignificant in spontaneous deliveries (from 1.22% to 0.60%, p = .065). CONCLUSION Based on the results of our study the manual protection of the perineum reduces the risk of OASIS in instrumental delivery significantly.
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Background The aim of this review article is to examine the evidence in the literature with regard to the safety of exercise in pregnancy. Material and Methods A literature search revealed fourteen randomised controlled trials which were... more
Background The aim of this review article is to examine the evidence in the literature with regard to the safety of exercise in pregnancy. Material and Methods A literature search revealed fourteen randomised controlled trials which were systematically reviewed. The outcome measures looked at were both short and long term consequences of training in healthy pregnant women. Results The methodology of all included studies was qualitatively evaluated, though few were graded as good. The majority were small and had variable compliance from the volunteers. There was a lack of standardisation of the training schedules: the frequency ranged from 3 - 5 times per week, training intensities varied from age related maximal heart rates of 50 - 75% and exercise periods ranged from 20 – 60 minutes in length. Overall however, the exercise could be classified as moderate. The literature revealed neither the fetus nor the mother derived harm from moderate exercise in pregnancy. Pregnant women who ex...
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Tidigare var den storsta anledningen till restriktivitet med traning hos gravida radslan for forhojd temperatur. Kroppstemperaturen stiger dock inte hos gravida vid upp till submaximal traning pa grund av forbattrad temperaturreglering.... more
Tidigare var den storsta anledningen till restriktivitet med traning hos gravida radslan for forhojd temperatur. Kroppstemperaturen stiger dock inte hos gravida vid upp till submaximal traning pa grund av forbattrad temperaturreglering. Det paradoxala fenomenet att kroppstemperaturen sjunker samtidigt som kvinnan kanner sig varmare och svettas lattare, tolkar vi som en forbattrad temperaturreglering under graviditet. Alla friska gravida kan trana, garna 30 minuter dagligen, dvs mer an 90 procent av alla gravida rekommenderas att vara fysiskt aktiva under graviditeten. Att bibehalla traningsnivan under okomplicerad graviditet och amningsperiod ar sannolikt det sakraste radet. Samtidigt ar det viktigt att lyssna pa kroppens signaler och anvanda sunt fornuft. Genom en generos installning till traning i samband med graviditet framjas sannolikt den framtida halsan. (Less)
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Longitudinal prospective study before, during and after normal pregnancy of the effect of short-term submaximal exercise on maternal oxygen saturation. Fourteen healthy women were recruited to the study before a planned pregnancy, and... more
Longitudinal prospective study before, during and after normal pregnancy of the effect of short-term submaximal exercise on maternal oxygen saturation. Fourteen healthy women were recruited to the study before a planned pregnancy, and were followed seven times during the pregnancy and for up to 6 month after delivery. A submaximal bicycle exercise test with a target heart rate of 85% of the predicted age-adjusted maximum was performed. Maternal oxygen saturation was continuously recorded using a pulse oximeter. Maternal oxygen saturation at maximum work-load had increased significantly already at 8 weeks gestation compared with preconception levels, and remained at a significantly higher level until 29 weeks of gestation. Thereafter, the oxygen saturation continued to be higher even at 6 month postpartum. During the exercise test, the lowest saturation was found during the late recovery period, this remained unchanged before, during and after pregnancy. A pregnant woman responds to short-term exercise by increasing the oxygen saturation until 29 weeks. After that, the saturation level decreases but remains at a higher level even 6 month after delivery compared with preconception levels.
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To estimate the ability of an intensive interventional program to decrease the number of obstetric anal sphincter injuries (OASIS), while simultaneously decreasing the rate of Caesarean sections (CS). The intervention, which aimed at... more
To estimate the ability of an intensive interventional program to decrease the number of obstetric anal sphincter injuries (OASIS), while simultaneously decreasing the rate of Caesarean sections (CS). The intervention, which aimed at decreasing the number of OASIS, started with a compulsory tutorial for all the midwives and physicians. At the same time, the clinic initiated a program to decrease the number of CS. We compared the outcomes before and after the intervention by calculating the risk ratios with 95% confidence intervals. The changes in selected outcomes were also tested using the test of relative proportions. The follow-up was extended for 1 year after the intervention. The number of deliveries by CS decreased significantly, as did the number of OASIS in all the subgroups, except for the multi-parous women. The rate of OASIS for instrumental deliveries (mostly by vacuum) decreased significantly (p < 0.003), as compared to pre-interventional period. The number of Grade ...
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The short-term effect of 20 mg of oral nifedipine on maternal and fetal hemodynamics was investigated in 12 women with pregnancy-induced hypertension. Within an hour after nifedipine, the mean arterial blood pressure fell by 17% and there... more
The short-term effect of 20 mg of oral nifedipine on maternal and fetal hemodynamics was investigated in 12 women with pregnancy-induced hypertension. Within an hour after nifedipine, the mean arterial blood pressure fell by 17% and there was a slight increase in maternal heart rate. There was also a decrease in the systolic/diastolic (S/D) ratio in the flow velocity waveform in the uterine artery in seven subjects, whereas the S/D ratio was unaffected in five subjects. Lack of change in the S/D ratio was associated with a less optimal pregnancy outcome: The neonates were delivered earlier, the rate of cesarean delivery was higher, and the newborns were smaller. No changes were observed in the fetal heart rate pattern or in the umbilical or middle cerebral artery flow velocity waveforms after nifedipine in hypertensive pregnancies.
Research Interests: Obstetrics, Medicine, Birth Weight, Pregnancy, Humans, and 15 moreHypertension, Hemodynamics, Ultrasonography, Female, Obstetrics Gynecology, Newborn Infant, Foetus, Adult, Cesarean Section, Fetus, Nifedipine, Blood Flow Velocity, Apgar Score, Paediatrics and reproductive medicine, and cerebral arteries
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Our purpose was to determine normative data for maternal cerebral blood flow indices. Study design. A prospective longitudinal study. The maternal middle cerebral artery was examined by transcranial Doppler ultrasound in 14 healthy women... more
Our purpose was to determine normative data for maternal cerebral blood flow indices. Study design. A prospective longitudinal study. The maternal middle cerebral artery was examined by transcranial Doppler ultrasound in 14 healthy women before (0-10 months prior to conception) and during pregnancy (at 8, 15, 22, 29, and 36 weeks of gestation), and twice after delivery (at 8 and 24 weeks). Middle cerebral artery blood flow velocities were recorded, and pulsatility index and cerebral perfusion pressure were calculated. Pulsatility index of middle cerebral artery peaked in mid-pregnancy and was constantly increased between 8 and 29 weeks of gestation. The diastolic middle cerebral artery velocity remained fairly constant at about 40 cm/s during the study period, while the systolic velocity peaked at 15 weeks (mean 102 cm/s). Cerebral perfusion pressure dropped to its lowest levels in mid-pregnancy and after delivery.
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This descriptive study explored the roles and responsibilities of expert midwives involved in teaching staff from midwifery students to senior consultants/physicians. We have earlier conducted an intervention project, aimed at decreasing... more
This descriptive study explored the roles and responsibilities of expert midwives involved in teaching staff from midwifery students to senior consultants/physicians. We have earlier conducted an intervention project, aimed at decreasing the number of anal sphincter tears. During this intervention a local core team of expert midwives was established. These experts continued the training of colleagues after the midwife instructor had fulfilled the active training period. Eighteen expert midwives from the four Norwegian hospitals which took part in this training program were recruited. To explore the views and experiences of these expert midwives, a questionnaire was completed, and the results were analyzed qualitatively. Before starting the program 24% of the midwives, working at the delivery ward were negative towards the supervision and project, while 46% were positive. One year after the program's start 92% were positive. Negative feedback at the beginning of the intervention ...
During vaginal delivery, the risk of obstetric anal sphincter injuries (OASIS) is well-known. Despite sufficient repair, 30-50% of women will experience anal incontinence. Recent studies from Norway have shown a reduction in the incidence... more
During vaginal delivery, the risk of obstetric anal sphincter injuries (OASIS) is well-known. Despite sufficient repair, 30-50% of women will experience anal incontinence. Recent studies from Norway have shown a reduction in the incidence of OASIS when the perineum is supported manually. In Denmark, the frequency of OASIS is the highest in Scandinavia and it is increasing. The aim of this study was to reduce the incidence of OASIS through an interventional programme. We conducted a study inspired by the Norwegian intervention. Our focus was on four points: 1) good communication between the delivering woman and the birth assistant, 2) visualisation of the perineum in the last stages of delivery, 3) support of the perineum during the final minutes of pushing and 4) episiotomy only on indication. A total of 768 primiparous and 1,175 multiparous women were enrolled in this quality improvement cohort study. Data were analysed for association with the occurrence of OASIS. The proportions ...
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This paper provides a short review of thrombocytopaenia in pregnancy based on a search in PubMed as well as clinical experience. Normal platelet count in pregnancy is 250-290 x 10(9)/l, Thrombocytopaenia in pregnancy may be defined as... more
This paper provides a short review of thrombocytopaenia in pregnancy based on a search in PubMed as well as clinical experience. Normal platelet count in pregnancy is 250-290 x 10(9)/l, Thrombocytopaenia in pregnancy may be defined as platelet counts below 150 x 10(9)/l. Benign gestational thrombocytopaenia (platelet count 70-150 x 10(9)/l without clinical findings or any maternal or fetal risk) develops in 5%-12% of all pregnancies in the third trimester. Immune thrombocytopaenia (ITP) occurs in about one or two out of 1000 pregnancies and may be complicated by fetal alloimmune thrombocytopaenia. Thrombocytopaenia is present in nearly half of the cases with preeclampsia. The HELLP syndrome (Haemolysis, Elevated Liver enzymes and Low Platelet count) is classified according to platelet counts. Thrombotic thrombocytopenic purpura (TTP), haemolytic uremic syndrome (HUS) and fatty liver may imply low platelet counts. Infections, folate deficiency, leukaemia, congenital conditions, drugs...
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We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic velocity can be used to detect fetal anemia in pregnancies complicated by maternal blood group immunization. We first studied normal values for... more
We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic velocity can be used to detect fetal anemia in pregnancies complicated by maternal blood group immunization. We first studied normal values for the middle cerebral artery peak systolic velocity in 135 fetuses (Group A), and also in 23 fetuses at risk for anemia who underwent 56 cordocenteses to assess the fetal hematocrit (Group B). A test to detect fetal anemia, based on the middle cerebral artery peak systolic velocity, was developed by using the data of the fetuses of Group A and Group B. Successively, the middle cerebral artery peak systolic velocity was prospectively determined in 16 fetuses at risk for anemia who underwent 42 cordocenteses (Group C) to assess the test developed, in a multicenter prospective fashion, by using the data of Group A and Group B. In the normal fetuses an exponential model expressed the increase of the middle cerebral artery peak systolic velocity values with advancing gestation. By using the data of the fetuses of Group A and Group B, four zones of anemia risk were identified. In Group C, none of the anemic fetuses had the middle cerebral artery peak velocity below the normal mean value, whereas all of the anemic fetuses had the peak velocity above the normal mean. The middle cerebral artery blood velocity increases with advancing gestation and is a non-invasive method of detecting anemia in pregnancies complicated by maternal blood group immunization.
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Research Interests: Physiology, Surgery, Biology, Health, Menstruation, and 20 moreMedicine, Multivariate Analysis, Humans, Ultrasonography, Measurement, Female, Follow-up studies, Sterilization, Menstrual Cycle, Clinical Sciences, Postoperative pain, Adult, Time Factors, Genitalia, Pelvic Pain, Ovary, Uterus, Blood Flow Velocity, Pulsatile Flow, and Vascular Resistance
Investigate blood pressure response to acral skin vasoconstriction in healthy and pre-eclamptic pregnancies. Healthy women were investigated from gestational week 8 to 52 weeks postpartum and pre-eclampsia subjects at diagnosis. Finger... more
Investigate blood pressure response to acral skin vasoconstriction in healthy and pre-eclamptic pregnancies. Healthy women were investigated from gestational week 8 to 52 weeks postpartum and pre-eclampsia subjects at diagnosis. Finger artery ultrasound Doppler, forearm laser Doppler fluximetry and photoplethysmographic blood pressure were recorded. Hand cooling to 19 °C induced vasoconstriction. Acral skin vasoconstriction increases blood pressure from 16 weeks until 12 weeks postpartum (p ≤ 0.01), with greatest responses in pre-eclampsia (p=0.047). Forearm skin perfusion is higher in pre-eclampsia (p=0.04). Acral skin vasoconstriction raises blood pressure in pregnancy, particularly in pre-eclampsia. Pregnancy accentuates important functional differences within skin.