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Lone Krebs

Publications and source records attributed to Lone Krebs.

7 recordsLinked to original sources
PubMed2006

[Elective Caesarean section team--an organizational innovation].

INTRODUCTION: The increasing rate of delivery by caesarean section demands more effective use of resources in obstetrical departments and anaesthesiological departments. At the Danish State Hospital, Rigshospitalet, in 2002, we decided to optimise the cooperation between the various professionals involved, by softening the professional boundaries, and by performing most planned caesarean sections on the same day, carried out by the same team, the "elective caesarean section team" (EST). In 2003 a similar structure was established at Hvidovre Hospital. This paper describes the process of establishing EST, the organisational implications, and the results of an evaluation of EST by the users. MATERIALS AND METHODS: The case records of all caesarean sections performed by the EST-team at Rigshospitalet and Hvidovre Hospital in 2004, were examined. All users in a two-month period evaluated the EST by questionnaires at planned discharge. RESULTS: Most users (60.5%) were discharged after two days. The user evaluation showed a high level of satisfaction. CONCLUSION: The introduction of EST has increased the efficiency within the organisation for carrying out planned caesarean sections. It has generated a high level of satisfaction among users, and a high educational value for the staff.

Anesthesia Department, Hospital↗
PubMed2006

[Complications of elective Caesarean section performed by a special section team].

INTRODUCTION: Two Danish hospitals have introduced a new organizing structure according to which planned caesarean sections are performed by a team. Caesareans are normally carried out without complications, and this makes it possible to evaluate complications to the surgery isolatedly. The object of this article was to describe the medical complications in mother and child of planned caesarean section performed in team. MATERIALS AND METHODS: A total of 534 caesarean sections were performed in team in 2004. Information on complications to caesarean sections was obtained from medical records. RESULTS: The most frequent complication was blood loss of more than 1000 millilitres occurring in 2,2%. Other complications occurred with frequencies of about or less than 1%. 7% of the patients experienced a complication to caesarean performed in team. Respiratory morbidity occurred in 3.2% of the infants. CONCLUSION: Concerning the short-term consequences, there is a low rate of fetal and maternal complications in these women in the low-risk group. Long-term consequences are not expected.

Cesarean Section↗
PubMed2006

The relation of breech presentation at term to epilepsy in childhood.

OBJECTIVE: To investigate the relation between breech at term and epilepsy in childhood, and identify risk factors for epilepsy in term breech infants. STUDY DESIGN: Register-based study of all (n = 7514) singleton term infants without malformations, born between 1980 and 1994 and hospitalised with epilepsy until year 1996. For each case delivered in breech presentation (n = 290), the two subsequent deliveries of non-malformed, singleton infants delivered in breech presentation at term at the same hospital were selected as controls (n = 580). RESULTS: Breech presentation was a risk factor for epilepsy (OR: 1.2 [95% CI: 1.1, 1.3]). Breech infants with epilepsy were more often small for gestational age (9.7%) than breech infants without epilepsy (4.7%). Vaginal delivery was associated with low Apgar score, but mode of delivery and low Apgar score were not related to epilepsy. CONCLUSION: The increased risk of epilepsy in term breech infants is not related to intrapartum events, but to growth restriction in pregnancy.

Birth Weight↗
PubMed2003

Methodological difficulties in the comparison of indicators of perinatal health across Europe.

The main purpose of this article is to point out common pitfalls that can confuse comparative analyses of indicators of perinatal health and to discuss ways to overcome or minimize these difficulties. The challenge is to distinguish 'real' variations in the value of an indicator from variations due to differences in registration practices and definitions and from random variation. The first section presents the major properties that are desirable in indicators of perinatal health status and perinatal health care in Europe to be used for comparative purposes. The second section provides specific examples of the types of methodological difficulties encountered in European cross-country comparisons due to variations in the definition, measurement and construction of indicators. The conclusion discusses the PERISTAT project's responses to these difficulties and how these methodological constraints impact on the selection of an appropriate indicator set for Europe today.

Data Collection↗
PubMed2003

Elective cesarean delivery for term breech.

OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women with cesarean delivery, and anal sphincter rupture occurred in 1.7% of women with vaginal delivery. Elective cesarean delivery was not associated with subsequent ectopic pregnancy, miscarriage, placental complications, uterine rupture, or adverse neonatal outcome. Women with elective cesarean delivery were more often delivered by elective cesarean in their second pregnancy, compared with women delivered vaginally (RR 1.25; 95% CI 1.21, 1.29). Elective cesarean delivery was associated with a lower rate of a subsequent delivery during the study period and a longer mean delivery interval than for vaginal delivery. CONCLUSION: Elective cesarean delivery for term breech carries a low risk of severe maternal complications.

Adult↗
PubMed2002

Are intrapartum and neonatal deaths in breech delivery at term potentially avoidable?--a blinded controlled audit.

The aim of the study was to investigate whether deaths in term breech deliveries could have been avoided with improved care during pregnancy and delivery. All cases of intrapartum/early neonatal death of nonmalformed infants in breech presentation delivered at term in Denmark in the period 1982-92 were studied. For each of the 12 deaths two controls matched by presentation and planned mode of delivery were selected. Eleven obstetricians assessed the care through narratives that ended when the infant was delivered to umbilicus and stated if the infant died, and whether the "possible death" was potentially avoidable. The majority thought that 42% of cases and 9% of the controls had died. Antenatal and intrapartum care was suboptimal respectively in 17% and 25% of cases and 4% and 26% of controls. The assumed death was found to have been potentially avoidable in 58% of cases and 17% of controls. Care in pregnancies with IUGR, pre-eclampsia, placental abruption, post-maturity, the time from decision to performance of cesarean section, and compliance between patient and professionals were more often criticized in cases than in controls. Controlled audit seemed to be a valuable tool for quality improvement and for validation of litigation activities. In conclusion, infant death at term breech delivery was to a large extent potentially avoidable. However, even in controls, suboptimal care was not uncommon.

Abruptio Placentae↗