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Biomedical subjects

Pål Øian

Publications and source records attributed to Pål Øian.

12 recordsLinked to original sources
PubMed2006

Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes.

OBJECTIVE: The purpose of this study was to examine neonatal outcomes among women with a planned cesarean and a planned vaginal delivery at term. STUDY DESIGN: This prospective survey was conducted on 18,653 singleton deliveries that represent 24 maternity units during a 6-month period. The data were retrieved from the Medical Birth Registry of Norway and analyzed according to intended mode of delivery. RESULTS: Compared with planned vaginal deliveries, planned cesarean delivery increased transfer rates to the neonatal intensive care unit from 5.2% to 9.8% (P < .001). The risk for pulmonary disorders (transient tachypnea of the newborn infant and respiratory distress syndrome) rose from 0.8% to 1.6% (P = .01). There were no significant differences in the risks for low Apgar score and neurologic symptoms. CONCLUSION: A planned cesarean delivery doubled both the rate of transfer to the neonatal intensive care unit and the risk for pulmonary disorders, compared with a planned vaginal delivery.

Adult↗
PubMed2006

[A midwife-led birthing unit].

BACKGROUND: The Alternative Birth Centre (ABC) is a midwife-led unit which offers low-risk women integrated, individualised antenatal, intrapartum and postpartum care. MATERIAL AND METHODS: The study included 432 women who received their care at the ABC from November 1997 until July 2000. Demographic information and details about antenatal care were recorded for all women. Information about labour, delivery and the postnatal period were recorded for the 341 women who started their labour at the ABC. RESULTS: Of the 432 women who started their care at the ABC, 265 (61.3 %) gave birth there, 100 (38 %) were primiparous while 165 (62.3 %) were multiparous. 84 (19.4 %) women were not suitable for birth at the ABC for reasons such as preterm birth, postterm pregnancies, breech presentation and preeclampsia, and were referred back to their own hospital during pregnancy. Among the 341 women that started labour at the ABC, 76 (22 %) were transferred to the obstetrical department during labour. Three reasons accounted for 88 % off all transfers during labour: failure to progress (n = 34, 44.7 %), need for continuous fetal monitoring (n = 20, 26.3 %), and the need for pharmacological pain relief (n = 13, 17.1 %). Of the 76 women transferred in labour, 42 had a spontaneous vaginal birth while 36 (44.7 %) women had an operative delivery, 14 caesarean section, 16 vacuum extraction and 1 of them forceps delivery. One baby born at the ABC had an Apgar score below 7 at 5 min. ABC is a safe alternative to standard care for low-risk women.

Adult↗
PubMed2006

[The breakthrough series on Cesarean section].

BACKGROUND: The "breakthrough series" on caesarean section was organised in Norway in 1998/99 in response to professional concerns about rising caesarean section rates and the public debate about the topic. The aim was to gain more information and to reduce the inter-hospital variation of caesarean section rates. MATERIAL AND METHODS: Detailed information about 3000 caesarean sections (70% of all caesarean sections in Norway during the study period of 7 months) was collected. Twenty-four departments participated and were involved in a quality-improvement process. RESULTS: In 1998 the caesarean section rate among the participating departments was 13.5% (inter-hospital variation 8.6% to 20.4%). In 2002 the rate was 15.7% (inter-hospital variation 11.0%-24.5%). The most frequent indications were fetal stress, prolonged labour, previous caesarean section, breech presentation and maternal request. Of the women with a previous caesarean section, 45.5% had a new caesarean section in their next pregnancy. Complications occurred in 21% of all procedures; risk factors were general anaesthesia, low gestational age, fetal macrosomia and degree of cervical dilation. INTERPRETATION: The project highlighted quality improvement work and interdisciplinary working processes and led to more knowledge about caesarean section. The inter-hospital variation was unchanged four years after the project.

Cesarean Section↗
PubMed2005

[External cephalic version of breech presentation at term].

BACKGROUND: External cephalic version could be an alternative to either vaginal delivery or caesarean section in breech presentation at term. MATERIAL AND METHODS: A systematic literature review about external cephalic version in breech presentation. RESULTS: The numbers of breech presentation delivered by caesarean section could probably be reduced in Norway by offering version, but this would not affect perinatal mortality.

Breech Presentation↗
PubMed2004

Complications of cesarean deliveries: rates and risk factors.

OBJECTIVE: The purpose of this study was to determine complication rates after cesarean delivery and to identify independent risk factors for complications. STUDY DESIGN: In a prospective population-based cohort study in Norway, rates of predefined types of complications from 2751 cesarean deliveries were determined. The complications that were studied were intraoperative complications, blood loss, wound infection, cystitis, endometritis, hematoma, and reoperation. Independent risk factors were identified by stratification and multiple logistic regression analysis. RESULTS: Altogether, 21.4% of the women had > or =1 complications. The degree of cervical dilation, general anesthesia, low gestational age, and fetal macrosomia were independent risk factors. For operations that were performed at 9 to 10 cm cervical dilation, the complication rate was 32.6% versus 16.8% at 0 cm (odds ratio, 2.39; 95% CI, 1.77-3.22; P<.001). CONCLUSION: Cesarean delivery was associated with a high complication rate. Increasing cervical dilation and, in particular, cervical dilation of 9 or 10 cm at the time of operation, general anesthesia, low gestational age, and fetal macrosomia were identified as independent risk factors.

Adolescent↗
PubMed2003

Indications for cesarean deliveries in Norway.

OBJECTIVE: The purpose of this study was to investigate the indications for cesarean deliveries in Norway, related to type of operation, parity, and gestational age. STUDY DESIGN: This was a prospective survey that used information provided by clinicians at 24 maternity units. Two thousand seven hundred seventy-eight cesarean deliveries were included, which represents 69.7% of all cesarean deliveries in Norway during the study period. RESULTS: The cesarean delivery rate varied by maternal and gestational age, parity, and hospital of delivery. Seven indications accounted for 77.7% of the operations: fetal stress (21.9%), failure to progress (20.7%), previous cesarean delivery (8.9%), breech presentation >or=34 weeks of gestation (8.4%), maternal request (7.6%), preeclampsia (6.2%) and failed induction (4.0%). Of the total deliveries, 64.3% were emergency operations. CONCLUSION: Accurate information about indications for cesarean deliveries in Norway has been obtained. Two thirds of all deliveries were emergency operations; the most important indications were fetal stress and failure to progress. In the elective cesarean delivery group, the two most important indications were previous cesarean delivery and maternal request.

Adult↗
PubMed2003

Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts.

OBJECTIVE: To assess the inter-observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non-clinical setting, the inter-observer agreement between two experts in the non-clinical setting and to what degree fetal distress in labour could be predicted by the two experts. DESIGN: Observational study. SETTING: The maternity unit of Hammerfest Hospital, Norway. POPULATION: Eight hundred and forty-five high and low risk women. METHOD: The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (kappaw), proportion of agreement (Pa) and predictive values were calculated. MAIN OUTCOME MEASURES: Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios. RESULTS: Inter-observer agreement between Expert 1 and Expert 2: kappaw 0.38 (CI 0.31-0.46), Pa for reactive labour admission test 0.86 (CI 0.83-0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26-0.40). Agreement between Expert 1 and midwives/obstetricians: kappaw 0.25 (CI 0.15-0.36), Pa for reactive labour admission test 0.89 (CI 0.87-0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11-0.25). Agreement between Expert 2 and midwives/obstetricians: kappaw 0.28 (CI 0.20-0.37), Pa for reactive labour admission test 0.85 (CI 0.82-0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14-0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83. CONCLUSION: A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.

Cardiotocography↗
PubMed2002

[Postpartum hemorrhage--prophylaxis and treatment in Norway].

BACKGROUND: Routine oxytocic prophylaxis is known to significantly reduce the risk of severe postpartum haemorrhage (> 1,000 ml) and need for blood transfusion after delivery. To what extent this evidence is implemented in clinical practice in Norway is not known. MATERIAL AND METHODS: A telephone questionnaire survey was carried out in September 2001 to evaluate the routine clinical practice for prevention and treatment of postpartum haemorrhage in Norwegian delivery units. RESULTS: Data were available for 55 out of 57 institutions with a delivery unit. Routine third stage prophylaxis with 5-10 IU oxytocin was practiced in 47% of delivery units. Intravenous oxytocin infusion was used primarily in all the delivery units for the treatment of established primary postpartum haemorrhage. 74% of units used methylergometrine, 21% misoprostol as the second-line treatment. INTERPRETATION: Despite evidence for the use of oxytocics for the prevention of postpartum haemorrhage, less than half of delivery units in Norway practice routine prophylaxis in the third stage of labour. Norwegian women may benefit if all maternity care providers implement evidence-based practice.

Carboprost↗
PubMed2002

[Use of oxytocin augmentation after spontaneous onset of labor].

BACKGROUND: Use of oxytocin augmentation during labour is not systematically registered in Norway. We wanted to describe the use of oxytocin augmentation in Hammerfest Hospital from 1996 to 2000. MATERIAL AND METHODS: The patient files of all women who delivered in the study period (n = 2,725) were examined retrospectively. After exclusion because of induction of labour, planned Caesarean section, breech delivery, twin delivery and intrauterine fetal death, 2,122 women were included in the study. RESULTS: 490 of 969 nulliparas (51%) and 233 of 1,153 multiparas (20%) were augmented with oxytocin. 203 of the 239 nulliparas (85%) who had epidural anaesthesia and 287 of the 730 nulliparas (39%) without epidural anaesthesia were augmented, compared to 64 of the 96 multiparas (67%) and 169 of the 1,057 multiparas (16%). INTERPRETATION: In the present study, half of the primiparas and one fifth of the multiparas had their labour augmented with oxytocin. It is not known whether this is representative nationwide. There is a need for more research about dystocia, when intervention is appropriate and which women will benefit from oxytocin augmentation.

Adult↗
PubMed2002

Deliveries in maternity homes in Norway: results from a 2-year prospective study.

BACKGROUND: The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway. METHODS: A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum. RESULTS: The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection. CONCLUSION: Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.

Birthing Centers↗