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Biomedical subjects

Per E Børdahl

Publications and source records attributed to Per E Børdahl.

11 recordsLinked to original sources
PubMed2005

[Clinical practice variation in reduced fetal movements].

BACKGROUND: Reduced fetal movements imply a risk pregnancy. This condition is present in a significant proportion of pregnancies, but both the quality of information and that of clinical care is variable. MATERIAL AND METHODS: All delivery units in Eastern Norway and Bergen have registered all consultations for reduced fetal movements, as part of the international collaborative project "Fetal Movement Intervention Assessment" (Femina). Out of 23,933 deliveries, 1200 pregnancies were examined. In 1043 pregnancies the mother had spontaneously presented her concern over reduced fetal movements; these were included in analyses. Results are presented with a 95% confidence interval. RESULTS: Asphyxia, death, growth restriction or preterm birth occurred in 19.6% (16.6-22.6%) of cases, ranging between units from 9.1% to 26.5%. Standard procedures varied extensively; ultrasonography was used in 39.0% to 98.6% and Doppler in 4.5% to 74.6% of cases. There was an association between outcomes and the procedures used. Women who waited 24 hours with reduced or absent movements before contacting healthcare had increased risk. Among those with absent movements, 47% (42-52%) had such risk behaviour. INTERPRETATION: There is a need for quality improvements in the information to pregnant women as well as in the clinical management of affected pregnancies. This could have large health benefits. We propose new guidelines for information and management.

Cardiotocography↗
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↗
PubMed2005

Can cesarean section be performed without the woman's consent?

Occasionally, an obstetrician can experience conflicts between the mother and her fetus. In a situation where the life of the fetus is in danger, religious, cultural, or other convictions may cause the mother to refuse the physician's recommendations for delivery. When there is a medical indication to perform cesarean section, but the mother refuses, has the obstetrician then a right to perform a cesarean section to save the fetus from possible death or serious injury? In 1987, The Norwegian Directorate of Health made a statement on cesarean section without consent, but later, new legislation on patient rights has been introduced. In Norway, no scientific medical articles have been published on this topic, and no cases have yet been brought to court. Cases of court-ordered cesarean section have been reported from the UK and the USA. In this report, we discuss some of the ethical, moral, and legal aspects of forced cesarean sections.

Adult↗
PubMed2004

[Changes in Norwegian obstetric practices, 1915-1961].

BACKGROUND: Established in 1967, the Medical Birth Registry of Norway has detailed accounts of all births in Norway. We have, however, only limited knowledge of obstetric practices in Norway in the decades before the Birth Registry was established. One important source is the annual reports of the Maternity Clinic in Oslo. MATERIAL: We analysed the annual reports for the period 1915-1961 with special emphasis on operative deliveries. RESULTS: The obstetric forceps was used in 6.5-12.5% (median 8.7%) of cephalic presentations. In 1960, the vacuum extractor was used for the first time. The rate of caesarean sections increased from 1.5% in the late 1930s to 6.3% in 1961. The proportion of operative deliveries increased up until 1944-55 when it was 14-16%, then fell in the years to 1960 when it was about 12%. Between 1915-1934, maternal mortality was as high as 6.4 per thousand. From the mid-1930s, it steadily decreased to 0.6 per thousand in the last five-year period. Well over one third of the deaths were caused by eclampsia or serious preeclampsia. INTERPRETATION: Birth traumas and neonatal death was the price paid for saving the mothers' lives and health. The operative activity was higher than what might be expected on the basis of the late-1960s data in the Birth Registry. The increase in caesarean sections was steepest during the Second World War, at a time when the number of deliveries in the clinic rose substantially.

Birth Rate↗
PubMed2004

[Staffing and emergency service in Norwegian obstetrics and gynecology departments].

BACKGROUND: We have made a survey of activities, skills, staffing and emergency services in Norwegian units for obstetrics and gynaecology. MATERIAL AND METHODS: A questionnaire was sent to all 43 units in February 2003. RESULTS: All units replied; 42 reported to have delivery service with emergency staffing. The reported annual number of births varied from 100 to 5600 (median 825, mean 1258). There was a large difference in the number of doctors on call in relation to annual number of births, with the larger units having a higher number of births per doctor on call. 60% of deliveries took place in units with a specialist always available. The numbers of doctors in each unit varied from 1 to 48 (median 8, mean 11). The outpatient activity was higher in local hospitals. Physicians with doctorates were mostly to be found in university hospitals. INTERPRETATION: The survey demonstrates a large variation in emergency services, distribution of posts and academic skills. This may reflect different functions and geographic conditions, though there are also large differences among comparable institutions.

Clinical Competence↗
PubMed2003

[A watershed in Norwegian obstetrics].

BACKGROUND: Professional obstetrics in Norway developed during the 19th century. This paper analyses the development through the second half of the 19th century at the Maternity Clinic in Christiania (now Oslo). MATERIAL AND METHODS: All patient files from the years 1852, 1872 and 1892, a total of 1231 records, were analysed. Socio-demographic and gynaecologic data were registered as well as data about the delivery and the child. RESULTS: The number of deliveries increased nearly five times during the period. The proportion of married women increased from less than 20% to nearly 50%. Maternal mortality decreased from above 3% to below 1%, mostly because childbed fever became infrequent. The number of operative deliveries increased substantially, particularly the use of the obstetric forceps, in 1892 utilised in 6 % of deliveries. In the reviews published in those days, eclampsia and reduced contractions were the most frequently cited indications for the use of the obstetric forceps. Problems with the heart sound of the fetus were not mentioned. However, patient files demonstrate that a weak or missing heart sound of the fetus was also an important indication for the use of the forceps. INTERPRETATION: Giving birth at the clinic was gradually becoming an alternative for other than poor women, because it was safer than before and in some cases the obstetricians could offer effective help. However, at the end of the 19th century, not more than about 15% of all deliveries took place at the clinic. This paper demonstrates the importance of scrutinising patient files as a supplement to register data, as is the case today, too.

Adult↗
PubMed2003

Max Sänger - father of the modern caesarean section.

The major turning point in the development of the caesarean section appeared in 1882, when the German gynaecologist Max Sänger (1853-1903) suggested closing the uterine wound. Until this point, the wound was not sutured and so haemorrhage was a common cause of maternal death. Sänger's method quickly became standard, leading to a spectacular drop in maternal mortality. Sänger was one of the most renowned German gynaecologists at the end of the 19th century. He contributed to the entire fields of obstetrics and gynaecology, in particular in founding Monatsschrift für Geburtshülfe und Gynaekologie, the predecessor of this journal.

Cesarean Section↗
PubMed2002

[The gynecologist Max Sänger and his relationship with Nina and Edvard Grieg].

Hundred years ago, on 12 January 1903 the gynaecologist Max Sänger (1853-1903) died. He was one of the most well-known German gynaecologists at the end of the 19th century, and during the 20 years he practiced in Leipzig, he achieved an international reputation. His scientific work covered almost the whole field of contemporary obstetrics and gynaecology, and he is still remembered for his modification of the Caesarean operation, which substantially reduced maternal mortality. Sänger was closely linked to Norway, both professionally and personally. This paper describes his work as gynaecologist and his relationship to Norway, especially his friendship with Nina and Edvard Grieg.

Cesarean Section↗