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Biomedical subjects

Siri Vangen

Publications and source records attributed to Siri Vangen.

14 recordsLinked to original sources
PubMed2006

[Requested abortions in Oslo 2000-2003].

BACKGROUND: Women of non-Western origin are over-represented among women requesting induced abortion before the end of the 12th week of pregnancy, in Oslo, Norway. Our aim was to find out if that was also the case for women requesting induced abortion after week 12. MATERIAL AND METHODS: We assessed differences between Western and non-Western women in duration of pregnancy at request for induced abortion and the proportion accepted for abortion. All women requesting induced abortion after the 12th week of pregnancy at Ullevål University Hospital, Oslo from January 2000 to September 2003 (n = 378) were included. Information about the number of fertile women in Oslo according to ethnic background was found in the municipality of Oslo's statistical office. Other data were obtained from patient medical records. RESULTS: 23% (87/378) of all women requesting late induced abortion and 15.5% (20,636/132,843) of women aged 15-50 years in Oslo had non-Western background (p < 0.05). The mean gestational age at the time of requested abortion among non-Western women was 16.4 weeks and among Western women it was 15.6 weeks (p = 0.01). There was a non-significant increased risk of having the abortion request rejected for non-Western as compared to Western women (adjusted odds ratio 1.6; 95% CI 0.5-5.5), after control for gestational age and maternal age. INTERPRETATION: It is known that non-Western women in Oslo are over-represented among women giving birth and women requesting induced abortion in general. This study shows that non-western women are also over-represented among women requesting induced abortion after the 12th pregnancy week.

Abortion, Legal↗
PubMed2006

Maternal mortality in St. Petersburg, Russian Federation.

OBJECTIVE: To study the levels and causes of maternal mortality in St. Petersburg, Russian Federation. METHODS: We collected data about all pregnancy-related deaths in St. Petersburg over the period 1992-2003 using several sources of information. An independent research group reviewed and classified all cases according to ICD-10 and the Confidential Enquiries into Maternal Deaths in the United Kingdom. We tested trends of overall and cause specific ratios (deaths per 100,000 births) for four 3-year intervals using the chi2 test. FINDINGS: The maternal mortality ratio for the study period was 43 per 100,000 live births. A sharp decline of direct obstetric deaths was observed from the first to fourth 3-year interval (49.8 for 1992-94 versus 18.5 for 2001-03). Sepsis and haemorrhage were the main causes of direct obstetric deaths. Among the total deaths from sepsis, 63.8% were due to abortion. Death ratios from sepsis declined significantly from the first to second study interval. In the last study interval (2001-03), 50% of deaths due to haemorrhage were secondary to ectopic pregnancies. The death ratio from thromboembolism remained low (2.9%) and stable throughout the study period. Among indirect obstetric deaths a non-significant decrease was observed for deaths from cardiac disease. Death ratios from infectious causes and suicides increased over the study period. CONCLUSIONS: Maternal mortality levels in St. Petersburg still exceed European levels by a factor of five. Improved management of abortion, emergency care for sepsis and haemorrhage, and better identification and control of infectious diseases in pregnancy, are needed.

Abortion, Induced↗
PubMed2006

[Female circumcision--complications and treatment].

The majority of women with extensive forms of genital cutting develop one or more chronic complications such as dysmenorrhea, dyspareunia, pain and cysts in the perineum, vaginal obstruction with haematocolpos, relative urine retention and recurrent urinary tract infections. Extensive forms of circumcision also influence childbirths. The severity of the cutting is associated with the probability of developing later complications. The women's clinics at the regional hospital in Norway have established outpatient clinics to receive women with complications after genital cutting. The aim was to develop an adequate health service to the affected. In order to improve the access to care and to ensure anonymity the women may refer themselves. During 2004, a total of 60 women were treated. The majority suffered from poor urinary flow, pain at micturition, dysmenorrhea and dyspareunia. Reconstruction of the vaginal orifice was performed to relieve some of the discomforts. The numbers of women who visit the clinics are increasing. The surgical procedure itself is not technically difficult, but the consultation before and after the surgery require cultural sensitivity. As health care personnel we can influence the affected to realise that genital cutting is an assault against a small girl. Norwegian health care workers need to learn more about how to communicate well about the medical as well as the cultural and mental aspects of genital cutting.

Circumcision, Female↗
PubMed2005

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care.

BACKGROUND: Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. METHODS: We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. RESULTS: The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. CONCLUSION: Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate.

Journal Article↗
PubMed2005

[Pregnancy and birth in multicultural Norway].

Immigrants represent a new and increasing element in Norwegian health care. As the majority of immigrants are young adults, their first contact with the health care system is frequently in connection with pregnancy and birth. From a health perspective migration may be associated with increased risk. Socio-cultural habits may conflict with biomedical perceptions about what serves mother and child best and create barriers to necessary treatment and follow up. At the same time the woman herself may experience lack of knowledge of and accept for her central cultural values. Some immigrant groups have 2-3 times higher perinatal mortality than ethnic Norwegians. Third-world immigrants seem to be more exposed to unnecessary medical interventions, though they have unmet needs for adequate health care. In order to secure equality and quality in health care, health professionals should receive knowledge-based support based on biomedical and socio-cultural research in relation to multicultural issues.

Adult↗
PubMed2005

[Revisiting the Forsdahl-Barker hypothesis].

The hypothesis about the influence of the environment in early life for later health and development has been the basis for several hundred studies over the last two decades. Despite some diverging results in different studies and methodological shortcomings, including selection and confounding from socio-economic and other factors, there seems to be substantial evidence to the effect that the environment in early life is essential for later health and development. The association of low birthweight and risk of cardiovascular disease later in life is the most consistent finding, though the causal pathways for this connection have not been traced. Permanent damage caused by inadequate nutrition in critical periods of early life expressed as chronic disease later in life is a favoured hypothesis. To further elucidate potential mechanisms, there is a need for refining the measurement parameters for early experience. Placenta function, quality of nutrition, infections, hormonal and genetic factors may also play a role. The course-of-life approach claims that early life is an important period in human life, but not the only one. Continuous life events and socio-economic circumstances may modify early life experiences. Such an approach may be useful in order to see early life events in the right perspective.

Adolescent↗
PubMed2004

Qualitative study of perinatal care experiences among Somali women and local health care professionals in Norway.

OBJECTIVE: To explore how perinatal care practice may influence labor outcomes among circumcised women. STUDY DESIGN: In-depth interviews were conducted with 23 Somali immigrants and 36 Norwegian health care professionals about their experiences from antenatal care, delivery and the management of circumcision. RESULTS: Circumcision was not recognized as an important delivery issue among Norwegian health care professionals and generally the topic was not addressed antenatally. The Somalis feared lack of experience and sub-optimal treatment at delivery. All of the women expressed a strong fear of cesarean section. Health care professionals were uncertain about delivery procedures for infibulated women and occasionally cesarean sections were performed in place of defibulation. CONCLUSION: We hypothesize that neglect of circumcision may lead to adverse birth outcomes including unnecessary cesarean sections, prolonged second stage of labor and low Apgar scores. We suggest that infibulated women need a carefully planned delivery, correctly performed defibulation and adequate pain relief.

Attitude of Health Personnel↗
PubMed2003

[Do women die from pregnancy these days?].

BACKGROUND: Our aim was to estimate the number and causes of maternal deaths in Norway during 1981-2000. MATERIAL AND METHODS: We collected information from Statistics Norway about births, maternal deaths, and causes of death. RESULTS: We registered 47 maternal deaths. The rate was 3.5 per 100 000 births during the 1980s and 4.6 during the 1990s. Pregnancy-induced hypertension was the leading cause, accounting for 14 deaths (30%). Caesarean section and thromboembolism accounted for five deaths each, and four deaths were coded as postpartum sepsis. As opposed to the period before 1980, haemorrhage accounted for only one death. INTERPRETATION: Since 1980 there has been no decrease in the maternal mortality rate in Norway. Caesarean section was an important underlying cause of death. An enquiry into maternal deaths could answer whether there is a potential for further reduction of the maternal mortality rate, particularly from preeclampsia/eclampsia.

Cause of Death↗
PubMed2003

Outcome of pregnancy among immigrant women with diabetes.

OBJECTIVE: We studied outcome of pregnancy among immigrant women with diabetes. The women came from regions of the world with high incidence of impaired glucose tolerance and type 2 diabetes. Prevalences, secular trends, and sociodemographic risk factors of diabetes were also explored. RESEARCH DESIGN AND METHODS: Data from the Medical Birth Registry of Norway on all births from 1988 to 1998 for mothers born in South Asia and North Africa (11,268) and Norway (601,785) were analyzed. RESULTS: The prevalence of pregestational diabetes among the immigrants was 8.9/1,000 births, which was more than twice the rate among ethnic Norwegians (3.6/1,000). Time trends indicated increasing prevalences in both groups. Among the immigrants, diabetes was closely associated with maternal age. Maternal diabetes was associated with a significantly increased risk of pregnancy complications in both study groups. Increased risks were found for low birth weight, macrosomia, preterm birth, preeclampsia, and cesarean sections. Among ethnic Norwegians, maternal diabetes conferred a significantly increased risk of infant perinatal death (odds ratio 2.00, 95% CI 1,44-2.77). In the sample of immigrant women with predominantly type 2 diabetes, maternal diabetes was not significantly associated with perinatal death or congenital malformations in the offspring. CONCLUSIONS: The high prevalence of diabetes among immigrants from South Asia and North Africa represents a challenge for health care providers. To prevent adverse pregnancy outcomes and later cardiovascular and renal morbidity among these groups, early diagnosis of diabetes, adequate metabolic control, and relevant preventive measures are warranted.

Adult↗
PubMed2002

Perinatal complications among ethnic Somalis in Norway.

BACKGROUND: The majority of ethnic Somali women in Norway have undergone an elaborate form of circumcision (infibulation). The aim of this study was to examine the risk of perinatal complications among ethnic Somalis and to discuss its relation to circumcision. METHODS: We conducted a cross-sectional population-based registry study. Data on all births to women born in Somalia (1733) and Norway (702 192) from 1986 to 1998 was provided from the Medical Birth Registry of Norway. We analyzed the risk of perinatal complications among women of Somali origin vs. ethnic Norwegians using univariate and multivariate methods. RESULTS: Perinatal complications were more frequent among women of Somali origin than among ethnic Norwegians. These included induction of labor, fetal distress, secondary arrest, prolonged second stage of labor, operative delivery and perinatal death. Particularly elevated odds ratios were found for fetal distress (odds ratio=2.6, 95% confidence interval (CI); 2.2-3.0), emergency cesarean sections (odds ratio=3.0, 95% confidence interval 2.6-3.4), Apgar scores below seven (odds ratio = 3.1, 95% confidence interval 2.4-4.0) and prelabor fetal deaths (odds ratio=2.5, 95% confidence interval 1.7-3.7). CONCLUSION: Similar findings in infibulated vs. noncircumcised women have been demonstrated previously in other studies indicating that circumcision could play a role. The current study is the first to be conducted among Somali women in Europe. However, the results are not informative on whether the adverse birth outcomes are caused by infibulation as such or in combination with suboptimal perinatal care, intercurrent diseases and sociocultural factors. Somali women represent a high-risk group in obstetrics, calling for special attention and care.

Adult↗
PubMed2002

The heavier the better? Birthweight and perinatal mortality in different ethnic groups.

BACKGROUND: Mother's ethnicity is associated with her baby's birthweight and risk of perinatal mortality. Given the close relation between birthweight and perinatal mortality, we explored whether ethnic differences in birthweight explain ethnic differences in perinatal mortality. METHODS: Data on all births to mothers born in Norway (808 658), Pakistan (6854), Vietnam (3283) and North Africa (1461) from 1980 to 1995 were obtained from the Medical Birth Registry of Norway. The associations between birthweight and perinatal mortality among ethnic groups were analysed using univariate and multivariate methods. RESULTS: Mean birthweights were low for Vietnamese and Pakistani mothers (3202 g, 3244 g) and high for Norwegian and North African mothers (3530 g, 3559 g). Mean birthweights were largely unrelated to perinatal mortality, which was lowest for Vietnamese (8.2/1000, 95% CI: 5.1-11.3) and highest for Pakistanis (14.9/1000, 95% CI: 12.0-17.7). Intermediate perinatal mortality rates were found among Norwegians (9.5/1000, 95% CI: 9.3-9.7) and North Africans (9.6/1000, 95% CI: 4.6-14.6). Further comparison of weight-specific mortality rates between the two largest ethnic groups showed the low birthweight paradox, where among low-weight births, perinatal mortality was lower among Pakistani than among Norwegian babies. However, adjustment to a relative birthweight scale (units of standard deviations from population-specific mean value) revealed higher rates of weight-specific mortality among Pakistanis across the entire range of birthweights. Multivariate adjustment for relative birthweight and other factors did not change these results. CONCLUSIONS: Differences in perinatal mortality between the ethnic groups were not explained by differences in mean birthweight. Paradoxical differences in birthweight-specific mortality rates could be resolved by adjustment to a relative scale.

Adult↗