Knut Dalaker

The occurrence of placental abruption in Norway 1967‐1991

Study objective To study secular trends of placental abruption (PA), the effects of demographic variables and the use of cesarean section (CS) associated with PA.

Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section.

OBJECTIVE Our purpose was to evaluate, with respect to obstetric intervention and neonatal outcome, a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. STUDY DESIGN A clinical follow-up study was performed between 1984 and 1992 of all term singleton deliveries in breech presentation. Each case selected for vaginal delivery had a matched control in vertex presentation. RESULTS A total of 1212 infants presented as breech. Vaginal delivery increased from 45% to 57% (p = 0.004), and cesarean section for failure of vaginal delivery declined from 21% to 6% (p < 0.00001). None, however, died or had long-term sequelae because of a complicated or failed vaginal breech delivery. A total of 8.8% of those delivered vaginally in breech versus 5.0% of those in vertex presentation were admitted to the neonatal intensive care unit (p = 0.009). Among those with vaginal delivery, 2.5% in breech presentation were given the clinical diagnosis of birth asphyxia versus none in the vertex position (p = 0.0001). CONCLUSION Breech presentation at term may be selected for vaginal delivery if properly managed.

The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence

Objective To assess the effect of having a placental abruption on 1. the probability of having further pregnancies, and 2. the rate of recurrence in such pregnancies.

Perinatal mortality and case fatality after placental abruption in Norway 1967-1991

Study objective To study national secular trends in Norway of perinatal mortality and case fatality due to placental abruption (PA) and associations with cesarean section (CS).

Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection : A prospective, double-blinded, placebo-controlled, multicenter study

Background. Bacterial vaginosis (BV) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy. Vaginal application of 2% clindamycin cream is an efficacious treatment for BV, but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy.

Predicting preeclampsia in the second pregnancy from low birth weight in the first pregnancy.

Objective To evaluate the effect of low birth weight adjusted for gestational age in first pregnancies on preeclampsia in second pregnancies and to estimate the proportion of preeclampsia in second pregnancies attributable to histories of LBW for gestational age. Methods We conducted a cohort study based on linked data from the Medical Birth Registry of Norway, which covered all births in 1967–1992. Results Women who delivered infants under the third percentile birth weight were three times more likely to have initial or recurrent preeclampsia in second pregnancies than those who delivered infants at or above the tenth percentile. After adjusting for maternal age, year of birth, interpregnancy interval, education, chronic hypertension, diabetes mellitus, and change of partner, the increased risk persisted. Birth weight below the tenth percentile in the first delivery accounted for 10% of the total cases of preeclampsia in the second pregnancy and 30% of recurrent cases. Conclusion A history of low birth weight adjusted for gestational age is associated significantly with subsequent occurrence as well as recurrence of preeclampsia. These findings are consistent with the hypothesis of a shared etiologic factor or recurrent pathophysiologic mechanism for preeclampsia and fetal growth restriction. A history of fetal smallness for gestational age is found in a substantial proportion of all cases of preeclampsia and thus seems to be important in the etiology of preeclampsia.

Addison's disease and pregnancy.

Five case reports are presented illustrating that pregnancy and Addisons disease are not incompatible, provided adequate substitution therapy is given.

Obstetric history and the risk of placenta previa

Objective. To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors.

Outcome of pregnancies subsequent to placental abruption : a risk assessment

Objective. To assess the risk of small for gestational age (SGA), preterm birth, pregnancy induced hypertension (PIH), and perinatal death in the pregnancy immediate subsequent to a placental abruption (PA) in the same mother.

Reproductive career after breech presentation: subsequent pregnancy rates, interpregnancy interval, and recurrence

Objective To assess subsequent pregnancy rates and recurrence of breech, as well as interpregnancy interval after a breech presentation. Methods We conducted a national population registry-based study using data from 1967 to 1994, with maternal record linkage of sibships, comprising the first to the fourth birth of a mother. Results The subsequent pregnancy rate after a surviving breech birth was lower than after a surviving nonbreech birth. Women with two births, of which one was a perinatal loss, had a higher subsequent pregnancy rate, compared with those who had surviving infants. The subsequent pregnancy rate was lower after a cesarean delivery irrespective of presentation. The interpregnancy interval was shorter if the previous infant died, whereas presentation did not influence the interval. The adjusted odds ratio of recurrence of breech increased from 4.32 (95% confidence interval [CI] 4.08, 4.59) after one previous breech delivery to 28.1 (95% CI 12.2, 64.8) after three. Conclusion Breech and cesarean delivery lowered the subsequent pregnancy rate, probably because of the womens decision not to reproduce. Thus, preconceptional counseling with information, support, and reassurance regarding future pregnancies and deliveries might reduce the discouraging effect. A high odds ratio of recurrence of breech suggests effects of recurring specific causal factors of either genetic or more permanent environmental origin.