Lone Hvidman

Normal Serum Relaxin in Women with Disabling Pelvic Pain during Pregnancy

As part of a case control within cohort study 472 pregnant women answered a questionnaire post partum. Serum relaxin concentrations were measured by a homologous ELISA in samples collected from the women in the 30th week of pregnancy. Serum relaxin concentrations were not associated with pregnancy-associated pelvic pain. Thus, normal pregnant women without pelvic pain (n = 118) had mean concentrations of 343 pg/ml compared to 332 pg/ml in women (n = 59) with pelvic pain and some restriction in daily activities and to 349 pg/ml in women (n = 9) with severe pregnancy-induced pelvic pain. The present results do not suggest a role for relaxin in symptom-giving pelvic relaxation during human pregnancy.

Maternal deaths in Denmark 2002–2006

Objective. To describe a method for identification, classification and assessment of maternal deaths in Denmark and to identify substandard care. Design. Register study and case audit based on data from the Registers of the Danish Medical Health Board, death certificates and hospital records. Setting. Denmark 2002–2006. Population. Women who died during a pregnancy or within 42 days after a pregnancy. Methods. Maternal deaths were identified by notification from maternity wards and data from the Danish National Board of Health. A national audit committee assessed hospital records of direct and indirect deaths. Main outcome measures. Maternal mortality ratio, causes of death and suboptimal care. Results. In the study period, 26 women died during pregnancy or within 42 days from direct or indirect causes, leading to a maternal mortality ratio of 8.0/100,000 live births. Causes of death were cardiac disease, thromboembolism, hypertensive disorders of pregnancy, Streptococcus A infections, suicide, amniotic fluid embolism, cerebrovascular hemorrhage, asthma and diabetes. Conclusion. Our method proved valid and can be used for future research. Causes of death could be identified and learning points from the assessments could form the basis of focused education and guidelines. Future complementary ‘near miss’ studies and cooperation with other countries with comparable health systems are expected to improve the benefits of the enquiries, contributing to improved management of life‐threatening conditions in pregnancy and childbirth.

Informed consent: providing information about prenatal examinations.

Background. Choice in prenatal care has moved on from a paternalistic approach, to increased patient autonomy and informed decision‐making. This review summarises the existing literature on the information of pregnant women about prenatal examinations. The extent to which information about Down syndrome and screening tests empowers informed decision‐making are investigated, as are different ways of expressing a risk estimate. Results. Knowledge scores can be improved and decisional conflict reduced by group counselling, individual sessions, and by use of leaflets. None of the interventions leads to a raise in anxiety scores or influence uptake rates. Satisfaction with information provided was found unrelated to level of knowledge, but associated with having expectations for information met. Information on Down syndrome is missing (13–21%), or restricted (13%), limitations of screenings tests rarely mentioned, and written materials often insufficient. Women experience risk expressed as proportions or relative risk ratio significantly higher than percentage, number needed to treat, or absolute risk reduction. More women correctly understand relative risk reduction compared to absolute risk reduction and number needed to treat (60 versus 42 and 30%). Using medical words rather than lay terms significantly alter risk perception. Conclusions. Information can increase the level of knowledge and reduce decisional conflict, without raising anxiety scores. A clarification of the womens expectations seems paramount to obtain a perception of good information and informed consent. The information provided about Down syndrome and screening tests does not empower an informed consent based on relevant knowledge.

Randomised trial of structured antenatal training sessions to improve the birth process

Please cite this paper as: Maimburg R, Væth M, Dürr J, Hvidman L, Olsen J. Randomised trial of structured antenatal training sessions to improve the birth process. BJOG 2010;117:921–928.

Knowledge of prenatal screening and psychological management of test decisions.

To study associations between pregnant womens knowledge of prenatal screening and decisional conflict in deciding whether to participate in first‐trimester screening for Down syndrome in a setting of required informed consent, and to study associations between knowledge and personal wellbeing, and worries in pregnancy.

Informed consent: attitudes, knowledge and information concerning prenatal examinations

Background. Providing women with information enabling an informed consent to prenatal examinations has been widely recommended. Objective. The primary purpose of this review is to summarise the current knowledge of the pregnant womans expectations and attitudes concerning prenatal examinations, as well as the knowledge possessed by pregnant women undergoing prenatal examinations. Second, we explore their reasons for accepting or declining available screening tests. Results. More than 90% of the pregnant women expressed a positive attitude toward screening procedures in pregnancy. Most often (70–96%), the pregnant women were found knowledgeable about the procedural and practical aspects, but were more seldom (31–81%) able to correctly identify the purpose of tracing fetal malformations. Some 29–65% were not familiar with the existence of a false negative result, and 30–43% were found unaware of the possibility of a false positive result. The risk of miscarriage in relation to amniocentetesis [AC] is unknown to 11–53%. Uptake rates are associated with attitudes toward prenatal examinations, but no knowledge of the test offered. A total of 88% considered their health care provider an important source of information, and 57% stated that this information has influenced their decision. Conclusions. Pregnant women favor prenatal examinations, but the choice of participation does not seem to be based on insight to enable full informed consent. Health care providers are perceived as an essential source of information.

First‐trimester Down syndrome screening: pregnant women's knowledge

The primary aim of this study was to assess pregnant womens knowledge of first‐trimester combined Down syndrome screening in a setting of required informed consent. As the secondary aim, we wanted to identify relevant differences in knowledge level among subgroups of pregnant women, including those informed in different ways about prenatal examinations.

Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Prenatal screening for Downs syndrome and other chromosomal abnormalities is included in prenatal care programs in many countries. However, the potential association between prenatal screening and maternal anxiety remains an issue of debate.

Use of ICD-10 codes to monitor uterine rupture: validation of a national birth registry

OBJECTIVES Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine the validity of registration of uterine rupture in the MBR within the population of pregnant women with prior cesarean section by conducting a review of the medical records. STUDY DESIGN We reviewed 1709 medical records within the population of singleton pregnant woman delivering at term between 1997 and 2007. We retrieved the medical records of all women in the MBR with a code for uterine rupture during labor regardless of whether or not a prior cesarean section had been reported to the registry. In addition medical records of all women with a code for previous cesarean section and delivery of a child with adverse perinatal outcome were retrieved. RESULTS Among women recorded in the MBR with a previous cesarean section and uterine rupture, only 60.4% actually had a uterine rupture (partial or complete). At least 16.2% of complete uterine ruptures were not reported to the registry. Considering only complete uterine ruptures, the sensitivity and specificity of the codes for uterine rupture were 83.8% and 99.1%, respectively. CONCLUSION During the study period the monitoring of uterine rupture in the MBR was inadequate.

Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery.

To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD‐MR).