Lotte Berdiin Colmorn

The Nordic medical birth registers – a potential goldmine for clinical research

The Nordic medical birth registers have long been used for valuable clinical research. Their collection of data for more than four decades offers unusual possibilities for research across generations. At the same time, serum and blotting paper blood samples have been stored from most neonates. Two large cohorts (approximately 100 000 births) in Denmark and Norway have been described by questionnaires, interviews and collection of biological samples (blood, urine and milk teeth), as well as a systematic prospective follow‐up of the offspring. National patient registers provide information on preceding, underlying and present health problems of the parents and their offspring. Researchers may, with permission from the national authorities, obtain access to individualized or anonymized data from the registers and tissue‐banks. These data allow for multivariate analyses but their usefulness depends on knowledge of the specific registers and biological sample banks and on proper validation of the registers.

Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries.

The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries.

The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery

To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries.

Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS)

To assess the prevalence and risk factors of emergency peripartum hysterectomy.

Mode of first delivery and severe maternal complications in the subsequent pregnancy

Severe obstetric complications increase with the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery.

Potentially Avoidable Peripartum Hysterectomies in Denmark: A Population Based Clinical Audit.

Objective To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009–2012 and made short narratives of all cases. Results The most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies. Conclusion More than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.

Abnormally invasive placentaprevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries

The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries.

The Nordic Obstetric Surveillance Study: A Study of Complete Uterine Rupture, Abnormally Invasive Placenta, Peripartum Hysterectomy, and Severe Blood Loss at Delivery

There is a lack of reliable research regarding severe complications at delivery, which is most likely due to the rarity of such complications. There is also the issue of interactions between different severe complications, questionable reporting, and the absence of precise terminology. The Nordic Obstetric Surveillance Study (NOSS) evaluated the rate of uterine rupture, placenta accreta, peripartum hysterectomy, and severe blood loss during delivery in Nordic countries as well as the characteristics of the women who suffered these complications. The aim was to provide valuable information that might help guide the management of obstetric emergencies. In this prospective study, the authors collected cases of severe obstetric complications from maternity units in the Nordic countries from April 2009 to August 2012. A total of 135 maternity units were included, covering 91% of all Nordic deliveries. Cases of extreme complications were reported by the clinicians at these maternity units and extracted by the authors by means of medical birth registers, hospital discharge registers, and transfusion databases. The primary outcomes examined were the rates of various complications as well as any possible risk factors among the patient population. Out of the 605,362 deliveries that took place in the participating maternity units during the study period, there were 1019 instances of complications. The rate of severe blood loss was 11.6 of 10,000 deliveries. Complete uterine rupture occurred in 5.6 of 10,000 deliveries. The rate for placenta accreta was 4.6 of 10,000 deliveries, and the rate of peripartum hysterectomy was 3.5 of 10,000 deliveries. There was only 1 maternal death. Totally, 25% of the women suffered from 2 or more complications and complications were found to be most associated with being over 35 years of age, overweight, higher parity, and having previously given birth by means of cesarean delivery. More analyses are being undertaken by the NOSS group to confirm and refine these associations. NOSS provides population-based estimates for the incidence rates and risk factors associated with various severe complications during delivery. This data set could serve as the impetus for countless new research questions that can be explored by investigators. As these complications are relatively rare, the authors stress that it is important not to rely simply on personal experience when encountering them in patients. Rather, treatment of these complications should be the product of rigorous educational efforts and organizational methods to make sure that they are addressed in the most effective ways possible.

Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion

The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries.