Rikke Damkjær Maimburg

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.

Obstetric outcome in Danish children with a validated diagnosis of kernicterus

Objective. To validate the use of the kernicterus diagnosis in a clinical register in Denmark and to describe occurrence and obstetric outcome in children with a validated kernicterus diagnosis. Design. Population‐based cohort study. Setting. Denmark. Population. All children born from 1 January 1994 to 31 December 2003. Methods. We established a national population‐based cohort of children with a diagnosis of kernicterus based on data obtained from a mandatory national register and from a clinically established cohort. Information on obstetric outcome and child development was obtained from the registers and from the medical records. Main outcome measures. Validation of the kernicterus diagnosis and description of obstetric and long‐term outcomes in children with kernicterus. Results. We found 15 children with a diagnosis of kernicterus in the Danish National Hospital Register and eight children with a diagnosis of kernicterus in a clinically established cohort. A total of nine children had a validated diagnosis of kernicterus which leads to a cumulative incidence of kernicterus in Denmark of 1.3/100.000 newborns. Most of the nine children experienced suboptimal growth but otherwise normal pregnancy and delivery outcomes. All except one child developed severe neurological impairment in childhood. Conclusion. Kernicterus is still an existing disease in Denmark. The children with kernicterus experienced overall normal pregnancy and delivery outcomes but long‐term outcomes were affected. Validation of the kernicterus diagnosis in the hospital register was necessary.

Group-based antenatal birth and parent preparation for improving birth outcomes and parenting resources: Study protocol for a randomised trial

OBJECTIVES To examine the efficacy and cost-effectiveness of group based antenatal education for improving childbirth and parenting resources compared to auditorium based education. METHODS PARTICIPANTS 2350 Danish pregnant women and their partners ≥18 years old, recruited before 20+0 gestational weeks. Population-based individually randomised superiority trial with two parallel arms: Four sessions of birth and parent preparation in small groups (experimental group); two lectures in an auditorium (control group). Data is collected by (1) questionnaires at baseline (≈18 weeks of gestation), 37 weeks of gestation, 9 weeks-, 6 months-, and 1 year post-partum, (2) the hospital obstetric database, (3) national registers. PRIMARY OUTCOME use of epidural analgesia. SECONDARY OUTCOMES stress, parenting alliance; explorative outcomes: depressive symptoms, use of health care services, self-efficacy, well-being, family break-ups. Analyses will be intention-to-treat as well as per protocol. Process evaluation will be conducted using questionnaires and qualitative interviews. The incremental societal cost of the intervention will be computed and compared to the measured outcomes in a cost-effectiveness analysis. CONCLUSION To the best of our knowledge this is the largest well-designed randomised trial of its kind to date. The trial will bring much-needed evidence for decision makers of the content and form of antenatal education.

Neonatal hyperbilirubinemia and the risk of febrile seizures and childhood epilepsy

PURPOSE The aim of the study was to estimate the association between newborn children treated with phototerapy for hyperbilirubinemia and the subsequent risk of febrile seizures or epilepsy in early childhood. METHODS We conducted a follow-up study of singleton children (N=70 230) born between February 1998 and May 2003 from the Danish National Birth Cohort (DNBC). Information on exposure to phototherapy for hyperbilirubinemia was obtained from a questionnaire in the DNBC. Information on epilepsy and febrile seizures were obtained from the Danish National Hospital Registry (DNHR). Cox proportional hazard regression model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). RESULTS Newborns treated with phototherapy for hyperbilirubinemia had a higher risk of developing epilepsy in early childhood (HR: 1.66, 95% CI: 1.23-2.24) but not febrile seizures (HR: 1.04, 95% CI: 0.86-1.27). The increases risk of epilepsy were only present for boys (HR: 1.98, 95% CI: 1.40-2.78) not for girls (HR: 1.14, 95% CI: 0.64-2.02) CONCLUSION: Phototherapy for hyperbilirubinemia in newborns was associated with an increased risk of epilepsy for males in early childhood. No excess risk was seen with febrile seizures.

Women’s worries in first pregnancy: Results from a randomised controlled trial

It has been suggested that participation in an antenatal education programme will increase the level of worry in pregnant women. This randomised controlled trial, investigated womens worries in late pregnancy as a secondary outcome depending on their attendance in an antenatal education programme. We found that women attending the education programme reported a lower level of worry in late pregnancy, especially worries related to birth issues, compared to those who did not attend the antenatal education programme.

Homebirth organised in a caseload midwifery model with affiliation to a Danish university hospital – A descriptive study

OBJECTIVE To describe birth and neonatal outcome in women initiating a homebirth and cared for by a caseload midwifery teams with affiliation to a university hospital. Further, to describe the rate, time, and reasons for transfer between home and hospital. DESIGN A descriptive study using prospectively collected registry data on initiated homebirths. RESULTS A total of 268 women initiated a homebirth and 192 actually gave birth at home, equal to 1.99% of all births in Aarhus Municipality. The majority of the women who initiated a homebirth experienced a vaginal birth (92%) regardless of birthplace. Approximately 28% of the women were transferred from home to hospital during or after birth and 72% of the women had a homebirth as planned. Two children (both born in hospital) were admitted to the neonatal care unit requiring minor observation or treatment. CONCLUSION The majority of the women included in this study experienced a vaginal birth including those being transferred from home to hospital. Main reasons for being transferred were slow labor progress and rupture of membranes >18 h. The majority of those being transferred were nulliparous women and most transfers happened during birth.