Siri Vangen

Prevalence and risk factors of severe obstetric haemorrhage

Objective  To determine the prevalence, causes, risk factors and acute maternal complications of severe obstetric haemorrhage.

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

BackgroundMaternal 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.MethodsWe 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.ResultsThe 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.ConclusionWomen 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.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries

Objective  This study aimed to investigate pregnancy outcomes in Somali‐born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden.

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.

Uterine rupture after previous caesarean section

Please cite this paper as: Al‐Zirqi I, Stray‐Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG 2010;117:809–820.

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.

Cesarean section among immigrants in Norway

Objective. We studied prevalences and risk factors for cesarean section among different groups of immigrants from countries outside Western Europe and North America in comparison to ethnic Norwegians.

Delivery by Cesarean Section and Early Childhood Respiratory Symptoms and Disorders The Norwegian Mother and Child Cohort Study

Studies have indicated that children delivered by cesarean section are at an increased risk of developing wheezing and asthma. This could be the result of an altered immune system development due to delayed gut colonization or of increased neonatal respiratory morbidity. The authors examined the associations between delivery by cesarean section and the development of wheezing, asthma, and recurrent lower respiratory tract infections in children up to 36 months of age among 37,171 children in the Norwegian Mother and Child Cohort Study. Generalized linear models were used in the multivariable analysis. Children delivered by cesarean section had an increased likelihood of current asthma at 36 months of age (relative risk = 1.17, 95% confidence interval: 1.03, 1.32), and the association was stronger among children of nonatopic mothers (relative risk = 1.33, 95% confidence interval: 1.12, 1.58). No increased risk of wheezing or recurrent lower respiratory tract infections was seen among children delivered by cesarean section. Findings were similar among children delivered by acute and elective cesarean section. In conclusion, children delivered by cesarean section may have an increased risk of current asthma at 36 months, but residual confounding cannot be excluded. In future prospective studies, investigators should reexamine this association in different age groups.

Suboptimal care in stillbirths – a retrospective audit study

Background. Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub‐optimal factors in stillbirths were more frequent among non‐western than western women. Methods. Population‐based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998–2003 (4.2 per 1,000 deliveries); of these 31% were born to non‐western women. By audit, the stillbirths were attributed to optimal or sub‐optimal care factors. Multivariate methods were used to analyse the data. Results. Sub‐optimal factors were identified in 37% of the deaths. When compared to western women, non‐western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3–3.8), and an increased risk of sub‐optimal care (OR: 2.4; 95% CI: 1.5–3.9). More often, non‐western women received sub‐optimal obstetric care (p<0.001), as e.g. failure to act on non‐reassuring fetal status or incorrect assessment of labour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non‐western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non‐western mothers; an interpreter was used in 29% of these cases. Conclusions. Non‐western women constituted a risk group for sub‐optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non‐western women.

The impact of previous birth experiences on maternal fear of childbirth

This study aimed to assess the relation between fear of childbirth and previous birth experiences.