Does allocation of low risk parturient women to a separate maternity unit decrease the risk of emergency cesarean section?

Objective: To study whether the selection of low risk parturient women into a separate maternity unit leads to a lower risk of emergency cesarean section, compared to giving birth in a unit with mixed cases.

Design: Hospital based registry study.

Setting: Maternity units in two university hospitals in Oslo, Norway.

Can ultrasound measurements replace digitally assessed elements of the Bishop score?

Objective: To compare elements of the Bishop score and corresponding sonographic measurements before induction of labor, and assess how predictive factors can be used in a clinical setting.

Design: Prospective comparative clinical study.

Setting: Secondary referral center, university hospital.

Anal sphincter tears at spontaneous delivery: a comparison of five hospitals in Norway.

Objective: To analyze circumstances relating to severe anal sphincter tears occurring at spontaneous delivery, in view of reported differences in practice regarding manual perineal protection during delivery.

Design: Cohort study of midwife-conducted non-operative vaginal deliveries.

Setting: Five Norwegian hospitals with 12,438 consecutive deliveries during a 12-month period.

Ultrasound assessment of fetal head-perineum distance before induction of labor.

Objectives: To evaluate fetal head-perineum distance measured by ultrasound imaging as a predictive factor for induction of labor, and to compare this distance with maternal factors, the Bishop score and ultrasound measurements of cervical length, cervical angle and occiput position.

Methods: The study included 275 women admitted for induction of labor. The fetal head-perineum distance was measured by transperineal ultrasound imaging as the shortest distance from the outer bony limit of the fetal skull to the skin surface of the perineum.

Prediction of labour and delivery by ascertaining the fetal head position with transabdominal ultrasound in pregnancies with prelabour rupture of membranes after 37 weeks.

Purpose: To evaluate the proportion of fetal head rotation from occiput posterior (OP) to occiput anterior (OA) during labour after term prelabour rupture of membranes (PROM), and to study if OP before labour are associated with a higher risk of operative deliveries and a longer duration of labour.

Materials And Methods: A transabdominal ultrasound examination was performed in 152 women with PROM after 37 weeks with a single live fetus in cephalic position. The course of labour was compared in women with the fetal head in occiput posterior position or other positions before the start of labour.

Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term.

Objective: To evaluate whether engagement of the fetal head or cervical length in women with premature rupture of membranes (PROM) at term, are associated with time from PROM to delivery or need for operative delivery.

Methods: A transperineal ultrasound examination was performed in 152 women with a single live fetus in cephalic presentation after PROM (at > 37 gestational weeks). The shortest distance from the outer bony limit of the fetal skull to the skin surface of the perineum was measured in a transverse view, and the cervical length was measured in a sagittal view.

The term breech presentation. A retrospective study with regard to the planned mode of delivery.

Background: To analyze retrospectively a large group of term breech and vertex deliveries, with regard to the influence of the mode of delivery on the frequency of fetal and maternal complications.

Methods: All singleton breech deliveries after completed 36 weeks of pregnancy, with a live fetus, delivered at Rogaland Central Hospital, from September 1 1996 to the May 10 2001 were included (n = 575). Correspondingly as a control group, 582 cases in vertex presentation were analyzed.

Ropivacaine 1 mg/ml, plus fentanyl 2 microg/ml for epidural analgesia during labour. Is mode of administration important?

Background: Patient-controlled epidural analgesia (PCEA) with a moderate to high concentration of bupivacaine in obstetrics has been shown to give comparable analgesia and even higher level of satisfaction compared to continuous epidural infusion. We hypothesised that the use of a very low concentration technique (ropivacaine/fentanyl) might result in excessive dosing in the PCEA group, more motor blockade and a negative impact on spontaneous delivery rate.

Methods: We conducted a randomised, double-blind study of 60 nulliparous women at term comparing low concentration ropivacaine/fentanyl administered in either patient-controlled or fixed continuous infusion mode.

[Hemorrhage after Cesarean section].

Background: Caesarean delivery may cause serious complications; haemorrhage is one of them.

Material And Methods: By the use of information registered in a database in 1997-99 at Rogaland Central Hospital, 978 cesarean deliveries were investigated.

Results: Mean bleeding was 460 ml.

[Hemorrhage after vaginal delivery].

Background: Primary postpartum haemorrhage, defined as blood loss of more than 500 ml, is an important cause of maternal morbidity and mortality.

Material And Methods: By the use of information registered in a database in 1997-99 at Rogaland Central Hospital 11,681 women with vaginal births were investigated. In 1997 all women received 10 IU oxytocin routinely after delivery, in 1998 and 1999 the use of oxytocin was restricted to special indications.

A randomized prospective study of misoprostol and dinoproston for induction of labor.

Background: Misoprostol, a prostaglandin E1 analog registered for the prevention of gastric ulcers in NSAID-drug users, has been reported to be more effective for labor induction than the standard prostaglandin, dinoproston after vaginal application. There have been some concerns about possible hyperstimulation of the uterine activity and about the safety for the fetus with this new drug.

Methods: Two hundred and ten patients, 36 weeks pregnant or more, with an unfavorable cervix, single pregnancy, and intact membranes were randomized to receive misoprostol, 50 micrograms intravaginally every 6 hours, or dinoproston 0.

[Large fetus--a retrospective study].

Background: Large foetus is associated with increased risk of complications during labour and delivery.

Material And Methods: Data on deliveries and outcome of 504 macrosomic newborns (> or = 4,500 g) born 1995-97 at Rogaland Central Hospital, Norway.

Results: 74% of the mothers were multiparae.

Inborn errors of carnosine and homocarnosine metabolism.

Serum carnosinase deficiency with carnosinuria has been reported in 23 children with neurological signs and/or mental retardation. In adults four cases in one family had serum carnosinase deficiency, carnosinuria, and in addition elevated homocarnosine in CSF and in the brain. The mother was one of these cases but had no clinical symptoms; however her three children have spastic paraparesis, retinitis pigmentosa and mental retardation.

Cystathioninuria in Down's syndrome.

Secondary cystathioninuria is associated with various pathological conditions (Gjessing, 1963; Gjessing & Mauritzen, 1965; Endres & Wuttge, 1978). In many cases, cystathioninuria has been associated with mental retardation (Harris et al., 1959; Robb et al.

Plasma amino acids in dogs with osteochondrosis or hip dysplasia.

Radiography of the hip joints of mature dogs has shown that hip dysplasia is quite common in many middle and large size breeds in Norway. The heritability of hip dysplasia has been estimated in several studies to be between 0.2 and 0.

Fasting plasma amino acid concentrations in PKU children on two different levels of protein intake.

Two groups of children with phenylketonuria were treated with different amounts of protein. One group (RDA group) received protein as recommended by the U.S.

Cystathioninuria in a profoundly mentally retarded woman with spastic tetraplegia, deafness and abnormal liver function tests.

This article describes a profoundly mentally retarded woman with spastic tetraplegia, deafness and abnormal liver function tests with a secondary cystathioninuria. The cystathioninuria could be corrected with vitamin B6 supplementation.

A double-blind comparison of citalopram (Lu 10-171) and amitriptyline in depressed patients.

In a controlled, clinical, multicentre trial comprising a total of 43 patients (17 men and 26 women) citalopram was compared double-blindly with amitriptyline. Nineteen patients of each group were classified as endogeneously depressed, whereas four patients of the citalopram group and one of the amitriptyline group were classified as non-endogenously depressed. The patients were seriously ill with a high frequency of previous depressive episodes and of mental disorders among their closest relatives.

Homocarnosinosis: influence of dietary restriction of histidine.

Homocarnosinosis, an inherited disorder, is characterized by an elevated level of the dipeptide homocarnosine (Hca) in the CSF and the brain and, in addition, by carnosinuria and serum carnosinase deficiency. In three children with homocarnosinosis the biochemical aberration co-exists with paraplegia, retinitis pigmentosa, and a progressive mental deficiency. In the mother, however, only the biochemical aberration was present without clinical symptoms.

A new patient with hyperornithinaemia, hyperammonaemia and homocitrullinuria treated early with low protein diet.

The characteristic biochemical disturbances of the amino acid and pyrimidine metabolism are described and illustrated by the first case of the HHH syndrome reported in Norway. The disorder was treated with a low protein diet at an early age and the patient developed normally on this diet.