Janne Rossen

• Kessler, Jørg; Tappert, Christian; Rossen, Janne; Macsali, Ferenc & Robson, Michael (2025). Implementation of the Intrapartum Cesarean Delivery Classification System: a prospective observational study. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. 233(6 Suppl.), p. S627–S629. doi: 10.1016/j.ajog.2025.02.042. Full text in Research Archive
• Austad, Fride Efjestad; Kessler, Jørg; Magnussen, Elisabeth Balstad; Pripp, Are Hugo & Rossen, Janne (2025). Outpatient Versus Inpatient Induction of Labour With Oral Misoprostol: A Multicentre Randomised-Controlled Trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 132, p. 1562–1573. doi: 10.1111/1471-0528.18296. Full text in Research Archive
• Hægeland, Hanne Abel; Moi, Marianne Gunnufsen; Austad, Fride Efjestad; Oommen, Hanna; Rossen, Janne & Lukasse, Mirjam (2023). Women’s experiences and views of outpatient and inpatient induction of labor with oral misoprostol: A secondary qualitative study. European Journal of Midwifery (EJM). 7(33), p. 1–8. doi: 10.18332/ejm/172651. Full text in Research Archive Show summary

  Introduction: As labor induction rates continue to increase, so has the interest in performing induction in an outpatient setting for pregnancies defined as low-risk. Twenty women participated in the pilot study of a Randomized Controlled Trial (RCT) comparing inpatient and outpatient labor induction with oral misoprostol. This study aimed to explore women’s experiences of outpatient induction of labor and their views on this as an alternative method to inpatient labor induction. Methods: Semi-structured interviews were conducted, from November 2021 to January 2022 with eight women randomized to outpatient induction and four women randomized to inpatient induction. Verbatim transcribed interviews were analyzed using Graneheim and Lundman’s content analysis. Results: Three main categories emerged: the required framework around outpatient labor induction, what felt better at home and what felt safer at the hospital. To feel secure at home, women needed sufficient information, close follow-up while at home, and an easyto- administer induction method. Outpatient labor induction gave women the opportunity of constant support from the partner and increased freedom of movement and selfexpression. Some expressed relief over being randomized to inpatient labor induction, because of easy access to health providers, fetal monitoring, and not risking giving birth before arrival to the hospital. Women stressed the importance of being given a choice. Conclusions: Outpatient labor induction contributed to a positive birth experience and should be considered as an alternative for women with low-risk pregnancies. Shared decision-making, including the opportunity for women to change their mind, is essential as induction and early labor affects women’s whole childbirth experience.

• Austad, Fride Efjestad; Eggebø, Torbjørn Moe & Rossen, Janne (2019). Changes in labor outcomes after implementing structured use of oxytocin augmentation with a 4-hour action line. Journal of Maternal-Fetal & Neonatal Medicine. ISSN 1476-7058. p. 1–8. doi: 10.1080/14767058.2019.1702958. Full text in Research Archive
• Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegård, Ellen; Rasmussen, Steen & Bergholt, Thomas [Show all 7 contributors for this article] (2018). Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections? Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(7), p. 872–879. doi: 10.1111/aogs.13341. Full text in Research Archive Show summary

  Introduction Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. Material and methods In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000–2011 from Norway and Denmark were included [Ten‐group classification system (Robson) group 1]. In this case‐control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi‐square test and logistic regression were used to estimate associations and interactions. Results The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Conclusions Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset.

• Rossen, Janne; Lucovnik, Miha; Eggebø, Torbjørn Moe; Tul, Natasa; Murphy, Martina & Vistad, Ingvild [Show all 7 contributors for this article] (2017). A method to assess obstetric outcomes using the 10-Group Classification System: A quantitative descriptive study. BMJ Open. 7(7). doi: 10.1136/bmjopen-2017-016192. Full text in Research Archive Show summary

  Objectives Internationally, the 10-Group Classification System (TGCS) has been used to report caesarean section rates, but analysis of other outcomes is also recommended. We now aim to present the TGCS as a method to assess outcomes of labour and delivery using routine collection of perinatal information. Design This research is a methodological study to describe the use of the TGCS. Setting Stavanger University Hospital (SUH), Norway, National Maternity Hospital Dublin, Ireland and Slovenian National Perinatal Database (SLO), Slovenia. Participants 9848 women from SUH, Norway, 9250 women from National Maternity Hospital Dublin, Ireland and 106 167 women, from SLO, Slovenia. Main outcome measures All women were classified according to the TGCS within which caesarean section, oxytocin augmentation, epidural analgesia, operative vaginal deliveries, episiotomy, sphincter rupture, postpartum haemorrhage, blood transfusion, maternal age >35 years, body mass index >30, Apgar score, umbilical cord pH, hypoxic–ischaemic encephalopathy, antepartum and perinatal deaths were incorporated. Results There were significant differences in the sizes of the groups of women and the incidences of events and outcomes within the TGCS between the three perinatal databases. Conclusions The TGCS is a standardised objective classification system where events and outcomes of labour and delivery can be incorporated. Obstetric core events and outcomes should be agreed and defined to set standards of care. This method provides continuous and available observations from delivery wards, possibly used for further interpretation, questions and international comparisons. The definition of quality may vary in different units and can only be ascertained when all the necessary information is available and considered together.

• Rossen, Janne; Østborg, Tilde Broch; Lindtjørn, Elsa; Schulz, Jörn & Eggebø, Torbjørn Moe (2016). Judicious use of oxytocin augmentation for the management of prolonged labor. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 95(3), p. 355–361. doi: 10.1111/aogs.12821. Full text in Research Archive
• Rossen, Janne; Økland, Inger; Nilsen, Odd Bjarte & Eggebø, Torbjørn Moe (2010). Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 89(10), p. 1248–1255. doi: 10.3109/00016349.2010.514324. Full text in Research Archive Show summary

  Objective. To analyze changes in postpartum hemorrhage over a 10-year period from 1998 to 2007, and to explore factors associated with severe hemorrhage. Design. Retrospective cohort study, prospectively collected information. Setting. Stavanger University Hospital, a secondary referral center, Norway. Population. An unselected population of 41,365 women giving birth at the hospital. Methods. We analyzed changes over time in mean postpartum hemorrhage, severe postpartum hemorrhage and associated factors. Estimated blood loss >1,000 ml was defined as severe hemorrhage. Data were collected from the hospital's database. Main outcome measures. Severe postpartum hemorrhage and obstetric interventions. Results. We observed an increase in severe hemorrhage during the study period. After cesarean sections, the risk of severe hemorrhage was twice the risk of severe hemorrhage after vaginal deliveries (5.9%; 95% CI 5.3-6.6 vs. 2.8%; 95% CI 2.6-2.9). The most important factors associated with severe hemorrhage following vaginal deliveries were twin deliveries (OR 6.8), retained placenta (OR 3.9) and inductions of labor (OR 2.2). For cesarean sections, twin deliveries had the strongest association with severe hemorrhage (OR 3.7) followed by general anesthesia (OR 3.0). Obstetric interventions became more frequent; elective cesarean sections increased from 2.4 to 4.9%, acute cesarean sections from 5.5 to 8.9%, operative vaginal deliveries from 9.3 to 12.5%, inductions of labor from 14.3 to 15.8% and augmentations of labor from 5.8 to 29.3%. Conclusions. The incidence of severe postpartum hemorrhage increased, and this may be related to more frequent use of obstetric interventions.

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• Skjeldestad, Finn Egil; Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegaard, Ellen & Rasmussen, Sven [Show all 7 contributors for this article] (2017). Maternal age, epidural analgesia and oxytocin augmentation as risk factors for cesarean delivery in nulliparous women in spontaneous labor at term. Full text in Research Archive
• Rossen, Janne; Østborg, Tilde Broch; Lindtjørn, Elsa; Schulz, Jørgen & Eggebø, Torbjørn Moe (2015). Targeted use of oxytocin augmentation. Full text in Research Archive
• Rossen, Janne; Skjeldestad, Finn Egil; Eggebø, Torbjørn Moe & Robson, M (2014). Assessment of quality of care in labor and delivery using the Ten Group Classifi-cation System (TGCS). Full text in Research Archive
• Rossen, Janne; Robson, M; Rettedal, Siren; Lindtjørn, Elsa & Eggebø, Torbjørn Moe (2014). Assessment of quality of care in labor and delivery using the Ten Group Classification System (TGCS). Full text in Research Archive
• Rossen, Janne; Eggebø, Torbjørn Moe & Vistad, Ingvild (2017). Oxytocin augmentation and its association with labor outcomes. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232623983. Full text in Research Archive Show summary

  Stimulering av rier med oxytocin og sammenheng med fødselsutfall Oxytocin blir ofte brukt under fødselen for å øke styrken på riene. Mangel på klare indikasjoner for bruk av oxytocin har ført til ulik praksis og tilfeldig bruk. Hensikten med studien var å undersøke om det kan være en sammenheng mellom bruken av oxytocin og hvordan fødselen blir for kvinnen og for barnet. Studie I Vi undersøkte retrospektivt risikofaktorer for blødning over 1000 ml etter fødselen og om dette hadde endret seg fra 1998 til 2007. Blødning over 1000 ml økte i studieperioden og risikoen var dobbelt så stor etter keisersnitt sammenlignet med vaginal fødsel (2.8 % vs. 5.9 %). Igangsetting av fødsel, stimulering av rier og keisersnittfrekvens økte, og disse faktorene viste sammenheng med alvorlig blødning etter fødselen. Bruk av oxytocin for stimulering av rier økte fra 5.8 % til 29.3 %. Studie II Målet med denne studien var å presentere en metode for å evaluere og kvalitetssikre utfall og hendelser for mor og barn i forbindelse med fødsel. Michael Robson har laget en metode der fødende kvinner kan klassifiseres i ti ulike grupper. Metoden ble først utviklet for å klassifisere bruken av keisersnitt. I denne studien presenterer vi hvordan vi kan klassifisere 16 fødselsutfall i henhold til de ti gruppene. Vi presenterer resultater fra fødeavdelinger i Stavanger, Dublin og nasjonale data fra Slovenia. Studie III Fødeavdelingen ved Stavanger universitetssjukehus endret indikasjonene og rutinene for oxytocinbruk i 2010. I løpet av en 5 års periode ble bruken av oxytocin under fødselen signifikant redusert fra 35.5 % til 23.6 %. Antall akutte keisersnitt og antall barn med lav pH i navlesnora gikk ned i samme tidsperiode og vi diskuterer om dette kan ha en sammenheng med redusert bruk av oxytocin. Flere kvinner opplevde blødning over 1000ml og varighet av fødsel over 12 timer. Studie IV Fødselsregistrene i Norge og Danmark ble brukt for å undersøke bruken av oxytocin for ristimulering hos førstegangsfødende kvinner med spontan fødselstart til termin. Vi fant at bruk av oxytocin økte med kvinnenes alder, bruk av epiduralbedøvelse og med akutte keisersnitt. Formålet med studien var å vurdere samspillet mellom disse faktorene. Ristimulering viste sammenheng med lavere forekomst av keisersnitt hos kvinner med epiduralbedøvelse, spesielt hos kvinner over 35 år. Konklusjon Målrettet bruk av oxytocin for stimulering av rier førte til redusert bruk av oxytocin og viste sammenheng med færre akutte keisersnitt og færre barn med lav pH i navlesnora. Kvinner med epiduralbedøvelse kan imidlertid ha fordel av ristimulering. Flere ulike faktorer har innvirkning på fødselsforløp og fordeler og ulemper må vurderes i forhold til hverandre. Robsons 10-gruppe klassifikasjonssystem kan være et nyttig hjelpemiddel for å kvalitetssikre fødselsutfall og for å sammenligne ulike fødeavdelinger

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