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• Denstad, Silje Eilertsen; Volløyhaug, Ingrid; Lieng, Marit; Salvesen, Øyvind Olav & Lonnée-Hoffmann, Risa Anna Margaretha (2026). Three-Year Changes in Health-Related Quality of Life after Laparoscopic Hysterectomy: A Registry-Based Cohort Study. Journal of minimally invasive gynecology. ISSN 1553-4650. doi: 10.1016/j.jmig.2026.03.036. Full text in Research Archive
• Denstad, Silje Eilertsen; Volløyhaug, Ingrid; Lieng, Marit; Moawad, Gaby & Lonnée-Hoffmann, Risa Anna Margaretha (2026). Risk factors for vaginal cuff dehiscence after robot-assisted total laparoscopic hysterectomy: A retrospective cohort study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 105(3), p. 545–552. doi: 10.1111/aogs.70143. Full text in Research Archive
• Aas-Eng, Mee Kristine; Young, Victoria Solveig; Dormagen, Johann Baptist; Pripp, Are Hugo; Hudelist, Gernot & Lieng, Marit (2023). Lesion-to-anal-verge distance in rectosigmoid endometriosis on transvaginal sonography vs magnetic resonance imaging: prospective study. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. 61(2), p. 243–250. doi: 10.1002/uog.26083. Full text in Research Archive Show summary

  ABSTRACT Objectives To compare transvaginal sonography (TVS) and magnetic resonance imaging (MRI) with intraoperative measurement (IOM) using a rectal probe in the estimation of the location of rectosigmoid endometriotic lesions, i.e. lesion‐to‐anal‐verge distance (LAVD), and to compare two different MRI techniques for measuring LAVD. Methods This was a prospective single‐center observational study that included women undergoing surgery for symptomatic rectosigmoid endometriosis by discoid (DR) or segmental (SR) resection from December 2018 to December 2019. TVS and MRI were performed presurgically for each participant to evaluate LAVD, and the measurements on imaging were compared with IOM using a rectal probe. Clinically acceptable difference and limits of agreement (LoA) between TVS and MRI compared with IOM were set at ± 20 mm. Two different measuring methods for MRI, MRI Center and MRI Direct , were proposed and evaluated, as there is currently no guideline to describe deep endometriosis on MRI. Bland–Altman plots and LoA were used to assess agreement of TVS and both MRI methods with IOM. Systematic and proportional biases were assessed using paired t ‐test and Bland–Altman plots. Results Seventy‐five women were eligible for inclusion. Twenty‐eight women were excluded, leaving 47 women for the analysis. Twenty‐three DR and 26 SR procedures were performed, with both procedures performed in two women. The Bland–Altman plots showed that there were no systematic differences between TVS or MRI Center when compared with IOM for all included participants. MRI Direct systematically underestimated LAVD for lesions located further from the anal verge. TVS, MRI Center and MRI Direct had LoA outside the preset clinically acceptable difference when compared with IOM. LAVD was within the clinically acceptable difference from IOM of ± 20 mm in 70% (33/47) of women on TVS, 72% (34/47) of women on MRI Center and 47% (22/47) of women on MRI Direct . Conclusions TVS should be the preferred method to estimate the location of a rectosigmoid endometriotic lesion, i.e. LAVD, as it is more available, less expensive and has a similar accuracy to that of MRI. Estimating LAVD can be relevant for planning colorectal surgery for rectosigmoid endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar J. A.; Bottcher, Bettina; Fosse, Erik & Ali, Hadil [Show all 10 contributors for this article] (2022). Exploring the impact of indication on variation in rates of intrapartum caesarean section in six Palestinian hospitals: a prospective cohort study. BMC Pregnancy and Childbirth. 22:892, p. 1–8. doi: 10.1186/s12884-022-05196-8. Full text in Research Archive Show summary

  Background Caesarean section rates are rising globally. No specific caesarian section rate at either country-level or hospital-level was recommended. In Palestinian government hospitals, nearly one-fourth of all births were caesarean sections, ranging from 14.5 to 35.6%. Our aim was to assess whether variation in odds for intrapartum caesarean section in six Palestinian government hospitals can be explained by differences in indications. Methods Data on maternal and fetal health were collected prospectively for all women scheduled for vaginal delivery during the period from 1st March 2015 to 30th November 2016 in six government hospitals in Palestine. Comparisons of proportions in sociodemographic, antenatal obstetric characteristics and indications by the hospital were tested by χ2 test and differences in means by one-way ANOVA analysis. The odds for intrapartum caesarean section were estimated by logistic regression. The amount of explained variance was estimated by Nagelkerke R square. Results Out of 51,041 women, 4724 (9.3%) underwent intrapartum caesarean section. The prevalence of intrapartum caesarean section varied across hospitals; from 7.6 to 22.1% in nulliparous, and from 5.8 to 14.1% among parous women. The most common indications were fetal distress and failure to progress in nulliparous, and previous caesarean section with an additional obstetric indication among parous women. Adjusted ORs for intrapartum caesarean section among nulliparous women ranged from 0.42 (95% CI 0.31 to 0.57) to 2.41 (95% CI 1.70 to 3.40) compared to the reference hospital, and from 0.50 (95% CI 0.40–0.63) to 2.07 (95% CI 1.61 to 2.67) among parous women. Indications explained 58 and 66% of the variation in intrapartum caesarean section among nulliparous and parous women, respectively. Conclusion The differences in odds for intrapartum caesarean section among hospitals could not be fully explained by differences in indications. Further investigations on provider related factors as well as maternal and fetal outcomes in different hospitals are necessary.

• Johanson, Maja Lieng & Lieng, Marit (2021). Changes in route of hysterectomy in Norway since introduction of robotic approach. Facts, views & vision in ObGyn.. ISSN 2032-0418. 13(1), p. 35–40. doi: 10.52054/FVVO.13.1.005. Full text in Research Archive Show summary

  Introduction: From 2008, several Norwegian Health Trusts have acquired surgical robotic systems, and robotic hysterectomy accounted for 15 % of all hysterectomies performed in Norway in 2018. Robotic assisted hysterectomy is costly, and there is no evidence that the clinical outcome of robotic assisted hysterectomy is superior compared to the outcomes following other minimal invasive hysterectomies such as vaginal and laparoscopic hysterectomies. The objectives of this study were to describe the implementation of robotic hysterectomy and changes in other hysterectomy approaches, such as open abdominal, laparoscopic and vaginal hysterectomy in hospitals with and without robotic systems for hysterectomy. Methods: Quantitative study based on hysterectomy data between 2010 to 2018 from the Norwegian Patient Registry. Results: 9 out of 19 health trusts performed robotic assisted hysterectomy during the study period. The rate of abdominal hysterectomies declined during the study period, both in the health trusts with and without available surgical robotic systems. The rate of other minimally invasive hysterectomies also declined in some health trusts after the implementation of robotic assisted hysterectomy. Discussion: Robotic hysterectomy has been implemented and is increasing in Norway without a thorough evaluation of the effect on patient safety and possible economic consequences. According to our findings, it appears that the implementation of robotic hysterectomy has not had a significant impact on the use of open abdominal hysterectomy. Although associated with increased costs and a lack of evidence of improved clinical outcomes for women, robotic hysterectomy has furthermore to some extent replaced other minimal invasive hysterectomies.

• Comelon, Marlin; Ræder, Johan; Drægni, Tomas; Lieng, Marit & Lenz, Harald (2021). Tapentadol versus oxycodone analgesia and side effects after laparoscopic hysterectomy. A randomised controlled trial. European Journal of Anaesthesiology. ISSN 0265-0215. 38(9), p. 995–1002. doi: 10.1097/EJA.0000000000001425. Full text in Research Archive
• Aas-Eng, Mee Kristine; Lieng, Marit; Dauser, B.; Diep, Lien My; Leonardi, M. & Condous, G. [Show all 7 contributors for this article] (2021). Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. 58(6), p. 933–939. doi: 10.1002/uog.23728. Full text in Research Archive Show summary

  Objective To investigate the agreement of measurements of the three diameters of rectosigmoid deep endometriosis (DE) lesions between presurgical evaluation using transvaginal sonography (TVS) and postsurgical specimen measurement (PSM). Methods This was a prospective observational multicenter study including symptomatic women undergoing surgical treatment for DE involving the rectosigmoid, by either discoid or segmental resection, from April 2017 to December 2019. TVS was performed presurgically to evaluate lesion size (craniocaudal–midsagittal length, anteroposterior thickness and transverse diameter), in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement, and was compared with PSM. The agreement of lesion dimensions between the two methods was assessed by Bland–Altman plots and limits of agreement and additionally by the intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. Systematic and proportional bias was assessed using the paired t-test. Results A total of 207 consecutive women were eligible for inclusion. Forty-one women were excluded, leaving 166 women for final analysis. A total of 123 segmental resections and 46 discoid resections were performed (both procedures were performed in three women). The mean difference between TVS and PSM was 0.90 (95% CI, 0.85–0.95) mm for lesion length measurements, 1.03 (95% CI, 0.98–1.09) mm for lesion thickness measurements and 0.84 (95% CI, 0.79–0.89) mm for transverse diameter measurements. Bland–Altman analysis demonstrated good agreement between the two methods for measurements of lesion length. Furthermore, there was good reliability and correlation between TVS and PSM for lesion length measurements, as demonstrated by an ICC of 0.82 (95% CI, 0.75–0.87) and Pearson's correlation coefficient of 0.72 (95% CI, 0.62–0.80), moderate-to-good reliability and correlation for lesion thickness measurements, with an ICC of 0.76 (95% CI, 0.67–0.82) and Pearson's correlation coefficient of 0.61 (95% CI, 0.51–0.70), and poor-to-moderate reliability and correlation for transverse diameter measurements, with an ICC of 0.58 (95% CI, 0.39–0.71) and Pearson's correlation coefficient of 0.46 (95% CI, 0.33–0.58). Conclusion Preoperative TVS determines accurately rectosigmoid DE lesion length. TVS can thereby contribute to optimal planning of surgical treatment options in women with rectosigmoid DE. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• Ravlo, Merethe; Moen, Mette Haase; Bukholm, Ida Rashida Khan; Lieng, Marit & Vanky, Eszter (2021). Ureteric injuries during hysterectomy—A Norwegian retrospective study of occurrence and claims for compensation over an 11-year period. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 101(1), p. 68–76. doi: 10.1111/aogs.14293. Full text in Research Archive Show summary

  Introduction: Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative conditions. Our aims were to evaluate and learn from compensation claims to The Norwegian System of Patient Injury Compensation (NPE) for ureteric injury occurring during hysterectomies to predict risk factors, time of identification, symptoms, and consequences, and to relate these cases to injuries registered in The Norwegian Patient Registry. Material and methods: A retrospective study of ureteric injuries occurring during hysterectomies, reported to NPE and the Norwegian Patient Registry from 2009 through 2019. Results: During the study period, 53 096 hysterectomies were registered in The Norwegian Patient Registry, of which ureteric injury was documented in 643 (1.2%). More ureteric injuries were registered in large hospital trusts than in small trusts (1.3% vs. 0.7%, p < 0.05). NPE received 69 claims due to ureteric injury occurring during hysterectomy, comprising 11% of all injuries in the study period. Compensation was approved for 15%. Women who claimed compensation were younger (48.1 ± 8.9 years vs. 55.1 ± 13.6 years, p < 0.01), more likely to have had a benign diagnosis (89.9% vs. 52.1%, p < 0.01), and more likely to have had the ureteric injury recognized after discharge (58.0% vs. 33.0%, p < 0.001) compared with non-complainants. Identification of the ureters during the hysterectomy was documented in 30% of the NPE patient files. Additional information for the NPE cases included the following. The most common symptoms of unidentified injury were pain (77%), fever (12%), urinary leakage (13%), and anuria (8%). Re-operation was necessary in 77% of the cases, and 10% of the women lost one kidney. Long-term consequences after repair, such as loss of a kidney or persistent pain, were seen in 17%. No women died because of the injury. Conclusions: The incidence of ureteric injury occurring during hysterectomy in Norway was 1.2%; 11% involved a claim for compensation, and 15% of these had their case approved. Most ureteric injuries were not recognized during the hysterectomy. Documentation of peroperative identification of the ureters during hysterectomy was often missing. Vigilance to pain as a postoperative symptom of peroperative unrecognized ureteric injury may result in earlier diagnosis and treatment.

• Johanson, Maja Lieng; Dögl, Malin Andrea Elisabeth & Lieng, Marit (2020). Hysterektomi i Norge 2008–18. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.20.0167. Full text in Research Archive Show summary

  Background: Hysterectomy is a common gynaecological procedure. No Norwegian guidelines for the choice of hysterectomy surgical method exist, but international guidelines recommend minimally invasive surgery. The objective of this study was to investigate the kinds of surgical methods that were used for hysterectomies in the period 2008-18. Furthermore, we wished to identify the scope of robot-assisted hysterectomies and to find out whether salpingectomies are undertaken on a benign indication in Norway. Material and method: The study is based on data from the Norwegian Patient Registry. Relevant variables for all gynaecological hysterectomies in Norway in the period 2008-18 were collected at the individual level. Results: During the study period, 53 178 hysterectomies were registered in the Norwegian Patient Registry. The proportion of hysterectomies that were performed with minimally invasive techniques increased from 41 % to 73 % during the study period. Robot-assisted hysterectomies accounted for 15 % of the total in 2018. The number of concomitant salpingectomies also increased during the period, and were performed in more than half of all hysterectomies undertaken on a benign indication. Interpretation: Norwegian gynaecologists largely follow international guidelines and recommendations regarding minimally invasive hysterectomy and salpingectomy. Although the total proportion of minimally invasive hysterectomies is now relatively high, there are considerable variations between the different health trusts.

• Aas-Eng, Mee Kristine; Montanari, Eliana; Lieng, Marit; Keckstein, Joerg & Hudelist, Gernot (2020). Transvaginal tonographic imaging and associated techniques for diagnosis of ovarian, deep endometriosis, and adenomyosis: A comprehensive review. Seminars in Reproductive Medicine. ISSN 1526-8004. 38, p. 216–226. doi: 10.1055/s-0040-1718740. Full text in Research Archive
• Ravlo, Merethe; Lieng, Marit; Bukholm, Ida Rashida Khan; Moen, Mette Haase & Vanky, Eszter (2020). Claims for compensation from women with cervical cancer in Norway-A retrospective, descriptive study of a 12-year period. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 99(11), p. 1546–1553. doi: 10.1111/aogs.13930. Full text in Research Archive Show summary

  Introduction: In Norway, all patient-reported claims for compensation are evaluated by The Norwegian System of Patient Injury Compensation (NPE). The number of claims from women with cervical cancer is rising, and the approval rate is high. Our aim was to study claims for compensation from women with cervical cancer to identify the type of failures, when, during the time-course of treatment, the medical failures occurred, and the consequences of the failures. Material and methods: A retrospective, descriptive study of claims for compensation to NPE from cervical cancer patients during a 12-year period, from 2007 through 2018. We used anonymized medical expert statements and summaries of NPE cases. Results: In all, 161 women claimed compensation for alleged medical failure related to cervical cancer. Compensation was approved for 100 (62%) women. Mean age at the time of alleged failure was 37.5 years (SD ±9.9). The main reasons why women sought medical attention were routine cervical screening (56%), or vaginal bleeding or discharge (30%). In approved cases, incorrect evaluation of cytology and histology was the cause of most failures (72%). Mean delay of cervical cancer diagnosis for approved cases was 28 months (SD ±22). Treatment not in accordance with guidelines was the cause of failure in 2% of the cases, and failure during follow up was the cause of failure in 12%. Consequences of the failures were as follows: worsening of cancer prognosis (89%), treatment-induced adverse effects, such as loss of fertility (43%) and/or loss of ovarian function in premenopausal women (50%), and permanent injury after chemo-radiation (27%). Seven women (7%) died, most probably as a consequence of the failure. Conclusions: The main cause of medical failure in women with cervical cancer was incorrect pathological diagnosis. The main consequences of failures were worsening of cancer prognosis and treatment-induced adverse effects. Increased focus on the quality of pathological examinations, and better routines in all parts of the cervical examinations might improve patient safety for women in risk of cervical cancer.

• Goderstad, Jeanne Mette; Fosse, Erik; Sandvik, Leiv & Lieng, Marit (2020). Development and validation of a curriculum for laparoscopic supracervical hysterectomy. Facts, views & vision in ObGyn.. ISSN 2032-0418. 12(2), p. 83–90. Full text in Research Archive
• Aas-Eng, Mee Kristine; Dauser, Bernhard; Lieng, Marit; Diep, Lien My; Leonardi, M. & Condous, G. [Show all 7 contributors for this article] (2020). Transvaginal sonography accurately measures lesion-to-anal-verge distance in women with deep endometriosis of the rectosigmoid. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. 56(5), p. 766–772. doi: 10.1002/uog.21995. Full text in Research Archive Show summary

  Objectives First, to investigate the accuracy of transvaginal sonography (TVS) for presurgical evaluation of the distance between the most caudal part of the endometriotic lesion and the anal verge (lesion‐to‐anal‐verge distance (LAVD)) in women with rectosigmoid deep endometriosis (DE), compared with intraoperative measurement (IOM). Second, to assess the agreement between anastomosis height and LAVD measured using TVS. Methods This was a prospective observational multicenter study of symptomatic women who were scheduled for surgical treatment of rectosigmoid DE, by either discoid or segmental resection, between April 2017 and September 2019. Presurgical TVS was performed to evaluate the LAVD in two ways, depending on the level of the lesion. Method 1: for lesions at the level of the rectovaginal septum (RVS), the caudal part of the lesion was identified on TVS and an index finger was placed on the TVS probe at the level of the anal verge. The probe was withdrawn and the distance from the tip of the TVS probe down to the index finger was measured using a ruler, representing the LAVD. Method 2: for lesions above the RVS, the distance between the caudal part of the lesion and the lower lip of the posterior cervix was measured in a frozen image (LAVD‐1), and the distance between the lower lip of the posterior cervix and the anal verge (LAVD‐2) was measured using Method 1. These two measurements (LAVD‐1 and LAVD‐2) were added together and the result represented the total LAVD. During surgery, a rectal probe was used to perform IOM of LAVD, which was considered as the gold standard test. Agreement between LAVD measured using TVS and the IOM was assessed using Bland–Altman analysis. The intraclass correlation coefficient (ICC) for absolute agreement and Spearman's correlation coefficient were also calculated. Systematic and proportional bias were tested for significance using the paired t‐test. Similar analysis was performed to assess agreement between LAVD measured using TVS and anastomosis height. Results A total of 147 consecutive women were considered eligible for inclusion. Fourteen women were excluded initially. Thirty‐four discoid resections and 102 segmental resections were performed; both procedures were performed in three women. Two more women were excluded from the final analysis because the measurements represented extreme outliers. The mean LAVD measured using TVS was 114.8 ± 36.5 mm and the mean IOM was 116.9 ± 42.3 mm. There was no statistically significant difference between LAVD measured using TVS and IOM (mean difference, –2.12 mm (95% CI, –6.33 to 2.05 mm); P = 0.32). Bland–Altman analysis showed that there was good agreement between the two methods. The ICC was 0.81 (95% CI, 0.74–0.86) and Spearman's correlation coefficient was 0.68 (95% CI, 0.56–0.77). The mean difference between LAVD measured using TVS and anastomosis height was statistically, but not clinically, significant (mean difference, 10.25 mm (95% CI, 5.94–14.32 mm); P = 0.0005), and the ICC was 0.78 (95% CI, 0.66–0.85). Conclusions There is good agreement between the LAVD measured using TVS and the IOM in women with rectosigmoid DE. As a consequence, TVS could be useful for estimation of the height of the final surgical anastomosis in women undergoing full‐thickness resection for rectosigmoid DE. This is of pivotal importance in reducing the risk of complications and need for a temporary stoma, and could improve patient counseling.

• Tellum, Tina; Nygård, Ståle & Lieng, Marit (2019). Non-invasive diagnosis of adenomyosis: a structured review and meta-analysis of diagnostic accuracy. Journal of minimally invasive gynecology. ISSN 1553-4650. 27(2), p. 408–418. doi: 10.1016/j.jmig.2019.11.001. Full text in Research Archive
• Goderstad, Jeanne Mette; Sandvik, Leiv; Fosse, Erik & Lieng, Marit (2019). Development and validation of a general and easy assessable scoring system for laparoscopic skills using a virtual reality simulator. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 4, p. 1–5. doi: 10.1016/j.eurox.2019.100092. Full text in Research Archive
• Tellum, Tina; Qvigstad, Erik; Skovholt, Else K. & Lieng, Marit (2019). In vivo adenomyosis tissue sampling using a transvaginal ultrasound-guided core biopsy technique for research purposes: Safety, feasibility, and effectiveness. Journal of minimally invasive gynecology. ISSN 1553-4650. 26(7), p. 1357–1362. doi: 10.1016/j.jmig.2019.02.002. Full text in Research Archive
• Mortensen, Berit; Diep, Lien My; Lukasse, Mirjam; Lieng, Marit; Dwekat, Ibtesam & Elias, Dalia [Show all 7 contributors for this article] (2019). Women's satisfaction with midwife-led continuity of care: An observational study in Palestine. BMJ Open. 9(11), p. 1–9. doi: 10.1136/bmjopen-2019-030324. Full text in Research Archive Show summary

  Abstract Objectives A midwife-led continuity model of care had been implemented in the Palestinian governmental health system to improve maternal services in several rural areas. This study investigated if the model influenced women’s satisfaction with care, during antenatal, intrapartum and postnatal period. Design An observational case-control design was used to compare the midwife-led continuity model of care with regular maternity care. Participants and setting Women with singleton pregnancies, who had registered for antenatal care at a rural governmental clinic in the West Bank, were between 1 to 6 months after birth invited to answer a questionnaire rating satisfaction with care in 7-point Likert scales. Primary outcome The mean sum-score of satisfaction with care through the continuum of antenatal, intrapartum and postnatal period, where mean sum-scores range from 1 (lowest) to 7 (highest). Secondary outcome Exclusive breastfeeding. Results Two hundred women answered the questionnaire, 100 who received the midwife-led model and 100 who received regular care. The median time point of interview were 16 weeks postpartum in both groups. The midwife-led model was associated with a statistically significant higher satisfaction with care during antenatal, intrapartum and postnatal period, with a mean sum-score of 5.2 versus 4.8 in the group receiving regular care. The adjusted mean difference between the groups’ sum-score of satisfaction with care was 0.6 (95% CI 0.35 to 0.85), p<0.0001. A statistically significant higher proportion of women who received the midwife-led continuity model of care were still exclusively breastfeeding at the time point of interview, 67% versus 46% in the group receiving regular care, an adjusted OR of 2.56 (1.35 to 4.88) p=0.004. Conclusions There is an association between receiving midwife-led continuity of care and increased satisfaction with care through the continuum of pregnancy, intrapartum and postpartum period, and an increased duration of exclusive breastfeeding.

• Tellum, Tina; MATIC, GORDANA; Dormagen, Johann Baptist; Nygård, Ståle; Viktil, Ellen & Qvigstad, Erik [Show all 7 contributors for this article] (2019). Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker. European Radiology. ISSN 0938-7994. 29(12), p. 6971–6981. doi: 10.1007/s00330-019-06308-3. Full text in Research Archive
• Ravlo, Merethe; Lieng, Marit; Bukholm, Ida Rashida Khan; Moen, Mette Haase & Vanky, Eszter (2019). Approved claims for compensation from gynecological patients in Norway?What characterizes the cases? A 14-year nationwide study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 98(8), p. 1070–1076. doi: 10.1111/aogs.13605. Full text in Research Archive Show summary

  Introduction: The Norwegian System of Patient Injury Compensation (NPE) evalu-ates all patient‐reported claims in Norway. Our aim was to study the cases from gy-necological patients approved by NPE in order to identify the main reasons for the injuries, the consequences of the treatment failure for the women, and the time course when the treatment failure occurred.Material and methods: A retrospective, descriptive study of approved gynecological compensation claims during a 14‐year period, based on patient files from NPE.Results: In all, 1454 women claimed compensation for injury related to gynecological treatment in Norway from 2000 to 2013. Compensation was approved for 438 (30.1%) women. Eleven women declined participation in the study and 16 cases were excluded, leaving 411 cases for further analyses. Consent to participate was given by 211 (51.3%) women, who gave full access to all their NPE files. Anonymized resumes and expert statements were used for the 138 (33.6%) women who did not respond and the 62 (15.1%) women who were deceased. Guidelines or good clinical practice were not followed in 40.5% of the cases. The most common reasons for injury were surgical complications (67.6%), delayed (22.4%) and incorrect (17.0%) diagnoses, and failure of communication (11.7%). The main consequences of injuries were need for extensive treatment (64.2%), permanent injury (55.2%) and impaired physical ability (41.9%). Worsening of cancer prognosis occurred in 58 women (14.1%) and death due to treatment failure in 29 (7.1%) women. Most failures occurred during the treatment period (75.2%).Conclusions: We found that the main reason for injuries in gynecological patients was non‐adherence to guidelines or good clinical practice. Surgery‐related injuries were most common. Increased focus on adherence to guidelines and surgical skills might improve patient safety for gynecological patients in Norway.

• Mortensen, Berit; Lieng, Marit; Diep, Lien My; Lukasse, Mirjam; Atieh, Kefaya & Fosse, Erik (2019). Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care ? An Observational Study in One Governmental Hospital in Palestine. EClinicalMedicine. 10, p. 84–91. doi: 10.1016/j.eclinm.2019.04.003. Full text in Research Archive Show summary

  Background:From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occu-pied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation betweenthe midwife-led model and maternal and neonatal health outcomes.Method:A register-based, retrospective cohort design was used, involving 2201 singleton births betweenJanuary 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton preg-nancies and mixed risk status, who either lived in villages that offered the midwife-led continuity modeland had registered at the governmental clinic, or who lived in villages without the midwife-led modeland received regular care, were compared. Primary outcome was unplanned caesarean section. Secondaryoutcomes were other modes of birth, postpartum anaemia, preterm birth, birthweight, and admission toneonatal intensive care unit.Findings:Statistically significant less women receiving the midwife-led model had unplanned caesareansections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64–0·99) and postpartum anaemia,19·8%vs 28·6%, aRR 0·72 (0·60–0·85). There was also a statistically significant lower rate of preterm births withinthe exposed group, 13·1% vs 16·8, aRR 0·79 (0·63–0·98), admission to neonatal intensive care unit, 7·0% vs9·9%, aRR 0·71 (0·52–0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13(0·02–0·97).Interpretation:Receiving the midwife-led continuity model of care in Palestine was associated with severalimproved maternal and neonatal health outcomes. Thefindings support further implementation of the model.Implementation research, including randomised studies, would be useful to further investigate the effect andfeasibility of the model in a low resource setting.Funding:This study was partly funded by the Research Council of Norway through the Global Health andVaccination Program (GLOBVAC), project number 243706. The implementation received public funding throughNorwegian Aid Committee (NORWAC)

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar J. A.; Böttcher, Bettina; Fosse, Erik & Ali, Hadil [Show all 10 contributors for this article] (2018). Caesarean section in Palestine using the Robson Ten Group Classification System: A population-based birth cohort study. BMJ Open. 8:e022875(10), p. 1–8. doi: 10.1136/bmjopen-2018-022875. Full text in Research Archive Show summary

  Objective: To analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS). Methods: The contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ2 test. Results: The overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation). Conclusion: Women in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour.

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit & Ali, Hadil [Show all 11 contributors for this article] (2018). Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: A population-based birth cohort study. BMJ Open. 8(3). doi: 10.1136/bmjopen-2017-019509. Full text in Research Archive Show summary

  Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals. Design A prospective population-based birth cohort study. Setting Obstetric departments in six governmental Palestinian hospitals. Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016. Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed. Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1). Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women. Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.

• Tellum, Tina; Nygård, Ståle; Skovholt, Else K.; Qvigstad, Erik & Lieng, Marit (2018). Development of a clinical prediction model for diagnosing adenomyosis. Fertility and Sterility. ISSN 0015-0282. 110(5), p. 957–964.e3. doi: 10.1016/j.fertnstert.2018.06.009. Full text in Research Archive
• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2018). Can a midwife-led continuity model improve maternal services in a low-resource setting? A non-randomised cluster intervention study in Palestine. BMJ Open. 8(3). doi: 10.1136/bmjopen-2017-019568. Full text in Research Archive Show summary

  Objectives: To improve maternal health services in rural areas, the Palestinian Ministry of Health launched a midwife-led continuity model in the West Bank in 2013. Midwives were deployed weekly from governmental hospitals to provide antenatal and postnatal care in rural clinics. We studied the intervention’s impact on use and quality indicators of maternal services after 2 years’ experience. Design: A non-randomised intervention design was chosen. The study was based on registry data only available at cluster level, 2 years before (2011and2012) and 2 years after (2014and2015) the intervention. Setting All 53 primary healthcare clinics in Nablus and Jericho regions were stratified for inclusion. Primary and secondary outcomes Primary outcome was number of antenatal visits. Important secondary outcomes were number of referrals to specialist care and number of postnatal home visits. Differences in changes within the two groups before and after the intervention were compared by using mixed effect models. Results: 14 intervention clinics and 25 control clinics were included. Number of antenatal visits increased by 1.16 per woman in the intervention clinics, while declined by 0.39 in the control clinics, giving a statistically significant difference in change of 1.55 visits (95% CI 0.90 to 2.21). A statistically significant difference in number of referrals was observed between the groups, giving a ratio of rate ratios of 3.65 (2.78–4.78) as number of referrals increased by a rate ratio of 3.87 in the intervention group, while in the control the rate ratio was only 1.06. Home visits increased substantially in the intervention group but decreased in the control group, giving a ratio of RR 97.65 (45.20 - 210.96) Conclusion: The Palestinian midwife-led continuity model improved use and some quality indicators of maternal services. More research should be done to investigate if the model influenced individual health outcomes and satisfaction with care.

• Aas-Eng, Mee Kristine; Langebrekke, Anton; Lieng, Marit & Qvigstad, Erik (2017). Management of Broad Ligament Defects and Herniation of Colon. Journal of minimally invasive gynecology. ISSN 1553-4650. 24(5), p. 713–714. doi: 10.1016/j.jmig.2016.12.002. Full text in Research Archive
• Skorstad, Mette; Kent, Andrew & Lieng, Marit (2016). Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 95(11), p. 1228–1234. doi: 10.1111/aogs.13008. Full text in Research Archive
• Goderstad, Jeanne Mette; Sandvik, Leiv; Fosse, Erik & Lieng, Marit (2016). Assessment of surgical competence: Development and validation of rating scales used for laparoscopic supracervical hysterectomy. Journal of Surgical Education. ISSN 1931-7204. 73(4), p. 600–608. doi: 10.1016/j.jsurg.2016.01.001. Full text in Research Archive
• Skorstad, Mette; Kent, Andrew & Lieng, Marit (2016). Uterine leiomyosarcoma - incidence, treatment, and the impact of morcellation. A nation-wide cohort study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 95(9), p. 984–990. doi: 10.1111/aogs.12930. Full text in Research Archive
• Berner, Espen; Qvigstad, Erik; MYRVOLD, ANNE KRISTINA & Lieng, Marit (2015). Pain reduction after total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy among women with dysmenorrhoea: A randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 122(8), p. 1102–1111. doi: 10.1111/1471-0528.13362. Full text in Research Archive
• Lieng, Marit; Berner, Espen & Busund, Bjørn (2015). Risk of Morcellation of Uterine Leiomyosarcomas in Laparoscopic Supracervical Hysterectomy and Laparoscopic Myomectomy, a Retrospective Trial Including 4791 Women. Journal of minimally invasive gynecology. ISSN 1553-4650. 22(3), p. 410–414. doi: 10.1016/j.jmig.2014.10.022. Full text in Research Archive
• Hald, Kirsten & Lieng, Marit (2014). Assessment of Periodic Blood Loss: Interindividual and Intraindividual Variations of Pictorial Blood Loss Assessment Chart Registrations. Journal of minimally invasive gynecology. ISSN 1553-4650. 21(4), p. 662–668. doi: 10.1016/j.jmig.2014.01.015. Full text in Research Archive
• Berner, Espen; Qvigstad, Erik; MYRVOLD, ANNE KRISTINA & Lieng, Marit (2014). Pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy: a prospective trial. Journal of minimally invasive gynecology. ISSN 1553-4650. 21(3), p. 406–411. doi: 10.1016/j.jmig.2013.10.011. Full text in Research Archive
• Berner, Espen; Qvigstad, Erik; Langebrekke, Anton & Lieng, Marit (2013). Laparoscopic Supracervical Hysterectomy Performed With and Without Excision of the Endocervix: A Randomized Controlled Trial. Journal of minimally invasive gynecology. ISSN 1553-4650. 20(3), p. 368–375. doi: 10.1016/j.jmig.2013.01.003. Full text in Research Archive
• Høyer-Sørensen, Christian Espen; Hortemo, Sigurd & Lieng, Marit (2013). Changing the route of hysterectomy into a minimal invasive approach. ISRN Obstetrics and Gynecology. ISSN 2090-4436. 2013. doi: 10.1155/2013/249357. Full text in Research Archive
• Hvingel, Bodil; Lieng, Marit; Roald, Borghild & Ørbo, Anne (2012). Vascular markers CD31, CD34, actin, VEGFB, and VEGFR2, are prognostic markers for malignant development in benign endometrial polyps. Open Journal of Obstetrics and Gynecology. ISSN 2160-8792. 2, p. 18–26. doi: 10.4236/ojog.2012.21004. Full text in Research Archive
• Majak, Guri B; Lieng, Marit & Qvigstad, Erik (2011). Clinical outcome after laparoscopic and open abdominal myomectomy. Gynecological Surgery. ISSN 1613-2076. 9(2), p. 231–234. doi: 10.1007/s10397-011-0699-z. Full text in Research Archive
• Qvigstad, Erik & Lieng, Marit (2011). Surgical treatment of endometrial cancer and atypical hyperplasia: a trend shift from laparotomy to laparoscopy. Obstetrics and Gynecology International. ISSN 1687-9589. doi: 10.1155/2011/829425. Full text in Research Archive
• Kozinszky, Zoltan; Bakken, Ragnhild Tøsse & Lieng, Marit (2011). Ectopic pregnancy after levonorgestrel emergency contraception. Contraception. ISSN 0010-7824. 83(3), p. 281–283. doi: 10.1016/j.contraception.2010.08.008. Full text in Research Archive
• Oppegaard, Kevin Sunde; Lieng, Marit; Istre, Olav; Berg, Anette; Qvigstad, Erik & Nesheim, Britt-Ingjerd (2010). A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 117(1), p. 53–61. doi: 10.1111/j.1471-0528.2009.02435.x. Full text in Research Archive
• Lieng, Marit; ISTRE, OLAV & Qvigstad, Eirik (2010). Treatment of endometrial polyps: a systematic review. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 89(8), p. 992–1002. doi: 10.3109/00016349.2010.493196. Full text in Research Archive
• Lieng, Marit; ISTRE, OLAV; Sandvik, Leiv; Qvigstad, Erik & Engh, Tove Vibeke (2010). Clinical Effectiveness of Transcervical Polyp Resection in Women with Endometrial Polyps: Randomized Controlled Trial. Journal of minimally invasive gynecology. ISSN 1553-4650. 17(3), p. 351–357. doi: 10.1016/j.jmig.2010.01.019. Full text in Research Archive
• Goderstad, Jeanne Mette; Lieng, Marit & Busund, Bjørn (2009). Kirurgisk behandling av benigne gynekologiske lidelser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 129(15), p. 1460–1463. Full text in Research Archive
• Lieng, Marit; Qvigstad, Erik; Dahl, Gunn Fallås & ISTRE, OLAV (2008). Flow differences between endometrial polyps and cancer: a prospective study using intravenous contrast-enhanced transvaginal color flow Doppler and three-dimensional power Doppler ultrasound. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. 32(7), p. 935–940. doi: 10.1002/uog.6267. Full text in Research Archive
• Lieng, Marit; Qvigstad, Erik; Sandvik, Leiv; Jorgensen, H; Langebrekke, Anton & ISTRE, OLAV (2007). Hysteroscopic resection of symptomatic and asymptomatic endometrial polyps. Journal of minimally invasive gynecology. ISSN 1553-4650. 14. doi: 10.1016/j.jmig.2006.09.018. Full text in Research Archive

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• Omtvedt, Marianne; Skrøppa, Siri; Joronen, K.; Ringen, Ingrid Marie; Skovholt, Else K. & Nebauer, Shane Desmond [Show all 9 contributors for this article] (2024). Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. 64(S1), p. 56–56. doi: 10.1002/uog.27870. Full text in Research Archive
• Blix, Ellen; Rotwitt, Alberte; Gravdahl, Oline Friestad; Holan, Synne; Ramleth, Ruth-Kari & McGovern, Peter [Show all 10 contributors for this article] (2023). Kollegene våre lider i frykt for å bli skutt eller bombet på jobb. 21.11.2023. Full text in Research Archive
• Dormagen, Johann Baptist; Matic, Gordana; Lieng, Marit & Qvigstad, Erik (2019). OP07.07: MUSA‐classification of junctional zone appearance in MRI shows a good diagnostic prediction of adenomyosis, while junctional zone measurement does not. Full text in Research Archive
• Ravlo, Merethe; Lieng, Marit; Bukholm, Ida Rashida Khan; Moen, Mette Haase & Vanky, Eszter (2018). Erstatningssaker i gynekologi - hva kan vi lære? Full text in Research Archive
• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2018). CAN A MIDWIFERY-LED CONTINUITY MODEL IMPROVE MATERNAL SERVICES IN A LOW RESOURCE SETTING? – A NON-RANDOMIZED CLUSTER INTERVENTION STUDY IN PALESTINE. Full text in Research Archive
• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2017). How a Continuity of Midwifery Care Model affect the usage and quality of maternal services in rural Palestine. Full text in Research Archive Show summary

  For the Lancet Palestinian Health Alliance (LPHA) conference 2017: How a Continuity of Midwifery Care Model affect the usage and quality of maternal services in rural Palestine Authors: Berit Mortensen MSc (beritmor@me.com) and Erik Fosse MD, Phd Medical Faculty, University of Oslo, and the Intervention Center Oslo University Hospital, Oslo, Norway Abstract 465 words: Background: The Palestinian Ministry of Health provided care for 45,6% of the pregnant women in the occupied West Bank in 2013. No report described the difference between urban and rural areas; nevertheless, private service providers are more available to women in urban areas. Women living in remote areas are vulnerable because Israeli armed soldier and settlers make it dangerous to move. Abdul Rahim et al. described governmental maternal services with poor quality and antenatal-visits lacking content, short consultation time and dissatisfaction with care. In 2013 the Ministry of Health started a stepwise implementation of a Continuity of Midwifery Care Model in rural areas on the West Bank in cooperation with Norwegian aid Committee (NORWAC). The model entailed deploying midwives from the local governmental hospital to ante-and postnatal care in rural clinics. This study explored if the model increased the usage and the quality of health services after two years’ experience in Nablus and Jericho regions. Methods: The study was based on registry data at cluster level. Data from 14 clinics offering the new model was compared with data from 25 clinics offering standard care. Primary outcome was: mean number of antenatal visits per woman, number of pregnant referred to higher level of care, number of women receiving postnatal home visits. We compared the change in outcomes two years before with two years after the implementation. Multilevel Poisson regression was used to examine difference between the intervention and standard care groups and testing the change. Findings: A statistical significant difference was found between the intervention and control group (p-value < 0.001) in all primary outcomes. In clinics with the new model the mean number of ante-natal visits per woman increased from 3.7 to 4.7, while in the clinics with standard care a decline was observed from 4.6 to 4.2 visits. The percentage of pregnant women referred to higher level of care increased from 7% to 25,6% in the intervention clinics. No such increase was observed in the control clinics. The percentage of postnatal home visits increased from 2% to 42% at the intervention clinics, while at the control clinics the visits dropped from 1.5% to 0.7%. Interpretation: The continuity model improved the usage and quality of maternal services in rural clinics in the West Bank. Continuity of care allows building a relationship where women experience respect and gain trust in the health care provided. The findings indicate that this relationship, as well as the care being provided by midwives from the hospitals, near the women`s home, increased usage of care and quality of service.

• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien My; Lieng, Marit & Fosse, Erik (2017). Does outreaching Continuity of Midwifery-care improve usage and quality of services in Palestine? Full text in Research Archive Show summary

  Does outreaching Continuity of Midwifery-care improve usage and quality of services in Palestine? Abstract: Background: The Palestinian Ministry of Health (PMoH) provides care for 54% of the pregnant women in the occupied West Bank. Women living in remote areas are vulnerable because the distance and Israeli military presence hinders them to reach central health-facilities. In 2013 PMoH implemented an outreaching Continuity of Midwifery Care Model, deploying midwives from the hospitals, to give ante- and postnatal care to women in selected remote villages in Palestine. Objective: Our study aims to assess the acceptability and quality of care of this model. Design: A pragmatic cluster-non-randomised controlled trial, comparing register-data from 14 intervention-clinics with 28 control-clinics (with various professionals and no continuity), in Nablus and Jericho district. We will measure the change before (baseline) and after the implementation, and compare the change in the intervention cluster with the control cluster. We hypothesize an increase in the number of pregnant women registering and increase in number of visits per woman at the intervention-clinics. We hypothesize increased identification of pregnancy complications requiring higher level of care, and an increase in postnatal home visits at the intervention-clinics Discussion: Continuity of care allows for the building of a relationship. A relationship where women experience respect and thus gain trust in the health care provided. We believe that this relationship, as well as the care being provided in the near vicinity of the home of the women, increases women’s usage of care. Meta-studies support continuum of care and more research regarding developing midwifery-led models in low-income countries are requested : We believe this study is an important contribution as such.

• Mortensen, Berit; Lukasse, Mirjam; Diep, Lien; Lieng, Marit; Abu-Awad, Amal & Suleiman, Munjid [Show all 7 contributors for this article] (2017). Kan kontinuitet i jordmoromsorgen forbedre helsetjenesten for gravide og barselkvinner i et lavinntektsland? – En ikke-randomisert intervensjonsstudie i Palestina. Full text in Research Archive Show summary

  Kan kontinuitet i jordmoromsorgen forbedre helsetjenesten for gravide og barselkvinner i et lavinntektsland? – En ikke-randomisert intervensjonsstudie i Palestina Innledning: For å bedre helsetilbudet for gravide og barselkvinner på landsbygda lanserte palestinsk helsedepartement i 2013 en modell for kontinuitet i jordmoromsorgen på den israel-okkuperte Vestbredden, i samarbeid med Norwegian Aid Committee (NORWAC). Modellen innebærer at jordmødre fra offentlige sykehus drar ut til landsbyer for å drive svangerskaps- og barselomsorg. Den samme jordmoren besøker samme landsby hver uke. De fleste føder ved det sykehuset jordmoren jobber. Mål: Studien undersøkte virkningen modellen hadde på bruken av tjenesten og noen kvalitetsforbedringsindikatorer etter to års erfaring. Materialer og metode: Intervensjonen var allerede i gang og en ikke-randomisert intervensjons design ble valgt. Studiet er basert på registerdata, kun tilgjengelig på institusjonsnivå (cluster), to år før (2011 & 2012) og to år etter (2014 & 2015) intervensjonen startet. Totalt ble 53 primærhelse klinikker i regionene Nablus og Jeriko, stratifisert for inkludering. Primærutfallet var gjennomsnittlig antall svangerskapskontroller. Viktige sekundære utfall var antall henvisninger til spesialisthelsetjenesten og antall hjemmebesøk etter fødsel. Forskjellen I endring før og etter intervensjonen ble sammenlignet mellom klinikker som hadde jordmormodellen og klinikker med ordinær svangerskaps- og barselomsorg. Resultater: Det ble inkludert 14 intervensjons-klinikker og 25 kontroll-klinikker i studien. Antall svangerskapskontroller økte med 1.16 per kvinne i klinikker med jordmormodellen, mens antall kontroller ble redusert med 0.39 kontroller per kvinne i klinikkene som ikke hadde jordmormodell. Dette ga en signifikant forskjell i endring på 1.55 kontroller [95% CI 0.90 – 2.21]. En signifikant forskjell i endring av antall henvisninger ble også observert mellom gruppene med en endringsratio på 3.65 [2.78 – 4.78]. Antall henvisninger økte med en rate ratio på 3.87 I klinikker med jordmormodellen, mens det ikke var noen signifikant endring i kontrollgruppen som hadde en ratio på 1.06. Jordmormodellen førte til at hjemmebesøk ble gjennomført i stor grad, mens klinikker med ordinær tjeneste nesten ikke utfører hjemmebesøk, en forskjell i endrings ratio på 97.65 (45.20 - 210.96) Konklusjon: Den palestinske modellen for kontinuitet i jordmoromsorgen økte kvinnenes bruk av helsetjenesten og noen kvalitetsindikatorer for svangerskaps og barselomsorg. Mer forskning bør utføres for å undersøke modellens innvirkning på individuelle helseutfall for mor og barn og på brukertilfredshet.

• Lieng, Marit; Matic, Gordana & Skovholt, Else K. (2017). OC22.05: *3D transvaginal ultrasound in adenomyosis: are we looking at all there is? Full text in Research Archive
• Lieng, Marit; Busund, Bjørn; Ræder, Johan & Iversen, Tor (2013). Innsatsstyrt finansiering og dagkirurgi. 133, p. 974–976. doi: 10.4045/tidsskr.13.0155. Full text in Research Archive
• Kozinszky, Zoltan & Lieng, Marit (2011). The Copper IUD and emergency contraception Response. Contraception. ISSN 0010-7824. 84(2), p. 207–207. doi: 10.1016/j.contraception.2010.12.007. Full text in Research Archive
• Holte, Therese Opsahl; Goderstad, Jeanne Mette; Lieng, Marit; Busund, Bjørn & Norderhaug, Inger Natvig (2009). Kikkhullskirurgi ved godartede gynekologiske lidelser. Folkehelseinstituttet. ISSN 9788281212862. Full text in Research Archive Show summary

  Det er stor variasjon i bruk av kikkhullskirurgi mellom de ulike gynekologiske avdelingene i Norge. Den nasjonale veilederen i generell gynekologi anbefaler kikkhullskirurgi ved kirurgisk behandling av kvinner med graviditet utenfor livmor, men gir ingen klare anbefalinger om hvilken operasjonsmetode som er å foretrekke ved behandling av cyster på eggstokk eller ved fjerning av livmor. Fagmiljøet ved Kvinneklinikken, Oslo universitetssykehus, Ullevål, henvendte seg til Kunnskapssenteret i forbindelse med en kartlegging av prosedyrevalg ved kirurgisk behandling av godartede gynekologiske lidelser i Norge. Oppdragsgiver ønsket en kunnskapsoppsummering om effekt og sikkerhet ved kikkhullskirurgi sammenliknet med tradisjonell åpen eller vaginal prosedyre.

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