Hely Katariina Laine

• Viheroksa, Raakel; Laine, Hely Katariina; Gissler, Mika; Paavilainen, Eija; Heinonen, Seppo & Räisänen, Sari (2026). Violence during pregnancy amplifies fear of childbirth: A nationwide cohort study in Finland. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. doi: 10.1002/ijgo.71116. Fulltekst i vitenarkiv
• Viheroksa, Raakel; Gissler, Mika; Laine, Hely Katariina; Paavilainen, Eija; Heinonen, Seppo & Räisänen, Sari (2026). Prevalence and Risk Factors of Intimate Partner Violence Among Pregnant Women: A Population-Based Study From Finland 2000–2020. Violence against Women. ISSN 1077-8012. doi: 10.1177/10778012261443489. Fulltekst i vitenarkiv
• Johansen, Marius; Omsland, Tone Kristin; Laine, Katariina; Håberg, Siri Eldevik & Magnus, Maria Christine (2026). Risk of postpartum depression among women with endometriosis: the Norwegian mother, father and child cohort study (MoBa). European Journal of Epidemiology (EJE). ISSN 0393-2990. 41, s. 197–206. doi: 10.1007/s10654-025-01338-2. Fulltekst i vitenarkiv Vis sammendrag

  Women with endometriosis have a higher burden of anxiety and depression. Whether they are at increased risk of postpartum depression (PPD) remains unclear. We aimed to compare the risk of PPD between women with and without endometriosis and to explore mediation by previous history of major depression and infertility. In a population-based cohort study, we compared 1,159 singleton pregnancies to women with self-reported endometriosis and 74,590 pregnancies to women without endometriosis. We calculated a djusted risk ratios (aRR) with 95% confidence intervals (CI) using multivariable log-binomial regression, adjusting for age, body mass index, education and income. Mediation analyses assessed the indirect effect of any history of major depression or infertility. Women with endometriosis had a higher risk of PPD (aRR: 1.34, 95% CI: 1.15–1.55). Mediation analyses indicated that a large part of this association was explained by a higher lifetime prevalence of major depression among women with endometriosis (natural direct effect of endometriosis: aRR: 1.17, 95% CI: 1.00-1.36; natural indirect effect of any history of major depression: aRR: 1.14, 95% CI: 1.08–1.20), with 49.3% proportion mediated. Infertility demonstrated a negative natural indirect effect on the association between endometriosis and PPD (aRR: 0.87, 95% CI: 0.81–0.94). Women with endometriosis had an elevated risk of PPD which was largely explained by a higher lifetime prevalence of major depression. Our findings suggest that they constitute a high-risk group and could benefit from closer follow-up to facilitate early identification and intervention.

• Laine, Hely Katariina & Räisänen, Sari (2025). Secular Trends in Recurrent Obstetric Anal Sphincter Injuries among 297,190 Women in Norway: A Cohort Study. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-025-06417-2. Fulltekst i vitenarkiv Vis sammendrag

  Introduction and Hypotheses A care bundle to prevent obstetric anal sphincter injuries (OASIS), including manual perineal protection, was launched in Norway in 2005. The study objective was to determine the secular trends of recurrent OASIS in second vaginal birth between 1999 and 2022. OASIS incidence among women without previous OASIS was analyzed for comparison. Methods Data for this cohort study were obtained from the Medical Birth Registry of Norway. The study included 297,190 women with singleton pregnancies and two vaginal births during the study period. The outcome was OASIS incidence at second vaginal birth, separately for women with a history of OASIS (recurrent OASIS) and those without. To study the contribution of episiotomy, epidural analgesia, birth mode, birthweight, and maternal age to the secular trends of OASIS, logistic regression analyses with crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were determined. Results Of the women with OASIS in their first vaginal birth, 5.4% (609 of 11,205) experienced recurrent OASIS in their second vaginal birth. The incidence of recurrent OASIS decreased from 7.7% in 1999–2002 to 3.5% in 2019–2022, representing a 51% reduction (95% CI 27–67%). Among women without previous OASIS, the OASIS incidence decreased from 1.6% in 1999–2002 to 0.6% in 2019–2022. Obstetric interventions or birthweight did not contribute to these reductions. Conclusions The incidence of recurrent OASIS halved in second vaginal births among women with a previous OASIS. This reduction is likely explained by the national care bundle to reduce OASIS, launched in Norway in 2005.

• Sugulle, Meryam; Laine, Hely Katariina; Tingleff, Tiril; Lahmami, Gulim & Räisänen, Sari (2025). Effects of fetal presentation on mode of delivery in 26 143 twin pregnancies: A nationwide, population-based observational study of 31-year real-world data. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. 170(3), s. 1309–1316. doi: 10.1002/ijgo.70103. Fulltekst i vitenarkiv
• Laine, Hely Katariina; Fodstad, Kathrine & Räisänen, Sari (2025). Obstetric anal sphincter injuries in spontaneous vaginal births in nulliparous pregnant individuals: a 21-year cohort study based on real-world data. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. doi: 10.1016/j.ajog.2025.06.014. Fulltekst i vitenarkiv
• Heitmann, Grethe Berger; Melland, Karin; Laine, Katariina; Flaathen, Eva Marie & Leonardsen, Ann-Chatrin Linqvist (2025). Women´s experiences with being exposed to external aortic compression in the management of postpartum hemorrhage: a qualitative study in Norway. BMC Pregnancy and Childbirth. doi: 10.1186/s12884-025-07914-4. Fulltekst i vitenarkiv
• Andreassen, Silje Malen; Costa, Denise Reis; Laine, Hely Katariina; Evenson, Kelly R.; Vangen, Siri & Owe, Katrine Mari (2025). Registered report: Predictors and trajectories of physical activity before, during, and following twin pregnancy from the Norwegian Mother, Father and Child Cohort Study. Journal of Sports Sciences. ISSN 0264-0414. doi: 10.1080/02640414.2025.2609026. Fulltekst i vitenarkiv
• Heitmann, Grethe Berger; Meland, Karin; Laine, Hely Katariina; Flaathen, Eva Marie & Leonardsen, Ann-Chatrin Linqvist (2025). Women´s experiences with being exposed to external aortic compression in the management of postpartum hemorrhage: a qualitative study in Norway. BMC Pregnancy and Childbirth. doi: 10.1186/s12884-025-07914-4. Fulltekst i vitenarkiv
• Fodstad, Kathrine; Laine, Katariina & Räisänen, Sari (2024). Obstetric anal sphincter injuries during instrumental vaginal delivery: An observational study based on 18-years of real-world data. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 131(13), s. 1824–1831. doi: 10.1111/1471-0528.17914. Fulltekst i vitenarkiv Vis sammendrag

  Objective To determine the prevalence and secular trends of obstetric anal sphincter injuries (OASIS) in vacuum and forceps deliveries in Norway, both with and without episiotomy. Design Population-based real-world data collected during 2001–2018. Setting Medical Birth Registry Norway. Population or Sample Nulliparous women with singleton foetuses in a cephalic presentation delivered by either vacuum or forceps (n = 70 783). Methods Logistic regression analyses were applied to the OASIS prevalence in six 3-year time periods. Both crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were determined. Main Outcome Measures OASIS prevalence. Results The OASIS prevalence in vacuum and forceps deliveries decreased from 14.8% during 2001–2003 to 5.2% during 2016–2018. The overall reduction between the first and last 3-year time period was 61% (aOR = 0.39, 95% CIs = 0.35–0.43). The only exception to this decreasing trend in OASIS was found in forceps deliveries performed without an episiotomy. The OASIS prevalence was approximately twofold higher in forceps compared to vacuum deliveries (aOR = 1.92, 95% CIs = 1.79–2.05). Performing either a mediolateral or lateral episiotomy was associated with a 45% decrease in the prevalence of OASIS relative to no episiotomy (aOR = 0.55, 95% CIs = 0.52–0.58). Conclusions Opting for vacuum rather than forceps delivery in conjunction with a mediolateral or lateral episiotomy could significantly lower the OASIS prevalence in nulliparous women.

• Lahmami, Gulim; Räisänen, Sari; Jacobsen, Anne Flem; Yli, Branka Markovic; Tingleff, Tiril & Laine, Katariina (2024). Clinical examination for identifying low-risk pregnancies suitable for expectant management beyond 40–41 gestational weeks: maternal and fetal outcomes. Archives of Gynecology and Obstetrics. ISSN 0932-0067. doi: 10.1007/s00404-024-07869-5. Fulltekst i vitenarkiv Vis sammendrag

  Purpose There is an ongoing discussion on whether the benefits of term elective labor induction outweigh its potential risks. This study evaluated the utility of a comprehensive clinical examination in identifying low-risk pregnancies suitable for expectant management beyond gestational age 40‒41 weeks and compared their outcomes with earlier labor induction by indication. Methods Pregnant women (n = 722) with ≥ 40 + 0 gestational weeks referred to a tertiary hospital were included in this prospective cohort. The study population was divided into the primary induction group (induction before 42 + 0 gestational weeks) and the expectant management group (spontaneous labor onset or induction at 42 + 0 gestational weeks), by decision based on a primary consultation. The Chi-square test and logistic regression were applied. The outcome measures were composite adverse fetal outcome (admission to a neonatal intensive care unit, metabolic acidosis, or Apgar score < 7 at 5 min), treatment with intrapartum antibiotics, intrapartum maternal fever ≥ 38 °C, intrapartum cesarean section, and postpartum hemorrhage ≥ 1500 ml. Results The main outcome measures did not differ significantly between the primary induction group (n = 258) and the expectant management group (n = 464): composite adverse fetal outcome (OR = 2.29, 95% CI = 0.92–5.68; p = 0.07), intrapartum cesarean section (OR = 1.00, 95% CI = 0.64–1.56; p = 1.00), postpartum hemorrhage ≥ 1500 ml (OR = 1.89, 95% CI = 0.92–3.90; p = 0.09), intrapartum maternal fever ≥ 38 °C (OR = 1.26, 95% CI = 0.83–1.93; p = 0.28), or treatment with intrapartum antibiotics (OR = 1.25, 95% CI = 0.77–2.02; p = 0.37). Conclusion A comprehensive clinical examination at 40‒41 gestational weeks can identify pregnancies that might be managed expectantly until 42 gestational weeks obtaining similar outcomes to those induced earlier.

• Lahmami, Gulim; Räisänen, Sari; Jacobsen, Anne Flem; Yli, Branislava Markovic; Tingleff, Tiril & Laine, Katariina (2023). Trends in Term Intrapartum Stillbirth in Norway. JAMA Network Open. 6(9), s. E2334830–E2334830. doi: 10.1001/jamanetworkopen.2023.34830. Fulltekst i vitenarkiv Vis sammendrag

  Importance Fetal death during labor at term is a complication that is rarely studied in high-income countries. There is a need for large population-based studies to examine the rate of term intrapartum stillbirth in high-income countries and the factors associated with its occurrence. Objective To evaluate trends in term intrapartum stillbirth over time and to investigate the association between the trends and term intrapartum stillbirth risk factors from 1999 to 2018 in Norway. Design, Setting, and Participants This cohort study used data from the Medical Birth Registry of Norway from 1999 to 2018 to examine rates of term intrapartum stillbirth and risk factors associated with this event. A population of 1 021 268 term singleton pregnancies without congenital anomalies or antepartum stillbirths was included in analyses, which were performed from September 2022 to February 2023. Exposure The main exposure variable was time, which was divided into four 5-year periods: 1999 to 2003, 2004 to 2008, 2009 to 2013, and 2014 to 2018. Main Outcomes and Measures The primary study outcome was term intrapartum stillbirth. Risk ratios were calculated, and multivariable logistic regression analyses were conducted to identify factors associated with secular trends of term intrapartum stillbirth. Results The study population consisted of 1 021 268 term singleton births (maternal mean [SD] age, 29.72 [5.01] years; mean [SD] gestational age, 39.69 [1.27] weeks). During the study period, there were 95 term intrapartum stillbirths (0.09 per 1000 births). Maternal age, the proportion of individuals born in a country other than Norway, and the prevalence of gestational diabetes, labor induction, operative vaginal delivery, and previous cesarean delivery increased over the course of the study period. Conversely, the prevalence of infants large for gestational age, hypertensive disorder in pregnancy, and spontaneous vaginal delivery and the proportion of individuals who smoked decreased. The term intrapartum stillbirth rate decreased by 87% (95% CI, 68%-95%) from 0.15 per 1000 births in 1999 to 2008 to 0.02 per 1000 births in 2014 to 2018. Three in 4 term intrapartum stillbirths (70 of 95) occurred during intrapartum operative deliveries. The increased prevalence of older maternal age and obstetric risk factors were not associated with the variation in intrapartum stillbirth rates among the time periods. The prevalence of term intrapartum stillbirth was higher for individuals who gave birth in maternity units with fewer than 3000 annual births (adjusted odds ratio, 1.67; 95% CI, 1.07-2.61) than for those who gave birth in units with 3000 or more annual births. Conclusions and Relevance Findings of this study suggest that, despite increases in maternal and obstetric risk factors, term intrapartum stillbirth rates substantially decreased during the study period. Reasons for this decrease may be due to improvements in intrapartum care.

• Laine, Katariina; Pay, Aase Serine Devold & Yli, Branka Markovic (2023). Time trends in caesarean section rates and associations with perinatal and neonatal health: a population-based cohort study of 1 153 789 births in Norway. BMJ Open. 13(2), s. 1–10. doi: 10.1136/bmjopen-2022-069562. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To study caesarean section (CS) rates and associations with perinatal and neonatal health in Norway during 1999–2018. Design Population-based cohort study. Setting Medical Birth Registry of Norway. Participants 1 153 789 births and 1 174 066 newborns. Methods CS, intrapartum, perinatal and neonatal mortality rates expressed as percentages (%) or per mille (‰) with 95% CIs. Primary and secondary outcome measures CS rates in the Robson Ten-Group Classification System; intrapartum, perinatal and neonatal mortality rates. Results The overall CS rate increased from 12.9% in 1999 to 16.7% in 2008 (p<0.001), and then reduced to 15.8% in 2018 (p<0.001). The largest reductions were observed in Robson groups 2 and 4. In Robson group 2, the planned CS rate decreased from 9.6% in 2007–2008 to 4.6% in 2017–2018, the intrapartum CS rate decreased from 26.6% in 2007–2008 to 22.3% in 2017–2018. In Robson group 4, the planned CS rate decreased from 16.1% in 2007–2008 to 7.6% in 2017–2018, and the intrapartum CS rate decreased from 7.8% in 2007–2008 to 5.2% in 2017–2018. The intrapartum fetal mortality rate decreased from 0.51 per 1000 (‰) in 1999–2000 to 0.14‰ in 2017–2018. Neonatal mortality decreased from 2.52‰ to 1.58‰. Conclusions CS rates in Norway increased between 1999 and 2008, followed by a significant reduction between 2008 and 2018. At the same time, fetal and neonatal mortality rates decreased. Norwegian obstetricians and midwives have contributed to maintaining a low CS rate under 17%. These findings indicate that restricting the use of CS is a safe option for perinatal health.

• Tingleff, Tiril; Räisänen, Sari; Vikanes, Åse Vigdis; Sandvik, Leiv; Sugulle, Meryam & Lahmami, Gulim [Vis alle 7 forfattere av denne artikkelen] (2022). Different pathways for preterm birth between singleton and twin pregnancies: a population-based registry study of 481 176 nulliparous women. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. s. 1–9. doi: 10.1111/1471-0528.17344. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore the contribution of pregnancy-related complications on the prevalence of extremely, very and late preterm births in singleton and twin pregnancies. To study the risk of spontaneous preterm birth in twin pregnancies compared with singleton pregnancies. Design Population-based registry study. Setting Medical birth registry of Norway and Statistics Norway. Population Nulliparous women with singleton (n = 472 449) or twin (n = 8727) births during 1999–2018. Methods Prevalence rates of pregnancy-related complications for extremely, very and late preterm birth in twin and singleton pregnancies were calculated with 95% confidence intervals. Multivariable logistic regression was applied to assess odds ratios for preterm birth, adjusted for obstetric and socio-economic factors. Main outcome measures Extremely preterm (<28+0 weeks of gestation), very preterm (28+0–33+6 weeks of gestation) and late preterm (34+0–36+6 weeks of geatation) birth. Results Preterm birth was significantly more prevalent in twin pregnancies than in singleton pregnancies in all categories: all preterm (54.7% vs 6.1%), extremely preterm (3.6% vs 0.4%), very preterm (18.2% vs 1.4%) and late preterm (33.0% vs 4.3%) births. Stillbirth, congenital malformation and pre-eclampsia were more prevalent in twin pregnancies than in singleton pregnancies, but the prevalence of complications differed in the three categories of preterm birth. Pre-eclampsia was more prevalent in singleton than in twin pregnancies ending in extremely and very preterm birth. The adjusted odds of spontaneous preterm live birth were between 19- and 54-fold greater in twin pregnancies than in singleton pregnancies. Conclusions Singleton and twin pregnancies seem to have different pathways leading to extremely, very and late preterm birth.

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar J. A.; Bottcher, Bettina; Fosse, Erik & Ali, Hadil [Vis alle 10 forfattere av denne artikkelen] (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, s. 1–8. doi: 10.1186/s12884-022-05196-8. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Sole, Kristina Baker; Staff, Anne Cathrine; Räisänen, Sari & Laine, Katariina (2022). Substantial decrease in preeclampsia prevalence and risk over two decades: A population-based study of 1,153,227 deliveries in Norway. Pregnancy Hypertension. ISSN 2210-7789. 28, s. 21–27. doi: 10.1016/j.preghy.2022.02.001. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Analyze secular trends of preeclampsia in Norway based on risk factors. Study design Population-based cohort study of 1,153,227 women using data from Medical Birth Registry of Norway from 1999 to 2018. Aggregated data from Norwegian Prescription Database from 2004 to 2018 were used. Main exposure variable was time period. Descriptive statistics identified the prevalence of preeclampsia, labor induction and aspirin use. Multiple logistic regression analysis was performed to estimate the risk of preeclampsia during the time periods. Main outcome measures Preeclampsia. Results Overall preeclampsia prevalence decreased from 4.3% in 1999–2002 to 2.7% in 2015–2018. A reduction was observed in all subgroups of women with known risk factors (age, nulliparity, diabetes, chronic hypertension, assisted reproduction, twin pregnancy). Adjusted risk of preeclampsia was reduced by 44% from 1999-2002 to 2015–2018 (aOR = 0.56, 95%CI 0.54, 0.58), while the net prevalence of gestational hypertension remained stable over the study period. Labor induction increased 104%. Aspirin prescriptions increased among fertile women in the general Norwegian population. Conclusions Preeclampsia prevalence and risk were reduced regardless of risk factors and despite an increased proportion of high-risk parturients (advanced age, lower parity, use of assisted reproduction). A corresponding increase in aspirin prescriptions among fertile women and an overall increase in labor inductions were also observed, suggesting that clinical interventions may partly explain the observed reduction in preeclampsia prevalence. Lower average blood pressure and improved health in the population may also explain some of the reduction.

• Tingleff, Tiril; Räisänen, Sari; Vikanes, Åse Vigdis; Sandvik, Leiv & Laine, Katariina (2021). Association between maternal country of birth and preterm birth: A population-based register study of 910,752 deliveries. Scandinavian Journal of Public Health. ISSN 1403-4948. 49, s. 904–913. doi: 10.1177/1403494821992894. Fulltekst i vitenarkiv Vis sammendrag

  Aims: The aim of this study was to analyse associations between maternal country of birth and preterm birth among women giving birth in Norway. Methods: A population-based register study was conducted employing official national databases in Norway. All singleton births, with neonates without major anomalies, between 1999 and 2014 were included ( N=910,752). We estimated odds ratios (ORs) for extremely preterm birth (&lt;28 weeks gestation), very preterm birth (28–33 weeks gestation) and late preterm birth (34–36 weeks gestation) by maternal country of birth. We conducted multivariable regression analyses, adjusting for maternal, obstetric and socio-economic confounders. Results: For extremely preterm births (0.4% of the study population), women with an unknown country of birth (adjusted OR (aOR)=3.09; 95% confidence interval (CI) 2.26–4.22) and women born in sub-Saharan Africa (aOR=1.66; CI 1.40–1.96) had the highest ORs compared to Norwegian-born women. For very preterm births (1.2% of the study population), women with an unknown country of birth (aOR=1.72; CI 1.36–2.18) and women born in South Asia (aOR=1.48; CI 1.31–1.66) had the highest ORs. For late preterm births (3.8% of the study population), women born in East Asia Pacific/Oceania (aOR=1.33; CI 1.25–1.41) and South Asia (aOR=1.30; CI 1.21–1.39) had the highest ORs. Conclusions: After adjusting for maternal, obstetric and socio-economic risk factors, maternal country of birth remained significantly associated with preterm birth. Women with an unknown country of birth and women born in sub-Saharan Africa were found to be at increased risk of extremely preterm birth.

• Sole, Kristina Baker; Staff, Anne Cathrine & Laine, Katariina (2021). Maternal diseases and risk of hypertensive disorders of pregnancy across gestational age groups. Pregnancy Hypertension. ISSN 2210-7789. 25, s. 25–33. doi: 10.1016/j.preghy.2021.05.004. Fulltekst i vitenarkiv
• Helmersen, Maria; Sørensen, Monica; Lukasse, Mirjam; Laine, Hely Katariina & Garnweidner-Holme, Lisa (2021). Women's experience with receiving advice on diet and Self-Monitoring of blood glucose for gestational diabetes mellitus: a qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 39(1), s. 44–50. doi: 10.1080/02813432.2021.1882077. Fulltekst i vitenarkiv Vis sammendrag

  Objective: We aimed to explore how women with gestational diabetes mellitus (GDM) experi- ence advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordin- ation and collaboration between healthcare professionals. Design, setting and subjects: Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using the- matic analysis. Results: Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with suffi- cient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more indi- vidually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women’s daily lives; however, they perceived the training in PHC and SHC as adequate. The women expe- rienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. Conclusions: Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own ca

• Bøhn, Kristin; Amundsen, Siv Merethe; Laine, Hely Katariina; Hvidtjørn, Dorte & Pay, Aase Serine Devold (2021). Feber under fødsel og antibiotikabehandling – en kvalitetssikringsstudie. Sykepleien Forskning. ISSN 1890-2936. doi: 10.4220/Sykepleienf.2021.86080. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Feber under fødsel defineres som kroppstemperatur ≥38 °C og forekommer ved omtrent 7 prosent av fødsler til termin. Tilstanden gir økt risiko for maternell og neonatal sykelighet og dødelighet. Korrekt bruk av antibiotika kan redusere forekomsten av alvorlige utfall for mor og barn. Hensikt: Kartlegge forekomst av feber under fødsel og bruk av antibiotika med denne indikasjonen ved Fødeavdelingen Ullevål på Oslo universitetssykehus samt vurdere om bruken av antibiotika var i henhold til klinikkens prosedyre. Metode: Gjennomgang av journaler til pasienter med fødsel til termin som var innlagt på fødeavdelingen i perioden 1.–30. april 2018. Resultat: Feber under fødsel (intrapartum feber) var registrert hos 67 av 552 pasienter (12 prosent). 99 pasienter (18 prosent) mottok behandling med feberreduserende medikamenter og/eller antibiotika grunnet feber. Av disse fikk 53 penicillin (54 prosent) grunnet mistanke om infeksjon. Kriteriene etter gjeldende prosedyre for profylaktisk antibiotikabehandling ble oppfylt hos 38 av de 53 pasientene som fikk penicillin (72 prosent). Penicillin i kombinasjon med gentamycin ble gitt til 21 av 99 pasienter (21 prosent) med indikasjon klinisk chorioamnionitt (betennelse i føtale membraner). Av disse 21 pasientene var det 15 (71 prosent) som oppfylte kriteriene for behandling. Konklusjon: Vi fant en høyere forekomst av intrapartum feber enn beskrevet i litteraturen. Journalgjennomgangen viste at bruken av antibiotika var i henhold til prosedyren på flere områder, men at det var utfordringer knyttet til overbehandling.

• Tingleff, Tiril; Vikanes, A.; Räisänen, S.; Sandvik, Leiv; Lahmami, Gulim & Laine, Katariina (2021). Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. s. 1–8. doi: 10.1111/1471-0528.17013. Fulltekst i vitenarkiv Vis sammendrag

  Objective To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth. Design Population-based registry study. Setting Medical Birth Registry of Norway and Statistics Norway. Population Women (n = 213 335) who gave birth to their first and second singleton child during 1999–2014 (total n = 426 670 births). Methods Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors. Main outcome measures Extremely preterm (<28+0 weeks), very preterm (28+0–33+6 weeks) and late preterm (34+0–36+6 weeks) second birth. Results Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47–22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59–17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11–7.70). Placental disorders contributed 30–40% of recurrent extremely and very preterm births and 10–20% of recurrent late preterm birth. Conclusion A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%).

• Laine, Katariina; Yli, Branislava Markovic; Cole, Vanessa; Schwarz, Christiane; Kwee, Anneke & Ayres-De-Campos, Diogo [Vis alle 21 forfattere av denne artikkelen] (2021). European guidelines on perinatal care- Peripartum care Episiotomy. Journal of Maternal-Fetal & Neonatal Medicine. ISSN 1476-7058. 35(25), s. 8797–8802. doi: 10.1080/14767058.2021.2005022. Fulltekst i vitenarkiv Vis sammendrag

  1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++–; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation) 2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation). 3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++–; Strong recommendation). 4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation)

• Pay, Aase Serine Devold; Johansen, Katarina; Staff, Anne Cathrine; Laine, Katariina; Blix, Ellen & Økland, Inger (2020). Effects of external cephalic version for breech presentation at or near term in high-resource settings: A systematic review of randomized and non-randomized studies. European Journal of Midwifery (EJM). 4. doi: 10.18332/ejm/128364. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: External cephalic version (ECV) for breech presentation involves manual manipulation of the fetus from breech to cephalic presentation at or near term, in an attempt to avoid breech birth. This systematic review summarizes the literature on the effects of ECV at or near term on pregnancy outcomes in high-resource settings. Methods: The MEDLINE, Embase, CINAHL, Cochrane Library, MIDIRS, and SweMED+ databases were searched for relevant articles published through April 2019, with no limitation on publication date. Clinical trials comparing the effects of ECV at ≥36 weeks, with or without tocolysis, with that of no ECV, conducted in northern, western, and central Europe, the USA, Canada, Australia, and New Zealand were eligible for inclusion. Results: Nine articles reporting on 184704 breech pregnancies were included. Pooled data showed that ECV attempts reduced the failure to achieve vaginal cephalic birth (risk ratio, RR=0.56; 95% CI: 0.45–0.71), caesarean section performance (RR=0.57; 95% CI: 0.50–0.64), and non-cephalic presentation at birth (RR=0.45; 95% CI: 0.29–0.68) compared with no ECV. ECV attempts also increased the incidence of Apgar score <7 at 5 minutes (RR=1.29; 95% CI: 1.10–1.52). Conclusions: Women for whom ECV is attempted at or near term are at reduced risk of caesarean section, non-cephalic presentation at term, and failure to achieve vaginal cephalic birth. Compared with no ECV, attempted ECV was also associated with a slightly increased risk of a low Apgar score at 5 minutes. The evidence is limited by the scarcity of high-quality research and the presence of risks of bias.

• Laine, Katariina & Räisänen, Sari (2020). Effect of maternal country of birth on intrapartum epidural use – A population-based register study of 602 095 deliveries. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 250, s. 41–47. doi: 10.1016/j.ejogrb.2020.04.013. Fulltekst i vitenarkiv Vis sammendrag

  Objective To assess intrapartum epidural use during vaginal delivery among immigrant women giving birth in Norway, compared with Norwegian born women, and to explore associations between epidural use and other maternal characteristics, fetal and obstetrical variables. Study design Population-based cohort study. Data were obtained from Norwegian Medical Birth Registry and Statistics Norway, including 602 095 deliveries in 1999-2014. Intrapartum epidural analgesia use was described in percentages. Multivariable logistic regression analysis was performed to investigate the association between maternal country of birth and intrapartum epidural use, adjusted with maternal and fetal comorbidity, age, stillbirth, birthweight, fetal presentation, delivery method and time period. Results There were significant differences in epidural use between women born in different parts of the world. Among nulliparous women, increased odds for intrapartum epidural use was observed among women born in Latin America compared with Norwegian born women, even after adjustment for maternal, fetal and obstetrical factors (aOR 1.93, CI 1.79-2.09). Reduced odds for intrapartum epidural use was observed among nulliparous women born in Sub-Saharan Africa (aOR 0.83, CI 0.78-0.88), East Asia and Pacific area (aOR 0.83, CI 0.80-0.87), and women with unknown country of birth (aOR 0.79, CI 0.71-0.89) compared with Norwegian born women. Similar pattern was observed among parous women from Latin America (aOR 1.69, CI 1.54-1.87), Sub-Saharan Africa (aOR 0.62, CI 0.57-0.67), East-Asia and Pacific area (aOR 0.68, CI 0.64-0.73), unknown country of birth (aOR 0.97, CI 0.84-1.13). Maternal hypertensive disorders, high infant birthweight, stillbirth, breech presentation and operative vaginal delivery increased the odds for use of intrapartum epidural analgesia. Conclusions We found differences between immigrant women from different parts of the world and use of intrapartum epidural, possibly related to un-measurable issues like cultural differences, maternal expectations and knowledge of safety on pain relief during childbirth. Intrapartum epidural use was more frequent in conditions related to maternal co-morbidity and factors indicating complicated delivery.

• Lahmami, Gulim; Räisänen, Sari; Jacobsen, Anne Flem; Sole, Kristina Baker; BJARKØ, LISA & Laine, Katariina (2020). Adverse perinatal outcomes in 665,244 term and post-term deliveries—a Norwegian population-based study. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 247, s. 212–218. doi: 10.1016/j.ejogrb.2020.02.028. Fulltekst i vitenarkiv
• Henriksen, Lena; Knutsen, Hanne Karoline & Laine, Katariina (2019). Fødselshjelp til fostre i seteleie ved Oslo universitetssykehus, Ullevål fra 2000–2012 :. Sykepleien Forskning. ISSN 1890-2936. s. 1–22. doi: 10.4220/sykepleienf.2019.77570. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det er omdiskutert hvordan kvinner bør føde ved seteleie. I oktober 2000 kom resultatene av The Term Breech Trial (TBT), som konkluderte med at planlagt keisersnitt var tryggest ved seteleie til termin. Studien endret i stor grad fødselshjelpen slik at det praktiseres planlagt keisersnitt ved seteleie i de este land i dag. I Norge har man anbefalt vaginal fødsel til utvalgte grupper ved seteleie både før og etter TBT-studien. Hensikt: Hensikten med studien har vært å beskrive klinisk praksis ved fødeavdelingen på Ullevål sykehus ved setefødsel og studere eventuelle forandringer i praksis etter år 2000. I tillegg har vi sammenliknet utfallet for den nyfødte, målt med Apgar-skår, ved ulike fødselsmetoder. Metode: Vi benyttet en retrospektiv registerstudie. Kvinner med foster i seteleie ≥34. svangerskapsuke ved Oslo universitetssykehus, Ullevål ble inkludert i perioden 2000–2012. Resultat: Det var til sammen 2986 kvinner med foster i seteleie i ≥34. svangerskapsuke ved Ullevål i studieperioden. Gjennomsnittlig var dette 3,8 prosent av fødslene ved sykehuset. I 2000 var andelen planlagte vaginale fødsler 62,9 prosent. Fra 2001 sank antallet kvinner selektert til vaginal fødsel frem mot 2006, da andelen var på det laveste med 34,2 prosent. Etter dette økte andelen igjen, og i 2012 ble 49,8 prosent av kvinnene med foster i seteleie planlagt til vaginal fødsel. Det var en høyere odds for lav Apgarskår, et mål som bedømmer vitaliteten til den nyfødte etter 5 minutter, hvis barnet var i gruppen som var selektert til planlagt vaginal fødsel. Konklusjon: På Ullevål fremstår det som om praksisen kan ha blitt påvirket av resultatene fra TBTstudien fra 2000. Etter en nedgang i planlagte vaginale fødsler frem mot 2007 steg andelen igjen mot slutten av studieperioden. En større andel barn hadde lav Apgar-skår i gruppen selektert til vaginal fødsel sammenliknet med den gruppen som var selektert til planlagt keisersnitt.

• Sultan, Ahmed A.; Thakar, Ranee; Ismail, KM; Kalis, V.; Laine, Katariina & Räisänen, SH [Vis alle 7 forfattere av denne artikkelen] (2019). The role of mediolateral episiotomy during operative vaginal delivery. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 240, s. 192–196. doi: 10.1016/j.ejogrb.2019.07.005. Fulltekst i vitenarkiv
• Hassan, Sahar J. A.; Laine, Katariina; Fosse, Erik; Abu-Rmeileh, Niveen M.E.; Ali, Hadil & Zimmo, Mohammed [Vis alle 9 forfattere av denne artikkelen] (2019). Induction of labor among singleton pregnancies in six palestinian governmental hospitals: A population-based cohort study. International Journal of Women's Health. 11, s. 597–605. doi: 10.2147/IJWH.S215781. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To explore rates and review practices regarding induction of labor (IOL) among singleton pregnancies in Palestine. Design: A prospective population-based cohort study. Setting: Six secondary and tertiary governmental hospitals located in the two regions of Palestine: West Bank and Gaza. Participants: Singleton pregnancies who had IOL in participating units during the study period were included (n=8290). Women having multiple gestations (1004), planned cesarean births (703), those admitted with cervical dilation >6cm (11228), and pregnancies with no record of cervical dilation and/or gestational age on admission (219) were excluded. Primary outcome measure: Rates of IOL in participating units and regions. Results: There were a total of 33,402 singleton births during the study period with an IOL rate of 24.8%. Rates of IOL significantly varied between units, ranging from 12.9% to 45.6% (P-value <0.05). The majority of women with no previous uterine scar were induced at gestational ages ≤40 weeks where 43.8% were induced at 39–40 gestational weeks (29.9% multiparous; 13.9% nulliparous) and 17.7% were induced between 37 and 38 gestational weeks (11.9% multiparous; 5.8% nulliparous). Conclusion: Significant variations in IOL practices between Palestinian hospitals and regions suggest overuse of IOL among singleton pregnancies in some units with the majority of these being performed before 40 weeks’ gestation. These findings indicate a gap between implementation of best evidence and current clinical practice.

• Torkildsen, Silje Engum; Svendsen, Helene; Räisänen, Sari; Sole, Kristina Baker & Laine, Katariina (2019). Country of birth and county of residence and association with overweight and obesity—a population-based study of 219 555 pregnancies in Norway. Journal of Public Health. ISSN 1741-3842. 41(4), s. e290–e299. doi: 10.1093/pubmed/fdz001. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: The aim was to study the effect of country of birth, educational level and county of residence on overweight and obesity among pregnant women in Norway. METHODS: Observational study based on Medical Birth Registry Norway and Statistics Norway. The study population consisted of 219 555 deliveries in 2006-2014. Body mass index (BMI) was registered at the first antenatal care visit. Multivariate regression analysis was used to explore the study aims. RESULTS: Overweight (BMI 25-29.9) was recorded in 22.3% of the women, obesity (BMI ≥30) in 12.2%. Highest rates of overweight (30.8%) and obesity (13.5%) was recorded among women from the Middle East and North Africa or with no education (30.7% and 17.2%). The prevalence of overweight and obesity was 39.5% in sparsely populated counties and 26.4% for women living in Oslo. Adjusted for country of birth, education level, age, parity, smoking and marital status, the relative odds of overweight and obesity were 65% (95% CI 59-72%) higher in sparsely populated counties compared to Oslo. CONCLUSIONS: The prevalence of overweight (BMI ≥25) was 34.5%. The factors associated with overweight were living in rural districts in Norway, lower education and being born in countries in the Middle East or Africa

• Laine, Katariina; Lahmami, Gulim; Sole, Kristina Baker; Pay, Aase Serine Devold; Heradstveit, Siri & Räisänen, Sari (2019). Prevalence and risk of pre-eclampsia and gestational hypertension in twin pregnancies: A population-based register study. BMJ Open. 9:e029908(7), s. 1–8. doi: 10.1136/bmjopen-2019-029908. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The aim of this study was to assess the prevalence and risk of pre-eclampsia and gestational hypertension in twin pregnancies compared with singleton pregnancies. Design Population-based cohort study. Setting Medical Birth Registry of Norway and Statistics Norway. Participants 929 963 deliveries with 16 174 twin pregnancies in 1999–2014. Methods Pre-eclampsia prevalences in twin and singleton pregnancies were described in percentages. Multivariable regression analyses were performed to assess the risks of pre-eclampsia and gestational hypertension in twin pregnancies compared with those in singleton pregnancies, adjusted for previously known risk factors. Primary and secondary outcome measures Prevalence and risk of pre-eclampsia and gestational hypertension. Results The prevalence of pre-eclampsia in the study population was 3.7% (3.4% in singleton pregnancies, 11.8% in twin pregnancies (p=0.001)). The OR for pre-eclampsia in twin pregnancies was three to fourfold compared with singleton pregnancies (OR 3.78; 95% CI 3.59 to 3.96). After adjustment for known risk factors, twin pregnancy remained an independent risk factor for pre-eclampsia (adjusted OR 4.07; 95% CI 3.65 to 4.54). The prevalence of gestational hypertension was 1.7% in women with singleton pregnancies and 2.2% in those with twin pregnancies (OR 1.27; 95% CI 1.14 to 1.41). After adjustment for known risk factors, gestational hypertension was not significantly associated with twin pregnancy. Conclusions The risk of pre-eclampsia in twin pregnancies was three to fourfold compared with singleton pregnancies, regardless of maternal age, parity, educational level, smoking, maternal comorbidity or in vitro fertilisation. The risk of gestational hypertension was not increased in women with twin pregnancies after adjustment for the main risk factors. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar J. A.; Böttcher, Bettina; Fosse, Erik & Ali, Hadil [Vis alle 10 forfattere av denne artikkelen] (2018). Caesarean section in Palestine using the Robson Ten Group Classification System: A population-based birth cohort study. BMJ Open. 8:e022875(10), s. 1–8. doi: 10.1136/bmjopen-2018-022875. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Ali, Hadil; Hassan, Sahar J. A.; Fosse, Erik; Zimmo, Kaled; Zimmo, Mohammed & Ismail, Khaled M.K. [Vis alle 8 forfattere av denne artikkelen] (2018). Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: A prospective interventional study. BMC Medical Education. 18:258, s. 1–10. doi: 10.1186/s12909-018-1363-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Obstetric anal sphincter injuries (OASIS) are associated with anal incontinence, dyspareunia and perineal pain. Bimanual perineal support technique (bPST) prevents OASIS. The aim of this study was to assess the effect of two different bPST training-methods on OASIS incidence. Methods This is a prospective-interventional quality improvement study conducted in two Palestinian maternity units between June 1 2015 and December 31 2016. Women having spontaneous or operative vaginal-delivery at ≥24 gestational-weeks or a birthweight of ≥1000 g (n = 1694) were recruited and examined vaginally and rectally immediately after vaginal birth by a trained assessor. Data on baseline OASIS incidence were collected during Phase-1 of the study. Subsequently, birth attendants in both maternity units were trained in bPST using two training modalities. A self-directed electronic-learning (e-learning) using an animated video was launched in phase-2 followed by a blended learning method (the animated e-learning video+ structured face-to-face training) in phase-3. OASIS incidence was monitored during phases-2 and 3. Variations in OASIS incidence between the three phases were assessed using Pearson-χ2-test (or Fisher’s-Exact-test). The impact of each training-method on OASIS incidence was assessed using logistic-regression analysis. Results A total of 1694 women were included; 376 in phase-1, 626 in phase-2 and 692 in phase-3. Compared to Phase-1, OASIS incidence was reduced by 45% (12.2 to 6.7%, aOR: 0.56, CI; 0.35–0.91, p = 0.018) and 74% (12.2 to 3.2%, aOR, 0.29, CI; 0.17–0.50, p < 0.001) in phases-2 and 3, respectively. There was also a significant reduction in OASIS incidence by 52% from phase-2 to phase-3 (6.7% (42/626) to 3.2% (22/692), p = 0.003). These reductions reached statistical significance among parous-women only (aOR: 0.18, CI; 0.07–0.49, p = 0.001) after the first training method tested in phase-2. However, the reduction was significant among both primiparous (aOR: 0.39, CI; 0.21–0.74, p = 0.004) and parous-women (aOR: 0.11, CI; 0.04–0.32, p < 0.001) after implementing the blended learning method in phase-3. Conclusion The animated e-learning video had a positive impact on reducing OASIS incidence. However, this reduction was enhanced by the use of a blended learning program combining both e- learning and face-to-face training modalities. Study registration number ClinicalTrialo.gov identifier: NCT02427854, date: 28 April 2015.

• Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit & Ali, Hadil [Vis alle 11 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Sole, Kristina Baker; Staff, Anne Cathrine & Laine, Katariina (2018). The association of maternal country of birth and education with hypertensive disorders of pregnancy: A population-based study of 960 516 deliveries in Norway. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(10), s. 1237–1247. doi: 10.1111/aogs.13393. Fulltekst i vitenarkiv
• Ali, Hadil; Sahar, Hassan; Zimmo, Kaled; Zimmo, Mohammed; Ismail, Khaled & Fosse, Erik [Vis alle 9 forfattere av denne artikkelen] (2018). Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study. Obstetrics and Gynecology International. ISSN 1687-9589. doi: 10.1155/2018/6345497. Fulltekst i vitenarkiv Vis sammendrag

  Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions’ distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61–4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8–4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.

• Zimmo, Kaled; Laine, Katariina; Fosse, Erik; Zimmo, Mohammed; Ali-Masri, Hadil & Böttcher, Bettina [Vis alle 9 forfattere av denne artikkelen] (2018). Impact of animated instruction on tablets and hands-on training in applying bimanual perineal support on episiotomy rates: an intervention study. International Urogynecology Journal. ISSN 0937-3462. s. 1–8. doi: 10.1007/s00192-018-3711-6. Fulltekst i vitenarkiv Vis sammendrag

  Introduction and hypothesis In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women. Methods An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal–Wallis test. Results Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84–1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33–0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40–0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35–0.68) in Hospital 2. Conclusions Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone.

• Zimmo, Kaled; Laine, Katariina; Fosse, Erik; Zimmo, Mohammed; Ali, Hadil & Zucknick, Manuela [Vis alle 8 forfattere av denne artikkelen] (2018). Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open. 8(7). doi: 10.1136/bmjopen-2018-021629. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women. Study design A prospective, population-based birth cohort study. Setting Obstetric departments in six Palestinian government hospitals. Participants All women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016. Methods All women were divided into two groups: first vaginal birth group (n=9108), including primiparous women and women with their first vaginal birth after one caesarean section, and the parous group (n=20 057). Each group was analysed separately. Data were presented as numbers and percentages or range. Differences in rates were assessed by the p values of χ2 test, or Fisher’s exact test if there are cell counts less than 5. Main outcome measures Episiotomy rates and indications among women of singleton births. Results The overall episiotomy rate was 28.7%: 78.8% for women with first vaginal birth (range 56.6%–86.0%) and 5.9% for parous women (range 1.0%–9.5%). The most common indications for episiotomy were ‘primiparity’ in the first vaginal birth group (69.9%) and ‘protecting the perineum’ in the parous group (59.5%). The least common indications were prolonged second stage (1.5%) and fetal distress (6.9%), respectively. Conclusion In Palestine, the majority of women who delivered vaginally for the first time had an episiotomy. Education of birth attendants, clinical audits, educational interventions and adherence to the updated guidelines may help to decrease the routine overuse of episiotomy.

• Ali, Hadil; Hassan, Sahar J. A.; Ismail, Khaled; Zimmo, Kaled; Zimmo, Mohammed & Fosse, Erik [Vis alle 8 forfattere av denne artikkelen] (2018). Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: An interventional quality improvement study. BMJ Open. 8:e020893(6), s. 1–10. doi: 10.1136/bmjopen-2017-020983. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore the impact of a training intervention on obstetric anal sphincter injuries’ (OASIS) detection rate. Design Prospective quality improvement interventional study. Setting Six secondary and tertiary maternity units in Palestine. Population Women having singleton vaginal births ≥23 weeks’ gestation or babies weighing ≥500 g (n=22 922). Caesarean births (n=5431), multiple gestations (n=443) and vaginal births of unregistered perineum status (n=800) were excluded. Interventions Training programme for enhancing OASIS detection was conducted between 31 January and 31 December 2015. International experts delivered 2-day standardisation workshop teaching OASIS diagnosis and repair to each maternity unit. They also provided additional training to three research fellows employed in three of the maternity units. This was followed by 13-week period of data collection (phase 1). Research fellows then delivered training intervention over 15-week interval (phase 2), including theoretical teaching and ‘onsite’ training in perineal trauma assessment within the six maternity units. Finally, 13-week postintervention observation (phase 3) followed. Primary outcome measure OASIS rates were used as surrogate for OASIS recognition. OASIS rates were compared between different phases and between the two maternity unit groups (research fellow and non-research fellow based) using Pearson’s χ² test. Results A total 22 922 women were included. Among primiparous women, OASIS rate was higher in phase 2 (2.8%, p<0.001) and phase 3 (3.1%, p<0.001) than phase 1 (0.5%). However, no significant differences were detected in the rates of severe OASIS (third-degree 3c and fourth-degree tears) between phase 1 and 2 (0.5% vs 0.3%), because this would have required at least 103 women with severe OASIS to be included in each phase. Among parous women, OASIS rate was significantly higher in phase 2 (0.6%, p=0.002) but not in phase 3 (0.4%, p=0.071) compared with phase 1 (0.2%). Research fellows’ maternity units showed higher OASIS rates among primiparous women in phase 2 (3.6% vs 1.4%, p=0.001) and phase 3 (4.3% vs 0.8%, p<0.001) than non-research fellows’ maternity units. Conclusions This work is basically an epidemiological study which has identified the prevalence of perineal lacerations and their severity on a large sample of women representative of an entire geographical ethnic region. The quality improvement intervention improved OASIS detection mainly in the research fellows’ maternity units. Regular mandatory national programmes in obstetric perineal trauma assessment and management by local champions are essential to mitigate the risk of missing significant degrees of trauma.

• Zimmo, Kaled; Laine, Hely Katariina; Fosse, Erik; Zimmo, Mohammed; Ali-Masri, Hadil Y. & Zucknick, Karola Manuela [Vis alle 8 forfattere av denne artikkelen] (2018). Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open. doi: 10.1136/bmjopen-2018-021629. Fulltekst i vitenarkiv
• Ali, Hadil; Vikanes, Åse Vigdis; Anti, Marit; Hassan, Sahar J. A.; Ismail, Khaled M. & Zimmo, Kaled [Vis alle 9 forfattere av denne artikkelen] (2017). Evaluation of an animated instructional video as a training tool for manual perineum support during vaginal delivery. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. 137(2), s. 213–219. doi: 10.1002/ijgo.12115. Fulltekst i vitenarkiv
• Zimmo, Kaled; Laine, Katariina; Vikanes, Åse Vigdis; Fosse, Erik; Zimmo, Mohammed & Ali, Hadil [Vis alle 9 forfattere av denne artikkelen] (2017). Diagnosis and repair of perineal injuries: Knowledge before and after expert training-a multicentre observational study among Palestinian physicians and midwives. BMJ Open. 7:e014183(4), s. 1–8. doi: 10.1136/bmjopen-2016-014183. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment. Methods: A questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3 months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test. Results: Among physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p<0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p<0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p<0.001). The corresponding numbers for midwives were 0% and 18% (p<0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p<0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p<0.001). Conclusions: Improvement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2 days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge.

• Hassan, Sahar; Vikanes, Åse Vigdis; Laine, Katariina; Zimmo, Kaled; Zimmo, Mohammed & Bjertness, Espen [Vis alle 7 forfattere av denne artikkelen] (2017). Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy and Childbirth. 17(1). doi: 10.1186/s12884-017-1296-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Electronic-health (e-health) provides opportunities for quality improvement of healthcare, but implementation in low and middle income countries is still limited. Our aim was to describe the implementation of a registration (case record form; CRF) for obstetric interventions and childbirth events using e-health in a prospective birth cohort study in Palestine. We also report the completeness and the reliability of the data. Methods Data on maternal and fetal health was collected prospectively for all women admitted to give birth during the period from 1st March 2015 to 31st December 2015 in three governmental hospitals in Gaza and three in the West Bank. Essential indicators were noted in a case registration form (CRF) and subsequently entered into the District Health Information Software 2 (DHIS 2) system. Completeness of registered cases was checked against the monthly hospital birth registries. Reliability (correct information) of DHIS2 registration and entry were checked for 22 selected variables, collected during the first 10 months. In the West Bank, a comparison between our data registration and entry and data obtained from the Ministry of Health patient electronic records was conducted in the three hospitals. Results According to the hospital birth registries, a total of 34,482 births occurred in the six hospitals during the study period. Data on the mothers and children registered on CRF was almost complete in two hospitals (100% and 99.9%); in the other hospitals the completeness ranged from 72.1% to 98.7%. Eighty birth events were audited for 22 variables in the three hospitals in the West Bank. Out of 1760 registrations in each hospital, the rates of correct data registration ranged from 81% to 93.2% and data entry ranged from 84.5% to 93.1%. Conclusions The registered and entered data on birth events in six hospitals was almost complete in five out of six hospitals. The collected data is considered reliable for research purposes.

• Räisänen, Sari; Hogue, Carol J R; Laine, Katariina; Kramer, Michael R; Gissler, Mika & Heinonen, Seppo (2017). A population-based study of the effect of pregnancy history on risk of stillbirth. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. 140(1), s. 73–80. doi: 10.1002/ijgo.12342. Fulltekst i vitenarkiv
• Pettersen-Dahl, Anita; Lahmami, Gulim; Sandvik, Leiv & Laine, Katariina (2017). Maternal body mass index as a predictor for delivery method. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(2), s. 212–218. doi: 10.1111/aogs.13265. Fulltekst i vitenarkiv
• Jansova, Magdalena; kalis, Vladimir; Rusavy, Zdenek; Rusavy, z; Räisänen, Sari & Laine, Katariina (2017). Fetal head size and effect of manual perineal protection. PLOS ONE. 12(12), s. 1–12. doi: 10.1371/journal.pone.0189842. Fulltekst i vitenarkiv Vis sammendrag

  Objective: The aim of this study was to evaluate whether a previously identified modification of Viennese method of perineal protection remains most effective for reduction of perineal tension in cases with substantially smaller or larger fetal heads. Methods: A previously designed finite element model was used to compare perineal tension of different modifications of the Viennese method of perineal protection to "hands-off" technique for three different sizes of the fetal head. Quantity and extent of tension throughout the perineal body during vaginal delivery at the time when the suboccipito-bregmatic circumference passes between the fourchette and the lower margin of the pubis was determined. Results: The order of effectiveness of different modifications of manual perineal protection was similar for all three sizes of fetal head. The reduction of perineal tension was most significant in delivery simulations with larger heads. The final position of fingers 2cm anteriorly from the fourchette (y = +2) consistently remains most effective in reducing the tension. The extent of finger movement along the anterior-posterior (y-axis) contributes to the effectiveness of manual perineal protection. Conclusion: Appropriately performed Viennese manual perineal protection seems to reduce the perineal tension regardless of the fetal head size, and thus the method seems to be applicable to reduce risk of perineal trauma for all parturients

• Fodstad, Kathrine; Staff, Anne Cathrine & Laine, Katariina (2016). Episiotomy preferences, indication, and classification - A survey among Nordic doctors. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 95(5), s. 587–595. doi: 10.1111/aogs.12856. Fulltekst i vitenarkiv
• Fodstad, Kathrine; Staff, Anne Cathrine & Laine, Katariina (2016). Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma. International Urogynecology Journal. ISSN 0937-3462. 27(10), s. 1513–1523. doi: 10.1007/s00192-016-3015-7. Fulltekst i vitenarkiv Vis sammendrag

  Introduction and hypothesis Knowledge on sexual complaints and time to sexual resumption after obstetric anal sphincter injury (OASI) is scarce. The aim of the study was to investigate self-reported sexual activity and coital problems 1 year postpartum in relation to perineal trauma, in addition to delivery mode. Methods Among 2,846 women recruited during pregnancy, all women who delivered with OASI (n = 42, all third-degree perineal tears), in addition to 20 randomly selected controls per OASI case, a total of 882 women, were sent a self-administered questionnaire addressing time to coital resumption after delivery and potential coital difficulty 1 year postpartum. Results By 8 weeks, half of the 561 responders (51.4 %) had resumed intercourse, increasing to 75.2 % by 12 weeks and 94.7 % 1 year postpartum. In multivariate regression analysis OASI was the strongest predictor for postponed coital onset, defined as after 8 weeks (aOR 5.52, CI 1.59–19.16). OASI was also the only significant predictor for dyspareunia 1 year after delivery (aOR 3.57, CI 1.39–9.19). Episiotomy was neither a risk factor for postponed coital onset nor for dyspareunia. There were no differences between episiotomy and second-degree laceration injury groups regarding postponed coital onset (p = 0.45) or dyspareunia (p = 0.67) 1 year postpartum. Conclusions Obstetric anal sphincter injury was a strong and independent predictor for both postponed coital resumption after delivery and for dyspareunia 1 year postpartum, whereas episiotomy and spontaneous second-degree lacerations were not. Our main finding of affected sexual activity after OASI further supports the need to reduce the rates of this obstetric injury to a minimum.

• Fodstad, Kathrine; Staff, Anne Cathrine & Laine, Katariina (2014). Effect of different episiotomy techniques on perineal pain and sexual activity 3 months after delivery. International Urogynecology Journal. ISSN 0937-3462. 25(12), s. 1629–1637. doi: 10.1007/s00192-014-2401-2. Fulltekst i vitenarkiv
• Jansova, Magdalena; Kalis, Vladimir; Rusavy, Zdenek; Zemcik, Robert; Lobovsky, Libor & Laine, Katariina (2014). Modeling manual perineal protection during vaginal delivery. International Urogynecology Journal. ISSN 0937-3462. 25(1), s. 65–71. doi: 10.1007/s00192-013-2164-1. Fulltekst i vitenarkiv
• Räisänen, Sari; Selander, T; Cartwright, Rufus; Gissler, Mika; Kramer, Michael R & Laine, Katariina [Vis alle 7 forfattere av denne artikkelen] (2014). The association of episiotomy with obstetric anal sphincter injury - a population based matched cohort study. PLOS ONE. 9:e0107053(9). doi: 10.1371/journal.pone.0107053. Fulltekst i vitenarkiv
• Laine, Katariina; Rotvold, Wenche & Staff, Anne Cathrine (2013). Are obstetric anal sphincter ruptures preventable? - Large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 92(1), s. 94–100. doi: 10.1111/aogs.12024. Fulltekst i vitenarkiv
• Fodstad, Kathrine; Laine, Katariina & Staff, Anne Cathrine (2013). Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study. International Urogynecology Journal. ISSN 0937-3462. 24(5), s. 865–872. doi: 10.1007/s00192-012-1960-3. Fulltekst i vitenarkiv
• Laine, Katariina; Räisänen, Sari; Cartwright, Rufus; Gissler, Mika; Kramer, Michael R & Jouhki, Maija-Riitta [Vis alle 7 forfattere av denne artikkelen] (2013). Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004–2011. BMJ Open. doi: 10.1136/bmjopen-2013-003216. Fulltekst i vitenarkiv
• Staff, Anne Cathrine; Laine, Katariina; Skjeldestad, Finn Egil & Sandvik, Leiv (2013). Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women. ISRN Obstetrics and Gynecology. ISSN 2090-4436. 2013. doi: 10.1155/2013/947572. Fulltekst i vitenarkiv Vis sammendrag

  The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark’s score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark’s score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely themost important factor for reducing bothersome anal incontinence among fertile women.

• Laine, Katariina; Sandvik, Leiv; Skjeldestad, Finn Egil & Staff, Anne Cathrine (2013). Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women. ISRN Obstetrics and Gynecology. ISSN 2090-4436. Fulltekst i vitenarkiv
• Acharya, Ganesh; albrecht, christiane; Benton, samantha J; Cotechini, Tiziana; Dechend, Ralf & Dilworth, M.R. [Vis alle 23 forfattere av denne artikkelen] (2012). IFPA Meeting 2011 workshop report I: Placenta: Predicting future health; roles of lipids in the growth and development of feto-placental unit; placental nutrient sensing; placental research to solve clinical problems – A translational approach. Placenta. ISSN 0143-4004. doi: 10.1016/placenta.2011.11.015. Fulltekst i vitenarkiv
• Laine, Katariina; Skjeldestad, Finn Egil; Sandvik, Leiv & Staff, Anne Cathrine (2012). Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open. 2(5). doi: 10.1136/bmjopen-2012-001649. Fulltekst i vitenarkiv Vis sammendrag

  Objective To compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after implementing a training programme for improved perineal support aimed at reducing the incidence of obstetric anal sphincter injuries. The secondary aim was to study incidence of obstetric anal sphincter injuries in subgroups defined by risk factors for OASIS. Design Population-based cohort study. Setting University hospital setting in Oslo, Norway. Participants Two cohorts of all delivering women in the largest hospital in Norway during two time periods (2003–2005 and 2008–2010) were studied. After excluding caesarean sections and preterm deliveries (< week 32), the study population consisted of 31 709 deliveries, among which 907 women were identified with obstetric anal sphincter injury. Primary and secondary outcome measures Incidence of OASIS in two time periods. Maternal, obstetrical and foetal risk factors for OASIS were collected from the hospital obstetric database. Univariate analyses and multivariate logistic regression analyses, presenting adjusted ODs for OASIS, were performed. Results The OASIS incidence was significantly reduced by 50%, from 4% (591/14787) in the first time period to 1.9% (316/16 922) in the second. This reduction could not be explained by changes in population characteristics or OASIS risk factors during the study years. The reduction of incidence of OASIS between the two study periods was consistent across subgroups of women; regardless of parity, delivery method and infant birth weight. Conclusions A marked reduction in the incidence of OASIS was observed in all studied subgroups of women after implementing the training programme for perineal protection. Further, this reduction could not be explained by the differences in patient characteristics across the study period. These findings indicate that the training programme with improved perineal protection markedly reduced the risk of OASIS.

• Kalis, V; Laine, Katariina; Leeuw, J W de; Ismail, K M & Tincello, D G (2012). Classification of episiotomy: towards a standardisation of terminology. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 119(5), s. 522–526. doi: 10.1111/j.1471-0528.2011.03268.x. Fulltekst i vitenarkiv
• Räisänen, Sari; Laine, Katariina; Jouhki, Maija-Riitta; Vehviläinen-Julkunen, Katri; Gissler, Mika & Heinonen, Seppo (2012). Risk of obstetric anal sphincter injury in vaginal births could be reduced. Duodecim. ISSN 0012-7183. 128(19), s. 1981–1987. Fulltekst i vitenarkiv
• Kalis, Vladimir; Landsmanova, Jana; Bednarova, Barbora; Karbanova, Jaroslava; Laine, Hely Katariina & Rokyta, Zdenek (2011). Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. 112(3), s. 220–224. doi: 10.1016/j.ijgo.2010.09.015. Fulltekst i vitenarkiv
• Laine, Hely Katariina; Skjeldestad, Finn Egil; Sanda, Birgitte; Horne, Hildegunn; Spydslaug, Anny E & Staff, Anne Cathrine (2011). Prevalence and risk factors for anal incontinence after obstetric anal sphincter rupture. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 90(4), s. 319–324. doi: 10.1111/j.1600-0412.2010.01057.x. Fulltekst i vitenarkiv
• Laine, Katariina; Pirhonen, Tiina Tellervo; Rolland, Rune & Pirhonen, Jouko (2008). Decreasing the incidence of anal sphincter tears during delivery. Obstetrics and Gynecology. ISSN 0029-7844. 111(5), s. 1053–1057. doi: 10.1097/AOG.0b013e31816c4402. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVE: To estimate if an interventional program causes a decrease in the frequency of anal sphincter ruptures. METHODS: A total of 12,369 vaginal deliveries between 2002 and March 2007 were enrolled in the interventional cohort study. Slowing the delivery of the infant’s head and instructing the mother not to push while the head is delivered was the intervention. Data were analyzed in relation to occurrence of anal sphincter tears. RESULTS: The proportion of parturients with anal sphincter tears decreased significantly during the study period from 4.03% (285 of 7,069) to 1.17% (42 of 3,577) (P<.001). A similar decrease was observed for instrumental deliveries (from 16.26% to 4.90%; P<.001) and noninstrumental deliveries (from 2.70% to 0.72%; P<.001). Although the number of patients with fourth-degree anal sphincter ruptures from 2002 through 2004 was 10, 13, and 11 per year, respectively, there was just one fourth-degree anal sphincter rupture during the whole study period of 18 months (P<.001). The number of episiotomies increased from 13.9% (980 of 7,069) in the years 2002–2004, to 23.1% during the first 9 months of the intervention (416 of 1,776; P<.001), but decreased to 21.1% (381 of 1,801) during the last 9 months of the intervention. CONCLUSION: As a result of this intervention the number of anal sphincter ruptures was reduced from 4.03% to 1.17%. LEVEL OF EVIDENCE: II

Se alle arbeider i NVA

• Andreassen, Silje Malen; Costa, Denise Reis; Laine, Katariina; Evenson, Kelly R.; Vangen, Siri & Owe, Katrine Mari (2025). Twins on board: How does carrying two affect physical activity levels? Norsk Epidemiologi, Supplement. ISSN 0803-4206. 33(Supplement 1), s. 8–8. doi: https:/www.ntnu.no/ojs/index.php/norepid. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Few longitudinal population-based studies have described physical activity patterns in women pregnant with twins, and studies on physical activity including the period after birth are lacking. We need knowledge of physical activity patterns in women pregnant with twins to develop physical activity recommendations. Aims: To describe stability and change in leisure-time physical activity (LTPA) from pre-pregnancy, through pregnancy and up to 18 months after birth in women pregnant with twins and compare patterns of LTPA by parity. Methods: We included 1,796 women pregnant with twins from the Norwegian Mother, Father and Child Cohort Study. LTPA was self-reported using a validated questionnaire in pregnancy weeks 17 and 30 and six and 18 months after birth. The women reported frequency of 14 different types of physical activities. Participants were eligible if they had a twin pregnancy, returned the first questionnaire, and reported LTPA at least once. To identify latent classes, we fitted a generalized latent class model including a quadratic term and with intercept and slope varying across individuals. We report estimated latent class-specific mean trajectories of LTPA for the total sample and stratified by parity. Results: Two latent classes were identified: stable low-to-moderate LTPA (76.6%) and high LTPA (23.4%). In the high LTPA class, levels of LTPA decreased from pre-pregnancy to gestational week 30. LTPA increased after birth, but not to pre-pregnancy levels. The highly active class had a higher proportion of nulliparous women (59.9%), while the low-to-moderately active class had a higher proportion of multiparous women (53.9%). Conclusions: This is the first population-based study exploring longitudinal LTPA in women pregnant with twins. Despite the heavy burden associated with twin pregnancy, we observed relatively stable moderate to high levels of LTPA from pre-pregnancy, through pregnancy, and up to 18 months after birth. The potential consequences of physical activity in twin pregnancy on maternal and fetal health remain unexplored, and further research on physical activity in twin pregnancies are needed.

• Andreassen, Silje Malen; Costa, Denise Reis; Laine, Katariina; Evenson, Kelly R.; Vangen, Siri & Owe, Katrine Mari (2025). How do physical activity levels differ in twin and singleton pregnancies? European Journal of Public Health. ISSN 1101-1262. 35(Supplement_4). doi: 10.1093/eurpub/ckaf161.1712. Fulltekst i vitenarkiv Vis sammendrag

  Background: Twin pregnancy has been a contraindication to physical activity. Therefore, we lack population-based data describing physical activity in these pregnancies. We aimed to describe physical activity in women with twin and singleton pregnancies from pre-pregnancy through pregnancy and up to 18 months after birth. Methods: We used a population-based cohort including 1,938 twin and 109,370 singleton pregnancies in the Norwegian Mother, Father and Child Cohort Study (1999-2008). Frequency of 14 different types of leisure-time physical activities (LTPA) were self-reported using a validated questionnaire in pregnancy weeks 17 and 30 and at six and 18 months after birth. We performed descriptive statistics, including median weekly frequency of LTPA with interquartile range (IQR), and proportions of women reporting LTPA at least once weekly by plurality. Preliminary results: LTPA in women pregnant with twins declined from 4.00 times weekly (IQR: 2.50-6.25) pre-pregnancy to 2.25 times weekly (1.00-3.00) in pregnancy week 30. Corresponding frequencies for women with singletons were 4.00 (2.25-6.25) and 3.00 (1.25-4.25). The proportion of women reporting LTPA at least once weekly only differed in twin compared to singleton pregnancies in week 30, 61% and 70% respectively. In week 30, 10% of women pregnant with twins reported no LTPA compared to 3% of women with singletons. Eighteen months after birth, both women delivering twins and singletons resumed pre-pregnancy levels of LTPA. The most common types of LTPA were strolling and brisk walking in both groups of women. Conclusions: Patterns and types of LTPA were similar in women with twin and singleton pregnancies, except in pregnancy week 30 where levels of LTPA were lower in women carrying twins. This is the first population-based study on LTPA in women pregnant with twins. Thus, we need knowledge on who remains physically active, why physical activity changes, and potential consequences of physical activity in twin pregnancy. Key messages: • Women pregnant with twins were less physically active compared to women pregnant with singletons late in pregnancy. • Identifying physically inactive women and potential consequences of the decline in physical activity in women pregnant with twins is needed.

• Leeuw, Jan Willem de; Laine, Katariina; Manresa, Margareta; Raisanen, Sari; Kalis, Vladimir & Rušavý, Zdenĕk [Vis alle 7 forfattere av denne artikkelen] (2024). Delivering in or out of water, the OASI rates in the POOL cohort study are disturbingly high. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. doi: 10.1111/1471-0528.17933. Fulltekst i vitenarkiv
• Laine, Katariina; Räisänen, Sari; Yli, Branka Markovic & Tingleff, Tiril (2024). Comment on the study by Aanstad et al. “Intrapartum fetal monitoring practices in Norway: A population-based study”. Sexual & Reproductive HealthCare. ISSN 1877-5756. 41. doi: 10.1016/j.srhc.2024.101018. Fulltekst i vitenarkiv
• Fodstad, Kathrine; Laine, Katariina & Räisänen, Sari (2024). Authors' reply. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. doi: 10.1111/1471-0528.17958. Fulltekst i vitenarkiv
• Laine, Katariina & Tingleff, Tiril (2023). Tvillinggravide får ikke optimal profylakse mot pre-eklampsi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(8). doi: 10.4045/tidsskr.23.0331. Fulltekst i vitenarkiv
• Kessler, Jørg; Yli, Branislava Markovic; Overrein, Heidi & Laine, Katariina (2022). Ingen grunn til endring av anbefalinger om fosterovervåkning. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(16). doi: 10.4045/tidsskr.22.0662. Fulltekst i vitenarkiv
• Manresa, M.; Kalis, V.; Tayrac, Tayrac de; Leeuw, Leeuw de; Laine, Katariina & Räisänen, S. [Vis alle 7 forfattere av denne artikkelen] (2020). Hands up if you do not understand hands on. Midwifery. ISSN 0266-6138. 90. doi: 10.1016/j.midw.2020.102836. Fulltekst i vitenarkiv
• Laine, Katariina; Haugen, Guttorm; Johnsen, Synnøve Lian & Salvesen, Kjell Å (2019). Det er på tide å innføre ultralyd i uke 12. Fire spesialister i fødselshjelp og kvinnesykdommer. Fulltekst i vitenarkiv
• Staff, Anne Cathrine & Laine, Katariina (2012). Mange sfinkterskader kan forebygges. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 132(21), s. 2364–2365. doi: 10.4045/tidsskr.12.1168. Fulltekst i vitenarkiv
• Laine, Katariina; Skjeldestad, Finn Egil; Barbero, Mark Lewis Belandres & Staff, Anne Cathrine (2012). Similar reduction in OASR across all risk groups after implementation of a perineal protection program - a further reduction in the low risk groups is a challenge. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 91, s. 103–103. Fulltekst i vitenarkiv
• Kalis, V.; Laine, Katariina; Leeuw, J W de; Ismail, K M & Tincello, D G (2012). Classification of episiotomy: towards a standardisation of terminology Reply. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 119(10), s. 1284–1285. doi: 10.1111/j.1471-0528.2012.03424.x. Fulltekst i vitenarkiv
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