Per E Børdahl

We have performed a full cross-validation of this clinical Femina data collection against the routinely collected data of the Medical Birth Registry of Norway to validate the estimates of reduced mortality in the total population. The original estimate of fewer deaths during the intervention with OR 0.7 remains virtually unchanged for the original data collection. The validation procedures revealed inaccuracies in data from the Medical Birth Registry of Norway for a partial comparison with mortality outside the study area, and we here correct this comparison. We present new, corrected and cross-validated data. Despite comparability issues, the most robust and cross-validated estimates confirm similar estimates of reduced mortality during the quality improvement intervention.

Delayed maternal reporting of decreased fetal movement (DFM) is associated with adverse pregnancy outcomes. Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM. We aimed to evaluate an intervention of implementation of uniform information on fetal activity to women during the antenatal period.

Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals.

Established in 1967, the Medical Birth Registry of Norway has detailed accounts of all births in Norway. We have, however, only limited knowledge of obstetric practices in Norway in the decades before the Birth Registry was established. One important source is the annual reports of the Maternity Clinic in Oslo. We analysed the annual reports for the period 1915-1961 with special emphasis on operative deliveries. The obstetric forceps was used in 6.5-12.5% (median 8.7%) of cephalic presentations. In 1960, the vacuum extractor was used for the first time. The rate of caesarean sections increased from 1.5% in the late 1930s to 6.3% in 1961. The proportion of operative deliveries increased up until 1944-55 when it was 14-16%, then fell in the years to 1960 when it was about 12%. Between 1915-1934, maternal mortality was as high as 6.4 per thousand. From the mid-1930s, it steadily decreased to 0.6 per thousand in the last five-year period. Well over one third of the deaths were caused by eclampsia or serious preeclampsia. Birth traumas and neonatal death was the price paid for saving the mothers' lives and health. The operative activity was higher than what might be expected on the basis of the late-1960s data in the Birth Registry. The increase in caesarean sections was steepest during the Second World War, at a time when the number of deliveries in the clinic rose substantially.

Professional obstetrics in Norway developed during the 19th century. This paper analyses the development through the second half of the 19th century at the Maternity Clinic in Christiania (now Oslo). All patient files from the years 1852, 1872 and 1892, a total of 1231 records, were analysed. Socio-demographic and gynaecologic data were registered as well as data about the delivery and the child. The number of deliveries increased nearly five times during the period. The proportion of married women increased from less than 20% to nearly 50%. Maternal mortality decreased from above 3% to below 1%, mostly because childbed fever became infrequent. The number of operative deliveries increased substantially, particularly the use of the obstetric forceps, in 1892 utilised in 6 % of deliveries. In the reviews published in those days, eclampsia and reduced contractions were the most frequently cited indications for the use of the obstetric forceps. Problems with the heart sound of the fetus were not mentioned. However, patient files demonstrate that a weak or missing heart sound of the fetus was also an important indication for the use of the forceps. Giving birth at the clinic was gradually becoming an alternative for other than poor women, because it was safer than before and in some cases the obstetricians could offer effective help. However, at the end of the 19th century, not more than about 15% of all deliveries took place at the clinic. This paper demonstrates the importance of scrutinising patient files as a supplement to register data, as is the case today, too.

Hundred years ago, on 12 January 1903 the gynaecologist Max Sänger (1853-1903) died. He was one of the most well-known German gynaecologists at the end of the 19th century, and during the 20 years he practiced in Leipzig, he achieved an international reputation. His scientific work covered almost the whole field of contemporary obstetrics and gynaecology, and he is still remembered for his modification of the Caesarean operation, which substantially reduced maternal mortality. Sänger was closely linked to Norway, both professionally and personally. This paper describes his work as gynaecologist and his relationship to Norway, especially his friendship with Nina and Edvard Grieg.