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Objective: The aim of this national study was to examine the incidence of preterm pre-eclampsia (PE) and the proportion of women with risk factors for PE, according to the criteria suggested by the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), during a 10-year period in Denmark., Methods: Data from The Danish National Patient Registry and the Danish Medical Birth Registry were used to obtain the incidence of preterm PE with delivery < 37 weeks' gestation and risk factors for PE for all deliveries in Denmark from 1 January 2008 to 31 December 2017. The proportion of women with at least one high-risk factor and/or at least two moderate-risk factors for PE, according to the NICE and ACOG criteria, and the detection rate for preterm PE were examined. Race, socioeconomic status and the woman's weight at birth were not available from the registries used, and information on Type-2 diabetes was found to be invalid., Results: Of the 597 492 deliveries during the study period, any PE was registered in 3.2%, preterm PE < 37 weeks in 0.7% and early-onset PE < 34 weeks' gestation in 0.3%. These proportions remained largely unchanged from 2008 to 2017. Overall, the NICE criteria were fulfilled in 7.5% of deliveries and the ACOG criteria in 17.3%. In the total population, the NICE criteria identified 47.6% of those with preterm PE and the ACOG criteria identified 60.5%. The current criteria for offering aspirin treatment in Denmark largely correspond to having at least one NICE high-risk factor. In 2017, a total of 3.5% of deliveries had at least one NICE high-risk factor, which identified 28.4% of cases that later developed preterm PE., Conclusions: The incidence of preterm PE remained largely unchanged in Denmark from 2008 to 2017. Prediction of PE according to high-risk maternal factors could be improved by addition of moderate-risk factors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology., (© 2021 International Society of Ultrasound in Obstetrics and Gynecology.)

Objective: Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage., Design: Video review - observational study., Setting: A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark., Population: Obstetric teams managing real-life postpartum haemorrhage., Methods: We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 ml in the delivery room)., Results: Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P < 0.001), 0.2 versus 80% risk of a low clinical performance score (P < 0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P = 0.008). The results remained robust when adjusting for potential confounders such as bleeding velocity, aetiology, time of day, team size, and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem-solving, management of disruptive behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: the intraclass correlation was 0.97 (95% CI 0.96-0.98) for the non-technical score and 0.84 (95% CI 0.76-0.89) for the clinical performance score., Conclusion: Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes., Tweetable Abstract: Non-technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams., (© 2019 Royal College of Obstetricians and Gynaecologists.)

The aim of this commentary is to describe changes in women's care at an obstetric department that made it possible to reduce the number of beds from 40 to 29. Patient pathways were reviewed and revised using lean methodology. The mean length of stay was reduced from 70 to 59 h and the mean numbers of hospitalizations per woman from 1.26 to 1.20. At the organizational level, we introduced a Family Department, home management of newborns, home monitoring of the women with cardiotocography and blood samples, and intrapartum Group B Streptococcus-PCR. Additionally, an After Birth Clinic and network meetings for vulnerable women were established. In patient pathway, we reduced the hospitalization indicated by preterm premature rupture of membranes, preeclampsia and observation after birth laceration. According to National Patient Satisfaction surveys, there was no decrease in women's satisfaction after reducing the number of beds., (© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.)

Introduction: We aimed to examine whether cardiotocography (CTG) knowledge, interpretation skills and decision-making measured by a written assessment were associated with size of maternity unit, years of obstetric work experience and healthcare professional background., Material and Methods: A national cross-sectional study in the setting of a CTG teaching intervention involving all 24 maternity units in Denmark. Participants were midwives (n = 1260) and specialists (n = 269) and residents (n = 142) in obstetrics and gynecology who attended a 1-day CTG course and answered a 30-item multiple-choice question test. Associations between mean test score and work conditions were analyzed using multivariable robust regression, in which the three variables were mutually adjusted., Results: Participants from units with > 3000 deliveries/year scored higher on the test than participants from units with < 1000 deliveries/year (3000-3999 deliveries/year: mean difference 0.8, p < 0.0001; > 4000 deliveries/year: mean difference 0.5, p = 0.006). Participants with < 15 years of work experience scored higher than participants with > 15 years of experience (15-20 years of experience: mean difference - 0.6, p = 0.007; > 20 years experience: mean difference - 0.9, p < 0.0001). No differences were detected concerning professional background., Conclusions: CTG knowledge, interpretation skills and decision-making measured by a written assessment were positively associated with working in large maternity units and having < 15 years of obstetric work experience. This might indicate a challenge in maintaining CTG skills in small units and among experienced staff but could also reflect different levels of motivation, test familiarity and learning culture. Whether the findings are transferable to the clinical setting was not examined., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objective: To explore the association between clinical training characteristics and trainees' level of confidence in performing ultrasound scans independently., Methods: A cross-sectional e-survey was distributed to members of the national societies of junior obstetricians/gynecologists in Denmark, Sweden and Norway (n = 973). Multiple linear regression models were used to explore the effect that amount of time spent in specialized ultrasound units and clinical experience had on trainees' confidence in performing ultrasonography independently. Exploratory factor analysis was used to identify factors that contributed to trainees' confidence in performing ultrasonography. Trainees' ultrasound confidence was finally compared with their expected levels of performance., Results: Of the 682 respondents (response rate 70.1%), 621 met the inclusion criteria. Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently (P < 0.001). Trainees required more than 24 months of clinical experience and 12-24 days of training in specialized ultrasound units in order to feel confident about performing transvaginal and transabdominal ultrasound scans independently. Three factors were related to ultrasound confidence: technical aspects, image perception and integration of scan into patient care. There were significant differences between trainees' level of confidence and their expected levels of performance (P < 0.001)., Conclusions: Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently. Discrepancies between trainees' confidence and their expected levels of performance raised concerns about the adequacy of current ultrasound training programs., (Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.)

Background: Abuse in health care (AHC) has been associated with potential severe health consequences, and has further been related to maternal morbidity and mortality in childbirth. To improve our understanding of what qualifies as AHC and to support and optimise the health of women with these experiences, the objective of this study was to describe how women, who had previously endured AHC, gave meaning to and managed their experience during pregnancy, childbirth, and in the early postnatal period., Method: Women, who had reported substantial suffering as a result of a previous experience of abuse within the healthcare system, were purposefully selected from a Danish sample of a multinational cohort study on negative life events among pregnant women (the BIDENS Study). Eleven women were interviewed individually by means of a semi-structured interview guide. Transcripts of the interviews were analysed by means of qualitative systematic text condensation analysis., Results: Four categories were identified to describe the women's experience of AHC and its consequences on pregnancy and childbirth: abusive acts of unintentional harm, dehumanization, bodily remembrance, and finding the strength to move on. Abuse in health care may have profound consequences on the reproductive lives of the women, among others affecting sexuality, the desire to have children and the expectations of mode of delivery. However, the women described constructive ways to manage the experience, to which healthcare professionals could also contribute significantly., Conclusions: Regardless of whether AHC is experienced in childhood or adulthood, it can influence the lives of women during pregnancy and childbirth. By recognising the potential existence of AHC, healthcare professionals have a unique opportunity to support women who have experienced AHC.

From September 2010, all births in Denmark will be monitored from a quality perspective with the Danish National Indicator Project in order to document and develop the quality of the care provided during delivery. We describe the process of selecting the indicators based on relevance, scientific evidence, usefulness and applicability, acceptability and patient safety. Eight indicators were selected covering different aspects of delivery: anesthesia/pain relief; continuous support for women in the delivery room; lacerations, 3rd or 4th degree; acute cesarean section; post-partum hemorrhage; establishment of skin-to-skin contact between mother and newborn infant; severe fetal hypoxia; delivery of a healthy child after uncomplicated delivery. Registration will be mandatory for all delivery units in Denmark. Subsequently, the clinical units will receive feedback in the form of real-time monthly and quarterly standard reports including unadjusted results that may be used for the unit's own internal monitoring and development of quality., (© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.)

Using standard populations like "standard-primipara" (normal pregnancy, singleton term delivery and cephalic presentation) and "caesarean secundapara" (previous caesarean section and second birth) as the basis for interunit comparisons of maternity care will control for differences in casemix that may be seen at different units, thereby increasing the validity of comparisons. Focusing on clinically meaningful subsets of the population may have the additional benefit of clarifying the relationship between everyday clinical decision making, and the statistics from medical birth registration. Birth registry data from Rigshospitalet, Hvidovre Hospital and Herning Centralsygehus 1993-1994 have been used to illustrate the association between local quality improvement activities, on the one hand, and rates of interventions and foetal outcome in "standard-primipara" on the other.

Development og antenatal care and obstetrics in Denmark during the past decades has been carried out by distribution of advisory guiding principles from the Ministry of the Interior (Ministry of Health) and the Board of Health, most recently in 1985. On the basis of a review of the current problems in obstetrics, reassessment of the guiding principles is suggested, particularly development of obstetrics on the basis of well controlled assessments of new possibilities. As possibilities for improving the results of obstetrics, the problems concerning preconceptional examination, alternative methods, mini-centre arrangements, care of sick pregnant women in their own homes, employment of ultrasound and cardiotocography are described. Modern furnishing of maternity departments, improved midwifery and better cooperation between the staff groups involved are considered necessary to ensure that maternity care in Denmark can become even better than it is at present.

A perinatal audit of 109 neonatal deaths was carried out in three Danish counties (A, B and C) in order to investigate whether differences in the structure of antenatal care, delivery, and neonatal service had any influence on neonatal outcome and whether departure from generally accepted standards of satisfactory perinatal and neonatal care might have contributed to neonatal deaths. In the county (C) characterised by having no intensive neonatal care unit, significantly fewer liveborn infants with a gestational age of less than 28 weeks were reported to the Birth Register. County C had also significantly more potentially avoidable deaths compared with the county (B) which had a neonatal intensive care unit with specially trained staff available around the clock. The neonatal department in county A did not have specially trained doctors available in the hospital around the clock, and some cases of suboptimal care were caused by inadequate staffing and inappropriate decisions made by inexperienced junior doctors. The results indicate that it should be possible to improve the quality by having obstetric departments with access to neonatal intensive care units staffed with qualified personnel around the clock and by intensifying the postgraduate training of professionals performing peri- and neonatal care.