Hysterectomy in Norway 2008-18. / Hysterektomi i Norge 2008­18.

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

Elective induction of labor: A prospective observational study.

The aim of the present study was to assess indications for induction and describe the characteristics and delivery outcome in medical compared to non-medical/elective inductions. During a three-month period, 1663 term inductions were registered in 24 delivery units in Norway. Inclusion criteria were singleton pregnancies with cephalic presentation at gestational age 37+0 and beyond. Indications, pre-induction Bishop scores, mode of delivery and adverse maternal and fetal outcomes were registered, and compared between the medically indicated and elective induction groups. Ten percent of the inductions were elective, and the four most common indications were maternal request (35%), a previous negative delivery experience or difficult obstetric history (19%), maternal fatigue/tiredness (17%) and anxiety (15%). Nearly half of these inductions were performed at 39+0-40+6 weeks. There were fewer nulliparous women in the elective compared to the medically indicated induction group, 16% vs. 52% (p<0.05). The cesarean section rate in the elective induction group was 14% and 17% in the medically indicated group (14% vs. 17%, OR = 0.8, 95% CI 0.5-1.3). We found that one in ten inductions in Norway is performed without a strict medical indication and 86% of these inductions resulted in vaginal delivery.

Changes in induction methods have not influenced cesarean section rates among women with induced labor.

INTRODUCTION: Induction of labor has become more common in most countries during the last decade. We have compared methods and routines of labor induction as practiced in Norway in 2003 and 2013, and surveyed practices with regard to induction of labor without a medical indication in 2013. MATERIAL AND METHODS: A telephone interview with all delivery units in Norway was conducted in 2003. Data on preferred induction methods, use of prostaglandin, dosages, dose intervals and routes of administration were collected. In 2013, the same questionnaire was used, with additional questions on induction of labor without a medical indication. Data on overall cesarean section and induction rates were obtained from the Medical Birth Registry of Norway. RESULTS: From 2003 to 2013 the induction rate increased by 62% and the cesarean section rate by 6%. The cesarean section rate in women with induced labor remained stable at 17.1 and 17.4%, respectively. In 2003, 31 of 43 hospitals used dinoprostone for cervical ripening and induction. In 2013, 34 of 39 hospitals used misoprostol. A cervical balloon was used in three of 43 hospitals in 2003 compared with 31 of 39 in 2013. All but one hospital induced labor without a strict medical indication in 2013. CONCLUSION: The preferred methods for induction of labor changed within a decade to the use of misoprostol and cervical balloon. Induction of labor without strict medical indications is widely practiced. The changed induction methods have not influenced the cesarean section rates in women with induced labors.

Cervical insulin-like growth factor binding protein-1 (IGFBP-1) to predict spontaneous onset of labor and induction to delivery interval in post-term pregnancy.

OBJECTIVE: To evaluate whether insulin-like growth factor binding protein-1 (IGFBP-1) assessed in cervical secretion can predict successful induction and spontaneous onset of labor in post-term pregnancy, compared to ultrasound measurement of cervical length and Bishop score. DESIGN: Cohort study, originating from a randomized controlled trial. SETTING: Obstetric department of a university and tertiary referral hospital, Norway. POPULATION: Five hundred and eight post-term women who had been randomized to induction of labor or expectant management 1 week beyond estimated day of delivery (289 [±2] days of gestation). METHODS: Time to delivery was related to presence of IGFBP-1 in cervical secretion, Bishop score and ultrasound measurement of cervical length recorded at inclusion. MAIN OUTCOME MEASURES: Spontaneous onset of labor and delivery within 3 days in the expectant management, and delivery within 24 hours of induction in the induction group. Test characteristics (sensitivity, specificity and negative and positive values and likelihood ratios) for IGFBP-1, Bishop score and cervical length were calculated. Logistic regression and Cox regression were used to account for parity and body mass index. RESULTS: With expectant management, IGFBP-1 predicted spontaneous labor onset and delivery within 72 hours with low sensitivity and high specificity (0.45 and 0.80, respectively), as did Bishop score (0.24, 0.92). Cervical length was more sensitive (0.67, 0.58). IGFBP-1 predicted successful induction within 24 hours with low sensitivity and high specificity (0.30, 0.85), such as Bishop score (0.06, 1.00) and cervical length (0.45, 0.76). Parity enhanced successful induction. CONCLUSION: IGFBP-1 predicts both spontaneous labor onset and successful induction in post-term pregnancy. Bishop score and cervical length performed equally well.