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Bakgrunn: I Norge utføres abort kun i offentlige sykehus. I 2010 besluttet Helse- og omsorgsdepartementet å iverksette et toårig prøveprosjekt som ga avtalespesialister i fødselshjelp og kvinnesykdommer adgang til å tilby medikamentell abort før utgangen av 9. svangerskapsuke. Prøveprosjektet ble igangsatt 1.3.2015 og varte til 31.3.2017. I denne artikkelen presenterer vi de første erfaringene, herunder hvordan behandlingstilbudet ble mottatt av kvinnene., Materiale Og Metode: Gravide med en svangerskapsvarighet < 63 dager ultrasonografisk vurdert, som oppsøkte avtalespesialist for medikamentell abort, ble fortløpende inkludert i prosjektet (n = 476). Kvinnene inntok 200 mg mifepriston peroralt på legekontoret, 36-48 timer senere satte de selv 800 µg misoprostol vaginalt hjemme. Informasjon ble innhentet ved spørreskjema på den første konsultasjonen, under aborten og ved etterkontrollen 2-4 uker etter aborten., Resultater: Under aborten rapporterte 66 % (296/450) moderat eller sterk smerte og 79 % (358/451) moderat eller sterk blødning. De fleste opplevde det som trygt å være hjemme. 96 % (390/406) ville valgt medikamentell abort hos avtalespesialist ved en eventuell senere abort, og 97 % (392/405) ville anbefalt behandlingstilbudet til andre i samme situasjon., Fortolkning: Kvinnene i studien opplevde abortbehandling hos avtalespesialist som trygt. Tilbudet gir større valgfrihet til gravide som ønsker abort, og pasientene er tilfredse.

Background: The Directorate of Health’s national guide Et trygt fødetilbud – kvalitetskrav til fødselsomsorgen [A safe maternity service – requirements regarding the quality of maternity care] was published in December 2010 and was intended to provide a basis for an improved and more predictable maternity service. This article presents data from the maternity institutions on compliance with the quality requirements, including information on selection, fetal monitoring, organisation, staffing and competencies., Material and Method: The information was acquired with the aid of an electronic questionnaire in the period January–May 2015. The form was sent by e-mail to the medical officer in charge at all maternity units in Norway as at 1 January 2015 (n=47)., Results: There was a 100 % response to the questionnaire. The criteria for selecting where pregnant women should give birth were stated to be in conformity with the quality requirements. Some maternity institutions failed to describe the areas of responsibilities of doctors and midwives (38.5 % and 15.4 %, respectively). Few institutions recorded whether the midwife was present with the patient during the active phase. Half of the maternity departments (level 2 birth units) reported unfilled doctors’ posts, and a third of the university hospitals/central hospitals (level 1 birth units) reported a severe shortage of locum midwives. Half of the level 2 birth units believed that the quality requirements had resulted in improved training, but reported only a limited degree of interdisciplinary or mandatory instruction., Interpretation: The study reveals that there are several areas in which the health enterprises have procedures that conform to national quality requirements, but where it is still unclear whether they are observed in practice. Areas for improvement relate to routines describing areas of responsibility, availability of personnel resources and staff training.

Background: Symphysis-fundus measurement is used in pregnancy care to detect poor fetal growth. Symphysis-fundus measurement curves (percentile curves) and prediction of fetuses with a birth weight below the10th percentile have been published previously. The percentile curves show the distribution of symphysis-fundus measurements in the reference population and are recommended as the national standard. This article discusses the predictive value of this method for identification of neonates who are small for gestational age (SGA)., Material and Method: This is a population-based registry study of pregnant women who gave birth at Sahlgrenska University Hospital in Gothenburg in the period 2005 – 2010. Diagnostic accuracy was analysed using ROC curves and presented with the area under the curve (AUC) from gestational week 24 to 42. Sensitivity, specificity, and positive and negative predictive value were calculated., Results: A total of 42 018 pregnant women carrying a single fetus were included. The AUC values showed that a symphysis-fundus measurement late in pregnancy was a stronger predictor for determining fetuses that are small for gestational age than a measurement early in pregnancy. The AUC value increased from 0.61 in week 24 to 0.74 in week 40. With a threshold value at the 10th percentile, symphysis-fundus measurement has a total sensitivity of 47 % and a specificity of 79 %. A positive total test was defined as at least one measurement below the 10th percentile curve in the course of the pregnancy., Interpretation: Symphysis-fundus measurement may be important for the identification of high-risk pregnancies, but should preferably be used in conjunction with other clinical variables.