Forventninger og holdninger til amming blant gravide : En kvalitativ studie

Background: Norway is known to have high rates of breastfeeding, and the majority of mothers breastfeed their infants. However, many mothers experience problems breastfeeding, and far from every mother breastfeed exclusively for the recommended first six months. The purpose of this study was to explore the variation of expectatives and attitudes towards breastfeeding among pregnant women. Methods: The study was qualitative. 9 pregnant women were included in the study, all recruited through a health care station in the north-east of Oslo. Semi-structured interviews were used. The interviews lasted between 25 and 45 minutes each, and were subsequently transcribed and analyzed. Results: The participants expressed a strong wish to breastfeed their infants, primarily because they considered it the healthiest option for the baby. Use of formula feeding to achieve better night-sleep from 3 months of age was seen as beneficial. Even though all participants were aware of the immunologic and nutritional advantages of breastmilk compared to formula milk, they still assumed formula would be a better option if the mother smoked or if she had an unhealthy diet. First-time mothers were surprised by questions about possible lactational problems, they mostly thought it would go naturally and by itself. Conclusions: There are a lot of important gaps and misinterpretations concerning breastfeeding, some of which endanger a prolonged and happy period of breastfeeding in new mothers. Information ante-partum emphasizing that lactational problems are common, and where to seek help, is crucial to ensure mothers receive guidance early enough to avoid disruption of lactation

Anal incontinence and unrecognized anal sphincter injuries after vaginal delivery- a cross-sectional study in Norway

Background: Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed. Methods: All women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark's incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography. Results: In total 52,3% (n = 207) of the 396 invited women participated in the study. Mean St. Mark's score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury. Conclusion: The prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark's incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment. Keywords: Anal incontinence; Obstetric anal sphincter injury; Obstetric care; Occult injury

Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter

Abstract Background Sphincteroplasty is one of the treatment options for anal incontinence following obstetric injury. The aim of the study was to evaluate the long-term efect of sphincteroplasty with separate suturing of the internal and the external anal sphincter on anal continence. Methods A retrospective study was conducted on women who had sphincteroplasty for treatment of anal incontinence following obstetric injury. Women operated between January 1, 2011 and December 31, 2014 at Sykehuset Innlandet Hospital Trust Hamar, were invited to answer a questionnaire and participate in a clinical examination, including endoanal sonography. Results 111 (86.7%) women participated. Median postoperative follow-up was 44.5 months, and 63.8% of the participants experienced an improvement of at least three points in the St. Mark’s incontinence score. Fecal urgency and daily fecal leakage persisted in 39.4% and 6.4% of the participants, respectively. The internal anal sphincter improvement persisted in 61.8% of the participants, and there was a median reduction of their St. Mark’s score of 6.0 points between the preoperative value and the value at long-term follow-up. There was no signifcant change in the St. Mark’s score of patients with persistent dehiscence of the internal anal sphincter. Conclusions Sphincteroplasty, with separate suturing of the internal sphincter resulted in continence for stool maintained for at least 3 years in the majority of the patients, while there was an improvement in continence in nearly two-thirds. Keywords Anal incontinence · Obstetric anal sphincter injury · Sphincter repai