Introduction

The nine‐item list, with organizational and cultural changes, was implemented at the delivery unit in Linköping, Sweden between 2007 and 2010, aiming at improving the quality of care by offering more women a safe and attractive vaginal delivery. The target group for the intervention was nulliparous women at term with spontaneous onset of labor and cephalic presentation (Robson group 1). The aim of this study was to evaluate pregnancy outcomes before, during, early post and late post introduction of the nine‐item list.

Material and methods

Robson group 1 births (n = 12 763) from 2004 to 2018 were divided into four time periods; before the nine‐item list (2004‐2006), during introduction of the nine‐item list (2007‐2010), early post introduction of the nine‐item list (2011‐2014) and late post introduction of the nine‐item list (2015‐2018). The nine‐item list consists of monitoring of obstetric results, midwife coordinator, risk classification of women, three midwife‐competence levels, teamwork—the midwife, obstetrician and nurse working as a team with the common goal of a normal delivery, obstetric morning round, fetal monitoring skills and obstetric skills training. Perinatal outcomes before, during, early post and late post introduction were compared using a Student's t test for numerical variables and a Pearson chi‐squared test for categorical variables.

Results

Apgar score <7 at 5 minutes, Apgar score <4 at 5 minutes and umbilical cord arterial pH <7 did not differ significantly between the four time periods. Between before introduction and early post introduction, instrumental vaginal delivery decreased from 19.8% to 12.2% and cesarean section from 9.6% to 4.5%. The late post introduction period showed a maintained effect with 10.7% instrumental deliveries and 3.9% cesarean sections. Obstetric anal sphincter injury grade III decreased instantly during the introduction of the nine‐item list from 7.8% to 5.1% and thereafter remained unchanged.

Conclusions

Implementation of the nine‐item list increased the proportion of spontaneous vaginal deliveries by reducing the number of instrumental deliveries and cesarean sections without affecting the neonatal outcomes in nulliparous women with spontaneous onset of labor. The nine‐item list intervention seems to provide long‐term sustainable results.

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Robert Kochs upptäckt av Mycobacterium tuberculosis år 1882 var startpunkten till en ny tidsålder när det gäller behandling av tuberkulos. Snart lanserade han även tuberkulin som ett vaccin eller läkemedel mot tuberkolos. Hur reagerade svenska läkare på de nya rönen?

Although tuberculosis is often considered synonimous with pulmonary tuberculosis, approximately thierty percent of those afflicted suffered from non-pulmonary form that, if left untreated, were for the survivors, disfiguring and/or disabling. This paper deals with the developement of social policy and national legislation that were part of the attempt toconquer this form of Tb and thusprevent disabilities. 

This paper deals with the development of health legislation concerning various forms of tuberculosis in Sweden in the late 19th and early 20th centuries. It even sketches the kind of information that was disributed as one of the weapons in the struggle against tuberculosis. The question of why pulmonary tuberculosis received most attention is also discussed. Paramount are the relationships between the national and international organizations in the shaping of actions in Sweden. 

Artikeln behandlar mat och surrogatmat under hungerkriser i 1800-talets Sverige

This paper deals with the development of health legislation that was part of the fight against tuberculosis. It deals with not only the legislation passed, but even the changing political philosophies and scientific paradigms. Not least are the relationships between the national level and developments in the Nordic countries and other parts of Europe.

This paper seeks to explore the definitions of the concept of intersectionality, its use and the ways in which it has been adapted in the field of disability studies. Furthermore, it discusses the dimensions that the use of this concept may add to an analysis of the material in our study of the treatment of children and youths suffering from non-pulmonary tuberculous.