Missing departure of placenta after home birth – transfer to hospital etc. … – Board of Health

Exempt from public disclosure pursuant to offline a. § 13 cf. PAA. § 13 first paragraph. 1

Norwegian Board determines each year a significant number of supervisory issues facing healthcare professionals and businesses in the health service based on information on individual events. Some of these will be published on this website anonymously. The cases are intended as such matters for enterprises and personnel to benefit from them and to inform them about our business, and not as an aid to identification of individual cases and individual personnel.

The public demands for transparency in individual cases are handled through that anyone can request access to individual documents, based on publicly available mailing lists.

Norwegian Board of Health has decided to issue a warning pursuant to the Health § 56 first paragraph. We have determined that you have violated the acceptability requirements of the same Act § 4 in connection with a home birth the XXXXXX .

You can appeal the decision within three – 3 – weeks of receiving this letter.

Procedural process

Norwegian Board of Health received by letter dated XXXXXX from the County of XXXXXX sent a supervision about your business as a midwife. Audit case concerns your health care to XXXXXX (hereinafter the patient) when she gave birth at home the XXXXXX.

We oriented you by letter dated XXXXXX that we would consider giving you a warning. You stated you to this by letter dated XXXXXX.

Norwegian Board of Health has the resolution of currently imposed midwife XXXXXX a warning pursuant to the Health § 56 first paragraph of violating acceptability requirements of the same Act § 4.

We apologize for the long processing time.

the subject matter

You are a graduate of XXXXXX and became certified nurse the XXXXXX and midwife the XXXXXX. Your HPR – no. is XXXXXX. At the time of the incident had you pattern agreement with HELFO as privately practicing midwife registered sole proprietorships. You worked with a midwife XXXXXX.

Norwegian Board has considered the matter on the basis of the documents you’ve got submitted earlier in the proceedings. Below is a discussion of the factors that has been important for our assessment.

The patient, who was born XXXXXX, was a healthy first-time mothers with no special complications in pregnancy with forward XXXXXX. She was pregnant after IVF with a pregravid BMI of 28 and large symphysis-fundusmål during pregnancy. The patient had contacted you because she wanted a planned home birth, and you had agreed assistance during childbirth at home.

The XXXXXX kl. 18.05 she gave birth to a girl in her own home with midwifery from you and midwife XXXXXX. Placenta came not spontaneously after delivery of the child. The patient sat in fødekar during and after birth, and it is of note from the birth (written by midwife XXXXXX) that there was a small amount of blood equivalent to 100 ml of water at. 18.55. It is further stated that the patient ca. kl. 19.00 was asked to try to push out the placenta, without result. It was then inserted acupuncture needles, and the child was put to the breast to promote the disposal of the placenta.

Tl. 19.20 fainted patient in approximately one minute and she was then given a sugary drink. It appears that the patient was given 5 IU syntocinon i.m., and it was made controlled strokes in the umbilical cord. New dose syntocinon 5 IU was given at. 20.10.

Tl. 20.15 decided you to transfer the patient to the hospital. You have stated that the midwife XXXXXX first made six attempts to call inpatient phone pregnant before you contacted AMK center at. 20.25, when the patient got skinny pain and started bleeding. After this put you into same line and began i.v. liquid supply. In conversation with AMK was bleeding described alternately as “part” and “a little bit” . It was agreed hastetur with AMK (yellow response), and that you yourself should inform Kvinneklinikken on XXXXXX about admission.

The ambulance arrived at. 20.40, and the bleeding was when increasing and projected to 1200 to 1400 ml according ambulance journal. The patient was then circulatory influenced by pulse 140, respiration 18 to 26, BT 130/105 and pale / dank. The patient was in the upstairs and she syncopated when she was put up in a stretcher chair. The ambulance drove from home at. 21.06 and arrived at the hospital about kl. 21.15. The patient was on arrival at feed presjokkert without detectable blood pressure. It was immediately started væskeresucitering and made manual extraction of the placenta under anesthesia.

Statement dated XXXXXX to the County of XXXXXX

joint letter from you and midwife XXXXXX to the County of XXXXXX states among other things that you just before kl. 19.00 as signs that the placenta could be loose. It appears that acupuncture and urination slipped umbilical cord farther, and noon. 19.45 came membranes appear in the vaginal opening. Active printing, gently support the fundus and pull the umbilical cord was attempted unsuccessfully. It also appears that the fundus of the uterus all the way was monitored manually, that bleeding was observed continuously and that it was normal and sparse until. 20.20.

It further appears that you have undergone their own judgments and actions during the birth and that you criticize yourself for not having followed the recommendations in the guidelines for home birth Chapter 5.3. You said that the ambulance doctor in the car should have been called 60 minutes after the baby was born, although everything looked normal out at that time.

Statement from the patient and the baby’s father received XXXXXX

in a letter to the County Governor in XXXXXX, the patient and the child’s father stated that they had a nice birth, but it took too long before you went to XXXXXX hospital.

Your statement dated XXXXXX to Norwegian Board of Health

at home birth parts you on tasks by defining one as primary midwife and the other as secondary midwife. Primary Midwife leader birth and journal responsibility. Secondary Midwives provide practical help. It appears that you were secondary midwife during the actual birth.

You are of the opinion that an ambulance should have been called one hour after birth. In retrospect, that you ought to override your midwife colleague XXXXXX, and even taken the leadership of PM. 19:00. You write that you took over the lead from kl. 20.15. You are commenting that the Norwegian Board of Health has written that the bleeding was estimated at 1200-1400 ml, and points out that the journal is 1000-1200 ml. You stated that it was you who estimated the amount of bleeding and taking well to get an ambulance team to hurry up.

After questions from the Norwegian Board of Health, type the same line should have been at. 19:00 and that AMK should be summoned at once. Same line should have been at the latest. 19.20, when the patient fainted in connection with visits to the toilet. Moreover informs you that you always have with you syntocinon as nødmedikament, the event atoniblødning. You acknowledge that managing syntocinon as prophylaxis of bleeding before the placenta is delivered can cause uterine and cervixkramper obstructing placenta inside.

You state that you have clear procedures in that it is AMK 113 which should always be present complications and that procedure has been reviewed many times. You were therefore surprised when primary midwife had called inpatient phone Kvinneklinikken. At this time you had taken over leadership of the birth and stood by the patient, while primary midwife would provide transportation to the hospital.

Statement by midwife XXXXXX dated XXXXXX to the State Board of Health

midwife XXXXXX indicated that she chose to call Kvinneklinikken because it was scanty bleeding. She envisioned a quiet transfer, and she wanted to save time by making a phone call instead of two. According XXXXXX were you disagree on whether the placenta was loose but not passed cervix, or if it stuck to the uterine wall remains. She writes that the decision to stay home over this time and try all possible measures, was theirs and not the woman. XXXXXX has also commented that the amount of bleeding was estimated at 1000-1200 ml, not 1200 -1400 ml.

Legal basis for the assessment

The information in supervision by the case to assess whether you have acted contrary to the requirement of sound management in the Health § 4 in the first and second paragraph.

Below we list the relevant provision.

the Health § 4, first and second paragraph:

Health personnel shall conduct their work in accordance with the requirements to professional responsibility and diligent care that can be expected based on their qualifications, the nature of work and the situation in general.

Health professionals should abide by their professional qualifications, and shall obtain assistance or refer patients further where necessary and possible. If the patient needs dictate, the profession shall be by collaboration and cooperation with other qualified personnel. Health professionals have an obligation to participate in developing individual plans, when a patient or user is entitled to such a plan for patient and user Rights Act § 2-5.

The provision requires professional responsibility and caring help and to health professionals’ professional practice.

When assessing the contents of the acceptability requirements will Norwegian Board have regard to relevant administrative statements. Reference is made to the CMO Guideline for home birth (IS-2012).

What is prudent is decided after an assessment of each case, and how health workers ideally should have acted.

Norwegian Board of Health review

Norwegian Board has considered whether your health care to the patient after the child was born (after byrds time) was professionally acceptable.

in a home birth is not access to advanced monitoring or quick assistance by a doctor in the event needed. The decision on when a physician should be involved done by a midwife at the background of what is proper health care in the situation that exists. Soundness evaluation will be related to midwifery consensus, knowledge about the normal birth and general guidelines for selection by and under home birth.

The uterus is very blodrik in pregnancy, and the rejection of the placenta will guys who have supplied the placenta with blood described above. The closing of these guys are totally dependent on the uterine muscles to contract and squeeze the vessels so the bleeding stops. This usually happens naturally without complications during the first few minutes after child birth. At & lt; 5% last phase longer than 30 minutes and can take up to one hour.

There are various risk factors for unsatisfactory contraction. The placenta (in whole or in part) is still in the uterus is one of them. In case of disposal of the placenta after birth, it will be especially high risk of bleeding if parts of the placenta detaches without the whole placenta is loose and let them squeeze out. Initially can also bleeding lie behind the placenta or membranes and did not appear, when there is an partial solution. During the first 30 minutes, bleeding quantity may be insignificant, but from 30-60 minutes often increases the amount and suddenly sharply increasing bleeding by sessile placenta is a well known problem. Risk of damage to health and death is great by severe bleeding at birth. After Byrds Bleeding is a serious and potentially fatal condition, and 30% of maternal deaths worldwide are caused by this.

Good practice at extended under byrds phase is to observe the patient clinically, accompanied by bleeding amount, inform the patient about the situation the risks that exist and refer the patient to hospital for 60 minutes, or earlier if there is bleeding. Physiological measures to encourage after-mills by adding your child to your chest or give other breast stimulation can contribute to the placenta detaches. Midwives can provide an easy and controlled kite in the umbilical cord to see if the placenta is free, though unacknowledged, and possibly let the umbilical cord is drained of blood. Powerful features in the umbilical cord, massaging and manipulation of the uterus before the placenta is loose must be avoided as it can cause partial solution and thereby increased bleeding.

Norwegian hospitals it is customary to give mandatory oxytocin to enhance drug right after baby is born to reduce bleeding amount and to prevent pathological bleeding. This reduces the risk of a byrds bleeding and shortens etterbyrdfasen. In the national professional guidelines for home birth (IS-2012) recommended that “ woman gets information about uterine agent and that she can choose whether she wants what routine or refrain . “

If the placenta has not arrived within 60 minutes, it is likely that the woman needs further active assistance for it to loosen and bleeding risk is then great. In guideline IS-2012 stated the following: “It is recommended that the woman transferred to hospital after 60 minutes If the placenta does not come by itself. Transfer shall take place even if after byrds bleeding is normal. “

The baby was born at. 18.05 and one hour later the placenta still not arrived. You gave the patient acupuncture and child were added to the chest to stimulate contractions. Kl. 19.10 was patient followed to the toilet to urinate further morkakeløsnende measures. After the State Board of Health assessment, this measure should have been done earlier to support the physiological processes.

Good practice after an hour would have been to inform the patient about the situation, call the AMK and book transport on red response. Although it was not proven heavy bleeding at this time, the risk of sudden onset of bleeding with possible health large in the existing situation. Meanwhile, would you like risk prevention measures have prepared their departure and paved the way for the patient to be able to reside in the floor that end residence is located in while she waited for transport. In addition, should you have filed venous access.

Ca. kl. 19.30 fainted patient. It was then passed about 1.5 hours after birth without placenta resolution. Although there were only observed normal and sparse bleeding at this time, should you / your midwife have thought that the cause of fainting could result bleeding. Instead of giving the patient sweet drinks should you at the latest at this time called AMK and ordered transport on red response for transfer to the hospital and given patient venous access and hung up intravenous bag.

Ca. kl. 20.00 you had still not contacted AMK and commandeered transport. However, it was made controlled kite in umbilical cord and drug riestimulering. Drug riestimulering should not be used as steps to get the placenta away by prolonged etterbyrdstid. According to guidelines, the composition can be routinely as part of active approach to delivery of the placenta. The preparation is then right after the baby is born, such a practice by many hospital births. This will then usually shorten after third stage of labor and the amount of bleeding.

When the placenta is still not born after 60 minutes, there is a great likelihood that it sits so firmly that it must be scraped out. Syntocinon is perilous as measures in such a situation, as it can stimulate contraction which cause partial solution without placenta detaches completely and acknowledged, which can lead to severe bleeding. It should not be measures to get loosened one undescended placenta that is beyond 60 minutes at home birth. In such situations, patients should be sent to hospital. For patients in hospitals is this different, since any bleeding in a similar situation there can be handled quickly and efficiently.

We have noted the information that you and your colleague disagreed on whether the placenta was loose, but not passed cervix, or if it stuck to the uterine wall remains. In our opinion, it had no effect on the placenta was loose or not whether you should have made a transfer. The national guidelines suggest a transfer if the placenta is not reached after 60 minutes.

First kl. 20.15 was transferred to hospital decided. In a situation that prevailed there was urgent need for ambulances and AMK should have been contacted directly and commandeered transport with “red response”.

You have stated that you took the lead at. 20.15 and asked the primary midwife call an ambulance, while you were “bedside” patient. In our opinion would then have landscaped same line immediately. Same line, however, was filed first additional ten minutes later, and when your colleague.

Norwegian Board of Health finds an overall assessment that your health care to the patient after the child was born (after byrds time) was professionally irresponsible.

Assessment of whether you should be given a warning

Norwegian Board of Health finds that you have violated the Health § 4.

violations of Health Personnel provisions may we give warning pursuant to the Health § 56 which reads:

the board can issue a warning to healthcare professionals who intentionally or negligently violates obligations under this Act or regulations issued pursuant to it, if the breach of duty is suitable to endanger the safety of health and care services, to affix the patients and users with a substantial load or to substantially undermine confidence in healthcare or health and care services.

The board can give a warning to health care professionals who have demonstrated a behavior that is likely to significantly impair confidence in the profession.

Warning are individual decisions under the Public Administration.

To give warning is firstly a condition that you have acted negligently. In this assessment, the Norwegian Board of Health to decide whether you can be blamed. In the assessment, we could focus on whether you had alternatives of action in the current situation. You could summoned paramedics and prepared the patient for transfer to hospital earlier. Norwegian Board of Health finds on this basis that you acted negligently.

The second condition that must be met is that the act is likely to endanger the safety of health care services, apply patients or users a significant load or to substantially undermine confidence in healthcare or health and care services. It does not matter whether the action in the present case actually received such consequences.

In our assessment, the action likely to cause patients considerable load.

The main conditions to give you a warning pursuant to the Health § 56 first paragraph are fulfilled. The Board shall make a judgment on whether you should be given a warning. Such assessments are based on the purpose of giving warning that is responding to serious violations of the Health. The reaction will help to promote quality in health, patient safety and help prevent future breach of duty.

In our assessment, infringement of the Health so serious that it is necessary to respond with warning. We show that you have failed in a central area for a midwife who provides health care at home births, where there were clear guidelines and where the consequences of mistakes can be fatal.

Resolution

Norwegian Board provides pursuant to the Health § 56 first paragraph a warning for violation of the Act, § 4.

We will send information about the decision to Supervisory för care och care (IVO) in Sweden and National board of Health in Denmark, see attached copy.

you have the right to appeal this decision to the State board for Health Personnel, ref. the Health § 68. the deadline for appeals is three – 3 – weeks of receiving this letter. Read the attached information sheet with further information about the rules for appeal.

This should be sent to the Norwegian Board of Health. You must complain before eventually traveling litigation concerning the validity of the decision,. Administration § 27 b and the Health § 71.

Sincerely,

XXXXXX
XXXXXX

XXXXXX XXXXXX

The letter is approved electronically and sent therefore without signature

Attachments :
notification of the right to appeal administrative decisions
A copy of the message to the Supervisory för care och care (IVO) and National Board of Health

Cc:
County of XXXXXX
XXXXXX

Legal officer: XXXXXX
Health Academic coordinator: XXXXXX

Other letter on the matter

the decision on warning.

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Missing departure of placenta after home birth – transfer to hospital etc. … – Board of Health

Exempt from public disclosure pursuant to offline a. § 13 cf. PAA. § 13 first paragraph. 1

Norwegian Board determines each year a significant number of supervisory issues facing healthcare professionals and businesses in the health service based on information on individual events. Some of these will be published on this website anonymously. The cases are intended as such matters for enterprises and personnel to benefit from them and to inform them about our business, and not as an aid to identification of individual cases and individual personnel.

The public demands for transparency in individual cases are handled through that anyone can request access to individual documents, based on publicly available mailing lists.

Norwegian Board of Health has decided to issue a warning pursuant to the Health § 56 first paragraph. We have determined that you have violated the acceptability requirements of the same Act § 4 in connection with a home birth the XXXXXX .

You can appeal the decision within three – 3 – weeks of receiving this letter.

Procedural process

Norwegian Board of Health received by letter dated XXXXXX from the County of XXXXXX sent a supervision about your business as a midwife. Audit case concerns your health care to XXXXXX (hereinafter the patient) when she gave birth at home the XXXXXX.

We oriented you by letter dated XXXXXX that we would consider giving you a warning. You stated you to this by letter dated XXXXXX.

Norwegian Board of Health has the resolution of currently imposed midwife XXXXXX a warning pursuant to the Health § 56 first paragraph of violating acceptability requirements of the same Act § 4.

We apologize for the long processing time.

the subject matter

You are a graduate of XXXXXX and became certified nurse the XXXXXX and midwife the XXXXXX. Your HPR – no. is XXXXXX. At the time of the incident had you pattern agreement with HELFO as privately practicing midwife registered sole proprietorships. You worked with a midwife XXXXXX.

Norwegian Board has considered the matter on the basis of the documents you’ve got submitted earlier in the proceedings. Below is a discussion of the factors that has been important for our assessment.

The patient, who was born XXXXXX, was a healthy first-time mothers with no special complications in pregnancy with forward XXXXXX. She was pregnant after IVF with a pregravid BMI of 28 and large symphysis-fundusmål during pregnancy. The patient had contacted you because she wanted a planned home birth, and you had agreed assistance during childbirth at home.

The XXXXXX kl. 18.05 she gave birth to a girl in her own home with midwifery from you and midwife XXXXXX. Placenta came not spontaneously after delivery of the child. The patient sat in fødekar during and after birth, and it is of note from the birth (written by midwife XXXXXX) that there was a small amount of blood equivalent to 100 ml of water at. 18.55. It is further stated that the patient ca. kl. 19.00 was asked to try to push out the placenta, without result. It was then inserted acupuncture needles, and the child was put to the breast to promote the disposal of the placenta.

Tl. 19.20 fainted patient in approximately one minute and she was then given a sugary drink. It appears that the patient was given 5 IU syntocinon i.m., and it was made controlled strokes in the umbilical cord. New dose syntocinon 5 IU was given at. 20.10.

Tl. 20.15 decided you to transfer the patient to the hospital. You have stated that the midwife XXXXXX first made six attempts to call inpatient phone pregnant before you contacted AMK center at. 20.25, when the patient got skinny pain and started bleeding. After this put you into same line and began i.v. liquid supply. In conversation with AMK was bleeding described alternately as “part” and “a little bit” . It was agreed hastetur with AMK (yellow response), and that you yourself should inform Kvinneklinikken on XXXXXX about admission.

The ambulance arrived at. 20.40, and the bleeding was when increasing and projected to 1200 to 1400 ml according ambulance journal. The patient was then circulatory influenced by pulse 140, respiration 18 to 26, BT 130/105 and pale / dank. The patient was in the upstairs and she syncopated when she was put up in a stretcher chair. The ambulance drove from home at. 21.06 and arrived at the hospital about kl. 21.15. The patient was on arrival at feed presjokkert without detectable blood pressure. It was immediately started væskeresucitering and made manual extraction of the placenta under anesthesia.

Statement dated XXXXXX to the County of XXXXXX

joint letter from you and midwife XXXXXX to the County of XXXXXX states among other things that you just before kl. 19.00 as signs that the placenta could be loose. It appears that acupuncture and urination slipped umbilical cord farther, and noon. 19.45 came membranes appear in the vaginal opening. Active printing, gently support the fundus and pull the umbilical cord was attempted unsuccessfully. It also appears that the fundus of the uterus all the way was monitored manually, that bleeding was observed continuously and that it was normal and sparse until. 20.20.

It further appears that you have undergone their own judgments and actions during the birth and that you criticize yourself for not having followed the recommendations in the guidelines for home birth Chapter 5.3. You said that the ambulance doctor in the car should have been called 60 minutes after the baby was born, although everything looked normal out at that time.

Statement from the patient and the baby’s father received XXXXXX

in a letter to the County Governor in XXXXXX, the patient and the child’s father stated that they had a nice birth, but it took too long before you went to XXXXXX hospital.

Your statement dated XXXXXX to Norwegian Board of Health

at home birth parts you on tasks by defining one as primary midwife and the other as secondary midwife. Primary Midwife leader birth and journal responsibility. Secondary Midwives provide practical help. It appears that you were secondary midwife during the actual birth.

You are of the opinion that an ambulance should have been called one hour after birth. In retrospect, that you ought to override your midwife colleague XXXXXX, and even taken the leadership of PM. 19:00. You write that you took over the lead from kl. 20.15. You are commenting that the Norwegian Board of Health has written that the bleeding was estimated at 1200-1400 ml, and points out that the journal is 1000-1200 ml. You stated that it was you who estimated the amount of bleeding and taking well to get an ambulance team to hurry up.

After questions from the Norwegian Board of Health, type the same line should have been at. 19:00 and that AMK should be summoned at once. Same line should have been at the latest. 19.20, when the patient fainted in connection with visits to the toilet. Moreover informs you that you always have with you syntocinon as nødmedikament, the event atoniblødning. You acknowledge that managing syntocinon as prophylaxis of bleeding before the placenta is delivered can cause uterine and cervixkramper obstructing placenta inside.

You state that you have clear procedures in that it is AMK 113 which should always be present complications and that procedure has been reviewed many times. You were therefore surprised when primary midwife had called inpatient phone Kvinneklinikken. At this time you had taken over leadership of the birth and stood by the patient, while primary midwife would provide transportation to the hospital.

Statement by midwife XXXXXX dated XXXXXX to the State Board of Health

midwife XXXXXX indicated that she chose to call Kvinneklinikken because it was scanty bleeding. She envisioned a quiet transfer, and she wanted to save time by making a phone call instead of two. According XXXXXX were you disagree on whether the placenta was loose but not passed cervix, or if it stuck to the uterine wall remains. She writes that the decision to stay home over this time and try all possible measures, was theirs and not the woman. XXXXXX has also commented that the amount of bleeding was estimated at 1000-1200 ml, not 1200 -1400 ml.

Legal basis for the assessment

The information in supervision by the case to assess whether you have acted contrary to the requirement of sound management in the Health § 4 in the first and second paragraph.

Below we list the relevant provision.

the Health § 4, first and second paragraph:

Health personnel shall conduct their work in accordance with the requirements to professional responsibility and diligent care that can be expected based on their qualifications, the nature of work and the situation in general.

Health professionals should abide by their professional qualifications, and shall obtain assistance or refer patients further where necessary and possible. If the patient needs dictate, the profession shall be by collaboration and cooperation with other qualified personnel. Health professionals have an obligation to participate in developing individual plans, when a patient or user is entitled to such a plan for patient and user Rights Act § 2-5.

The provision requires professional responsibility and caring help and to health professionals’ professional practice.

When assessing the contents of the acceptability requirements will Norwegian Board have regard to relevant administrative statements. Reference is made to the CMO Guideline for home birth (IS-2012).

What is prudent is decided after an assessment of each case, and how health workers ideally should have acted.

Norwegian Board of Health review

Norwegian Board has considered whether your health care to the patient after the child was born (after byrds time) was professionally acceptable.

in a home birth is not access to advanced monitoring or quick assistance by a doctor in the event needed. The decision on when a physician should be involved done by a midwife at the background of what is proper health care in the situation that exists. Soundness evaluation will be related to midwifery consensus, knowledge about the normal birth and general guidelines for selection by and under home birth.

The uterus is very blodrik in pregnancy, and the rejection of the placenta will guys who have supplied the placenta with blood described above. The closing of these guys are totally dependent on the uterine muscles to contract and squeeze the vessels so the bleeding stops. This usually happens naturally without complications during the first few minutes after child birth. At & lt; 5% last phase longer than 30 minutes and can take up to one hour.

There are various risk factors for unsatisfactory contraction. The placenta (in whole or in part) is still in the uterus is one of them. In case of disposal of the placenta after birth, it will be especially high risk of bleeding if parts of the placenta detaches without the whole placenta is loose and let them squeeze out. Initially can also bleeding lie behind the placenta or membranes and did not appear, when there is an partial solution. During the first 30 minutes, bleeding quantity may be insignificant, but from 30-60 minutes often increases the amount and suddenly sharply increasing bleeding by sessile placenta is a well known problem. Risk of damage to health and death is great by severe bleeding at birth. After Byrds Bleeding is a serious and potentially fatal condition, and 30% of maternal deaths worldwide are caused by this.

Good practice at extended under byrds phase is to observe the patient clinically, accompanied by bleeding amount, inform the patient about the situation the risks that exist and refer the patient to hospital for 60 minutes, or earlier if there is bleeding. Physiological measures to encourage after-mills by adding your child to your chest or give other breast stimulation can contribute to the placenta detaches. Midwives can provide an easy and controlled kite in the umbilical cord to see if the placenta is free, though unacknowledged, and possibly let the umbilical cord is drained of blood. Powerful features in the umbilical cord, massaging and manipulation of the uterus before the placenta is loose must be avoided as it can cause partial solution and thereby increased bleeding.

Norwegian hospitals it is customary to give mandatory oxytocin to enhance drug right after baby is born to reduce bleeding amount and to prevent pathological bleeding. This reduces the risk of a byrds bleeding and shortens etterbyrdfasen. In the national professional guidelines for home birth (IS-2012) recommended that “ woman gets information about uterine agent and that she can choose whether she wants what routine or refrain . “

If the placenta has not arrived within 60 minutes, it is likely that the woman needs further active assistance for it to loosen and bleeding risk is then great. In guideline IS-2012 stated the following: “It is recommended that the woman transferred to hospital after 60 minutes If the placenta does not come by itself. Transfer shall take place even if after byrds bleeding is normal. “

The baby was born at. 18.05 and one hour later the placenta still not arrived. You gave the patient acupuncture and child were added to the chest to stimulate contractions. Kl. 19.10 was patient followed to the toilet to urinate further morkakeløsnende measures. After the State Board of Health assessment, this measure should have been done earlier to support the physiological processes.

Good practice after an hour would have been to inform the patient about the situation, call the AMK and book transport on red response. Although it was not proven heavy bleeding at this time, the risk of sudden onset of bleeding with possible health large in the existing situation. Meanwhile, would you like risk prevention measures have prepared their departure and paved the way for the patient to be able to reside in the floor that end residence is located in while she waited for transport. In addition, should you have filed venous access.

Ca. kl. 19.30 fainted patient. It was then passed about 1.5 hours after birth without placenta resolution. Although there were only observed normal and sparse bleeding at this time, should you / your midwife have thought that the cause of fainting could result bleeding. Instead of giving the patient sweet drinks should you at the latest at this time called AMK and ordered transport on red response for transfer to the hospital and given patient venous access and hung up intravenous bag.

Ca. kl. 20.00 you had still not contacted AMK and commandeered transport. However, it was made controlled kite in umbilical cord and drug riestimulering. Drug riestimulering should not be used as steps to get the placenta away by prolonged etterbyrdstid. According to guidelines, the composition can be routinely as part of active approach to delivery of the placenta. The preparation is then right after the baby is born, such a practice by many hospital births. This will then usually shorten after third stage of labor and the amount of bleeding.

When the placenta is still not born after 60 minutes, there is a great likelihood that it sits so firmly that it must be scraped out. Syntocinon is perilous as measures in such a situation, as it can stimulate contraction which cause partial solution without placenta detaches completely and acknowledged, which can lead to severe bleeding. It should not be measures to get loosened one undescended placenta that is beyond 60 minutes at home birth. In such situations, patients should be sent to hospital. For patients in hospitals is this different, since any bleeding in a similar situation there can be handled quickly and efficiently.

We have noted the information that you and your colleague disagreed on whether the placenta was loose, but not passed cervix, or if it stuck to the uterine wall remains. In our opinion, it had no effect on the placenta was loose or not whether you should have made a transfer. The national guidelines suggest a transfer if the placenta is not reached after 60 minutes.

First kl. 20.15 was transferred to hospital decided. In a situation that prevailed there was urgent need for ambulances and AMK should have been contacted directly and commandeered transport with “red response”.

You have stated that you took the lead at. 20.15 and asked the primary midwife call an ambulance, while you were “bedside” patient. In our opinion would then have landscaped same line immediately. Same line, however, was filed first additional ten minutes later, and when your colleague.

Norwegian Board of Health finds an overall assessment that your health care to the patient after the child was born (after byrds time) was professionally irresponsible.

Assessment of whether you should be given a warning

Norwegian Board of Health finds that you have violated the Health § 4.

violations of Health Personnel provisions may we give warning pursuant to the Health § 56 which reads:

the board can issue a warning to healthcare professionals who intentionally or negligently violates obligations under this Act or regulations issued pursuant to it, if the breach of duty is suitable to endanger the safety of health and care services, to affix the patients and users with a substantial load or to substantially undermine confidence in healthcare or health and care services.

The board can give a warning to health care professionals who have demonstrated a behavior that is likely to significantly impair confidence in the profession.

Warning are individual decisions under the Public Administration.

To give warning is firstly a condition that you have acted negligently. In this assessment, the Norwegian Board of Health to decide whether you can be blamed. In the assessment, we could focus on whether you had alternatives of action in the current situation. You could summoned paramedics and prepared the patient for transfer to hospital earlier. Norwegian Board of Health finds on this basis that you acted negligently.

The second condition that must be met is that the act is likely to endanger the safety of health care services, apply patients or users a significant load or to substantially undermine confidence in healthcare or health and care services. It does not matter whether the action in the present case actually received such consequences.

In our assessment, the action likely to cause patients considerable load.

The main conditions to give you a warning pursuant to the Health § 56 first paragraph are fulfilled. The Board shall make a judgment on whether you should be given a warning. Such assessments are based on the purpose of giving warning that is responding to serious violations of the Health. The reaction will help to promote quality in health, patient safety and help prevent future breach of duty.

In our assessment, infringement of the Health so serious that it is necessary to respond with warning. We show that you have failed in a central area for a midwife who provides health care at home births, where there were clear guidelines and where the consequences of mistakes can be fatal.

Resolution

Norwegian Board provides pursuant to the Health § 56 first paragraph a warning for violation of the Act, § 4.

We will send information about the decision to Supervisory för care och care (IVO) in Sweden and National board of Health in Denmark, see attached copy.

you have the right to appeal this decision to the State board for Health Personnel, ref. the Health § 68. the deadline for appeals is three – 3 – weeks of receiving this letter. Read the attached information sheet with further information about the rules for appeal.

This should be sent to the Norwegian Board of Health. You must complain before eventually traveling litigation concerning the validity of the decision,. Administration § 27 b and the Health § 71.

Sincerely,

XXXXXX
XXXXXX

XXXXXX XXXXXX

The letter is approved electronically and sent therefore without signature

Attachments :
notification of the right to appeal administrative decisions
A copy of the message to the Supervisory för care och care (IVO) and National Board of Health

Cc:
County of XXXXXX
XXXXXX

Legal officer: XXXXXX
Health Academic coordinator: XXXXXX

Other letter on the matter

the decision on warning.

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You are here: Home> …> Missing departure of placenta after home birth … – Board of Health

Exempt from public disclosure pursuant to offline a. § 13 cf. PAA. § 13 first paragraph. 1

Norwegian Board determines each year a significant number of supervisory issues facing healthcare professionals and businesses in the health service based on information on individual events. Some of these will be published on this website anonymously. The cases are intended as such matters for enterprises and personnel to benefit from them and to inform them about our business, and not as an aid to identification of individual cases and individual personnel.

The public demands for transparency in individual cases are handled through that anyone can request access to individual documents, based on publicly available mailing lists.

Norwegian Board of Health has decided to issue a warning pursuant to the Health § 56 first paragraph. We have determined that you have violated the acceptability requirements of the same Act § 4 in connection with a home birth the XXXXXX .

You can appeal the decision within three – 3 – weeks of receiving this letter.

Procedural process

Norwegian Board of Health received the letter from the County XXXXXX XXXXXX in submitted a supervision about your business as a midwife. Audit case concerns your midwife and XXXXXXs health care to XXXXXX (hereinafter the patient) when she gave birth at home the XXXXXX.

We oriented you by letter XXXXXX that we would consider giving you a warning. You stated you to this by letter dated XXXXXX.

Norwegian Board of Health has the resolution of currently imposed midwife XXXXXX a warning pursuant to the Health § 56 first paragraph of violating acceptability requirements of the same Act § 4.

We apologize for the long processing time.

the subject matter

You are a graduate of XXXXXX and became certified nurse the XXXXXX and midwife the XXXXXX, HPR no. XXXXXX. At the time of the incident had you pattern agreement with HELF0 as privately practicing midwife registered sole proprietorships. You worked with a midwife XXXXXX.

Norwegian Board has considered the matter on the basis of the documents you’ve got submitted earlier in the proceedings. Below is a discussion of the factors that has been important for our assessment.

The patient, who was born XXXXXX, was a healthy first-time mothers with no special complications in pregnancy with forward XXXXXX. She was pregnant after IVF with a pregravid BMI of 28 and large symphysis-fundusmål during pregnancy. The patient had contacted you because she wanted a planned home birth, and you had agreed assistance during childbirth at home.

The XXXXXX kl. 18.05 she gave birth to a girl in her own home with midwifery from you and midwife XXXXXX. You were primary midwife during the actual birth.

Placenta came not spontaneously after delivery of the child. The patient sat in fødekar during and after birth, and stated in your note from birth that there was a small amount of blood equivalent to 100 ml of water at. 18.55. It is further stated that the patient ca. kl. 19.00 was asked to try to push out the placenta, without result. It was then inserted acupuncture needles, and the child was put to the breast to promote the disposal of the placenta.

Tl. 19.20 fainted patient in approximately one minute and she was then given a sugary drink. It appears that the patient was given 5 IU syntocinon i.m., and it was made controlled strokes in the umbilical cord. New dose syntocinon 5 IU was given at. 20.10.

Tl. 20.15 decided you to transfer the patient to the hospital. You made at least six attempts to call inpatient phone pregnant before you contacted AMK center at. 20.25, when the patient had abdominal pain and started bleeding. After this put you into same line and began i.v. liquid supply. In conversation with AMK was bleeding described alternately as “part” and “a little bit” . It was agreed hastetur with AMK (yellow response), and that you yourself should inform Kvinneklinikken on XXXXXX about admission.

The ambulance arrived at. 20.40, and the bleeding was when increasing and projected to 1200 to 1400 ml according ambulance journal. The patient was then circulatory influenced by pulse 140, respiration 18 to 26, BT 130/105 and pale / dank. The patient was in the upstairs and she syncopated when she was put up in a stretcher chair. The ambulance drove from home at. 21.06 and arrived at the hospital about kl. 21.15. The patient was on arrival at feed presjokkert without detectable blood pressure. It was immediately started væskeresucitering and made manual extraction of the placenta under anesthesia.

Statement dated XXXXXX to the County of XXXXXX

In the joint letter from you and midwife XXXXXX to County of XXXXXX states among other things that you just before kl. 19.00 as signs that the placenta could be loose. It appears that the umbilical cord slipped further forward after acupuncture and urination, and noon. 19.45 came membranes appear in the vaginal opening. Active printing, gently support the fundus and pull the umbilical cord was attempted unsuccessfully. It also appears that the fundus of the uterus all the way was monitored manually, that bleeding was observed continuously and that it was normal and sparse until. 20.20.

It further appears that you have undergone their own judgments and actions during the birth and that you criticize yourself for not having followed the recommendations in the guidelines for home birth Chapter 5.3. You said that the ambulance doctor in the car should have been called 60 minutes after the baby was born, although everything looked normal out at that time.

Statement from the patient and the baby’s father received XXXXXX

in a letter to the County Governor in XXXXXX, the patient and the child’s father stated that they had a nice birth, but it took too long before you went to XXXXXX hospital.

Your statement dated XXXXXX to the State Board of Health

you state that you chose to call Kvinneklinikken because it was scanty bleeding. You looked for a peaceful transfer, and you wanted to save time by taking a single call instead of two. According to you were you disagree on whether the placenta was loose but not passed cervix, or if it stuck to the uterine wall remains. You write that the decision to stay home over this time and try all possible measures, was theirs and not the woman. Same line was added at approx. 20:30. You see in retrospect that you should ask your colleague to add same line while you contacted the Women’s Clinic. You also commented that the amount of bleeding was estimated at 1000-1200 ml, not 1200-1400 ml. You tell that syntocinon should have been set at an earlier date.

Statement by midwife XXXXXX dated XXXXXX to the State Board of Health

at home birth parts you on tasks by defining one as primary midwife and the other as secondary midwife. Primary Midwife leader birth and journal responsibility. Secondary Midwives provide practical help.

XXXXXX is of the opinion that an ambulance should have been called one hour after birth.

She writes that same line should have been at. 19:00 and that AMK should be summoned at once. Same line should have been at the latest. 19.20, when the patient fainted in connection with lavatory. XXXXXX acknowledges that managing syntocinon as prophylaxis of bleeding before the placenta is delivered can cause uterine and cervixkramper obstructing placenta inside.

XXXXXX says that you have clear procedures in that it is AMK 113 which should always be present complications, and she was therefore surprised when she became aware that you had called inpatient phone Kvinneklinikken.

Legal basis for the assessment

the information in supervision by the case to consider whether you have acted contrary with the requirement for proper business in the Health § 4 subsections.

Below we list the relevant provision.

the Health § 4 subsections:

Health personnel shall conduct their work in accordance with the requirements to professional responsibility and diligent care that can be expected based on their qualifications, the nature of work and the situation in general.

Health personnel shall act after their professional qualifications, and shall obtain assistance or refer patients further where necessary and possible. If the patient needs dictate, the profession shall be by collaboration and cooperation with other qualified personnel. Health professionals have an obligation to participate in developing individual plans, when a patient or user is entitled to such a plan for patient and user Rights Act § 2-5.

The provision requires professional responsibility and caring help and to health professionals’ professional practice.

When assessing the contents of the acceptability requirements will Norwegian Board have regard to relevant administrative statements. Reference is made to the CMO Guideline for home birth (IS-2012).

What is prudent is decided after an assessment of each case, and how health workers ideally should have acted.

Norwegian Board of Health review

Norwegian Board has considered whether your health care to the patient after the child was

born (after byrds time) was medically justifiable. We are initially to remark that it was you who was the primary midwife during the actual birth.

In a home birth is not access to advanced monitoring or quick means of a doctor if the need arises. The decision on when a physician should be involved done by a midwife at the background of what is proper health care in the situation that exists. Soundness evaluation will be related to midwifery consensus, knowledge about the normal birth and general guidelines for selection by and under home birth.

The uterus is very blodrik in pregnancy, and the rejection of the placenta will guys who have supplied the placenta with blood described above. The closing of these guys are totally dependent on the uterine muscles to contract and squeeze the vessels so the bleeding stops. This usually happens naturally without complications during the first few minutes after child birth. At & lt; 5% last phase longer than 30 minutes and can take up to one hour.

There are various risk factors for unsatisfactory contraction. The placenta (in whole or in part) is still in the uterus is one of them. In case of disposal of the placenta after birth, it will be especially high risk of bleeding if parts of the placenta detaches without the whole placenta is loose and let them squeeze out. Initially can also bleeding lie behind the placenta or membranes and did not appear, when there is an partial solution. During the first 30 minutes, bleeding quantity may be insignificant, but from 30-60 minutes often increases the amount and suddenly sharply increasing bleeding by sessile placenta is a well known problem. Risk of damage to health and death is great by severe bleeding at birth. After Byrds Bleeding is a serious and potentially fatal condition, and 30% of maternal deaths worldwide are caused by this.

Good practice at extended under byrds phase is to observe the patient clinically, accompanied by bleeding amount, inform the patient about the situation the risks that exist and refer the patient to hospital for 60 minutes, or earlier if there is bleeding. Physiological measures to encourage after-mills by adding your child to your chest or give other breast stimulation can contribute to the placenta detaches. Midwives can provide an easy and controlled kite in the umbilical cord to see if the placenta is free, though unacknowledged, and possibly let the umbilical cord is drained of blood. Powerful features in the umbilical cord, massaging and manipulation of the uterus before the placenta is loose must be avoided as it can cause partial solution and thereby increased bleeding.

Norwegian hospitals it is customary to give mandatory oxytocin to enhance drug right after baby is born to reduce bleeding amount and to prevent pathological bleeding. This reduces the risk of a byrds bleeding and shortens etterbyrdfasen. In the national professional guidelines for home birth (IS-2012) recommended that “ woman gets information about uterine agent and that she can choose whether she wants what routine or refrain . “

If the placenta has not arrived within 60 minutes, it is likely that the woman needs further active assistance for it to loosen and bleeding risk is then great. In guideline IS-2012 stated the following: “It is recommended that the woman transferred to hospital after 60 minutes If the placenta does not come by itself. Transfer shall take place even if after byrds bleeding is normal. “

The baby was born at. 18.05 and one hour later the placenta still not arrived. You gave the patient acupuncture and child were added to the chest to stimulate contractions. Kl. 19.10 was patient followed to the toilet to urinate further morkakeløsnende measures. After the State Board of Health assessment, this measure should have been done earlier to support the physiological processes.

Good practice after an hour would have been to inform the patient about the situation, call the AMK and book transport on red response. Although it was not proven heavy bleeding at this time, the risk of sudden onset of bleeding with possible health large in the existing situation. Meanwhile, would you like risk prevention measures have prepared their departure and paved the way for the patient to be able to reside in the floor that end residence is located in while she waited for transport. In addition, should you have filed venous access.

Ca. kl. 19.30 fainted patient. It was then passed about 1.5 hours after birth without placenta resolution. Although there were only observed normal and sparse bleeding at this time, should you / your midwife have thought that the cause of fainting could result bleeding. Instead of giving the patient sweet drinks should you at the latest at this time called AMK and ordered transport on red response for transfer to the hospital and given patient venous access and hung up intravenous bag.

Ca. kl. 20.00 you had still not contacted AMK and commandeered transport. However, it was made controlled kite in umbilical cord and drug riestimulering. Drug riestimulering should not be used as steps to get the placenta away by prolonged etterbyrdstid. According to guidelines, the composition can be routinely as part of active approach to delivery of the placenta. The preparation is then right after the baby is born, such a practice by many hospital births. This will then usually shorten after third stage of labor and the amount of bleeding.

When the placenta is still not born after 60 minutes, there is a great likelihood that it sits so firmly that it must be scraped out. Syntocinon is perilous as measures in such a situation, as it can stimulate contraction which cause partial solution without placenta detaches completely and acknowledged, which can lead to severe bleeding. It should not be measures to get loosened one undescended placenta that is beyond 60 minutes at home birth. In such situations, patients should be sent to hospital. For patients in hospitals is this different, since any bleeding in a similar situation there can be handled quickly and efficiently.

We have noted the information that you and your colleague disagreed on whether the placenta was loose, but not passed cervix, or if it stuck to the uterine wall

still. In our opinion, it had no effect on the placenta was loose or not whether you should have made a transfer. The national guidelines suggest a transfer if the placenta is not reached after 60 minutes. We have also noted that in your back meling dated XXXXXX shows lack of understanding of how serious and potentially dangerous condition is when the placenta still unacknowledged one hour after birth.

First kl. 20.15 was transferred to hospital decided. In a situation that prevailed there was urgent need for ambulances and AMK should have been contacted directly and commandeered transport with “red response”.

Norwegian Board of Health finds an overall assessment that your health care to the patient after the baby was born (after byrds time) was professionally irresponsible.

Assessment of whether you should be given a warning

Norwegian Board of Health finds that you have violated Health Personnel § 4.

violations of Health Personnel provisions we can give warning pursuant to the Health § 56 which reads:

the board can issue a warning to healthcare professionals who willfully or negligently violates obligations under this Act or regulations issued pursuant to it, if the breach of duty is liable to endanger the safety of health and care services, to affix the patients and users with a substantial load or to substantially undermine confidence in healthcare or health – and care service.

The board can give a warning to health care professionals who have demonstrated a behavior that is likely to significantly impair confidence in the profession.

Warning are individual decisions under the Public Administration.

To give warning is firstly a condition that you have acted negligently. In this assessment, the Norwegian Board of Health to decide whether you can be blamed. In the assessment, we could focus on whether you had alternatives of action in the current situation. You could summoned paramedics and prepared the patient for transfer to hospital earlier. Norwegian Board of Health finds on this basis that you acted negligently.

The second condition that must be met is that the act is likely to endanger the safety of health care services, apply patients or users a significant load or to substantially undermine confidence in healthcare or health and care services. It does not matter whether the action in the present case actually received such consequences.

In our assessment, the action likely to cause patients considerable load.

The main conditions to give you a warning pursuant to the Health § 56 first paragraph are fulfilled. The Board shall make a judgment on whether you should be given a warning. Such assessments are based on the purpose of giving warning that is responding to serious violations of the Health. The reaction will help to promote quality in health, patient safety and help prevent future breach of duty.

In our assessment, infringement of the Health so serious that it is necessary to respond with warning. We show that you have failed in a central area for a midwife who provides health care at home births, where there were clear guidelines and where the consequences of mistakes can be fatal.

Resolution

State Health provides pursuant to the Health § 56 first paragraph a warning for violation of the Act, § 4.

We will send information about the decision to Supervisory för care och care (IVO) in Sweden and National Board of Health in Denmark, see attached copy.

you have the right to appeal this decision to the State board for Health Personnel, ref. the Health § 68. the deadline for appeals is three – 3 – weeks of receiving this letter. Read the attached information sheet with further information about the rules for appeal.

This should be sent to the Norwegian Board of Health. You must complain before eventually traveling litigation concerning the validity of the decision,. Administration § 27 b and the Health § 71.

Sincerely,

XXXXXX
XXXXXX

XXXXXX XXXXXX

The letter is approved electronically and sent therefore without signature

Attachments :
notification of the right to appeal administrative decisions
A copy of the message to the Supervisory för care och care (IVO) and National Board of Health

Cc:
County of XXXXXX
XXXXXX

Legal officer: XXXXXX
Health Academic coordinator: XXXXXX

Other letter on the matter

the decision on warning.

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This year’s smartest mobile purchases? – Klikk.no

Kort sagt:

+ Pris

+ DAB+

+ Penn

+ Stor skjerm

- Litt slapp ytelse

- Uvant med betjeningsknapper på baksiden

Det er tre ting som gjør LGs nyeste smartmobil til et aktuelt mobilkjøp. Det første er at Stylus 2 er den første mobiltelefonen i Norge som også er utstyrt med en DAB+-mottager. Det betyr at du kan høre på radio stort sett over hele Norge. Dekningen på DAB skal nå være på nivå med FM-nettet. Forskjellen er at du nå minimum får inn tre NRK-kanaler, P1, P2 og P3, mens du på FM kunne oppleve kun å få inn P1.

Den andre grunnen som gjør Stylus 2 attraktiv er den store skjermen. Her får du nemlig en svært 5,7 tommers skjerm. Den tredje og siste argumentet for å velge Stylus 2 er at den er utstyrt med en penn, som blant annet kan brukes til å ta håndskrevne notater.

Les også: Et smart headset – eller bare rart? Sjekk ut hva Sony har laget her.

Radiomobilen

Om cirka åtte måneder starter FM-signalene sakte, men sikkert å forsvinne fra Norge. Det betyr at du som hører mye på radio må ha en DAB+-mottager.

Hjemme er ikke dette noen problem, siden de aller fleste av oss faktisk har tilgang til en digitalradio eller kan strømme radio via internett. Ute på tur er det litt verre. Her vil du enten måtte ha en bærbar DAB+-radio eller strømme radio via mobilen.

Her dukker det opp flere problemer. Utvalget av små og bærbare DAB+-radioer er ikke veldig stort og strømming via mobilen forutsetter at du faktisk har god og stabil dekning og at du på mobilen har et abonnement med stor nok datapakke til at du ikke går «tom» for data på grunn av radiolytting. I verste fall vil radiolyttingen på mobilen kunne koste deg en del kroner.

Les også: Så bra er HTC 10

Virker DAB+ på mobilen?

Ja, DAB+ på Stylus 2 fungerer helt greit. I testperioden lyttet vi til radio både på jobb, hjemme, i bil, på tog, på T-bane og mens vi var ute og gikk. Stort sett var radiolyttingen problemfri. I tunneler opplevde vi at forbindelsen brøt og at lyden ble dårlig. Med appen Radio.no var ikke dette et like stort problem, siden denne appen automatisk veksler til 4G (streaming) når den ikke får inn DAB+-signalene. Lydkvaliteten på radiosendingen vi lyttet til varierte noe. Alt fra veldig flat og platt lyd til «grei nok» radiolyd. Du skal med andre ord ikke forvente at Stylus 2 og DAB+ gir deg de helt store HiFi-opplevelsene.

Et tips til deg som ikke har DAB i bilen, så bør du kanskje vurdere om ikke Stylus 2 kan være en løsning. Vi koblet Stylus 2 til vår bil via Bluetooth med greit resultat. I løpet av neste år må du nemlig forholde deg til at du mister radioen i bilen din – om du da ikke alt har en DAB+-radio.

Fra TT Micro får vi også opplyst at de kommer med en egen bilholder med DAB-antenne til Stylus 2 i sommer, noe som vil kunne sikre gode mottaksforhold når du bruker DAB+ på Stylus 2 i bilen.

Stor skjerm og nyttig penn

LG Stylus 2 er en stor mobil med sin 5,7 tommers skjerm. Den er likevel ikke fysisk større enn for eksempel iPhone 6s Plus med 5,5 tommers skjerm. Oppløsningen på 1280 x 720 punkter fungerer greit, selv om vi etter hvert er begynt å bli bortskjemt med høyere oppløsning på så store skjermer.

Integrert i «mobilkroppen» til Stylus 2 har LG også fått plass til en «penn». Dette er bare en «dum» stylus – en «pekepinne» med andre ord. Men, når du henter fram pennen fra «parkeringsplassen», så spretter det opp en meny med noen praktiske hurtigvalg, som notat, ta et skjermbilde og en «skanner»-funksjon som er fin om du vil ta bilde av et dokument eller en kvittering. Pennen er kanskje ikke supernyttig, men fin om du liker å ta notater med håndskrift, drodle, tegne skisser, markere på dokumenter og så videre.

LG Stylus 2 har også knappene på baksiden, noe som er både litt rart og uvant i starten. Det største savnet her er imidlertid en fingeravtrykksleser, som kunne ha åpnet mobilen på en litt raskere måte enn å bruke kode.

Mellomklassemobil

Selv om LG Stylus 2 både ser og kjennes ut som en lekker mobil, så avslører ytelsestestene at det tross alt dreier seg om en ikke alt for kraftig mellomklassemobil. Vi må tilbake til vår test av Motorola Moto G3 for å finne en som ytelsesmessig tilsvarer LG Stylus 2. Det betyr ikke at Stylus 2 er en dårlig mobil, men her må du regne med at den av og til trenger å tenke seg om før den laster en app eller åpner en nettside. Vi opplevde dette ikke som et stort problem, men noe man bør være klar over om man er typen som laster ned alt av apper og spiller tunge spill.

Les også: Test av Beoplay A1

Ok kamera

Stylus 2 er utstyrt med to helt ok kamera. Hovedkameraet er et 13 megapiksels kamera, mens ansiktskameraet er på 8 megapiksel. Hovedkameraet tar helt greie bilder og vi synes faktisk resultatene ikke var så veldig langt bak de sammenlignbare bildene vi tok med iPhone 6s Plus.

Kamera-appen er også funksjonell med et par smarte løsninger. Her fungerer for eksempel hele skjermen som en utløserknapp og du kan bruke volumknappene bak på telefonen som utløserknapp.

Batterilevetiden på Stylus 2 er også god. Vi målte den til 10 timer og 27 minutter. Vi testet også om DAB+-lytting var mindre batterikrevende enn streaming via 4G. Resultatet vårt tilsa at ren DAB+ streaming ga cirka 44 prosent bedre batterikapasitet. I denne testen skrudde vi av både 4G og WiFi. I virkeligheten ville det nok ha stått på, slik resultatet ikke ville ha blitt så stort.

Disagree on China’s export numbers mean – Dagens Næringsliv

Kina

Publisert: 08.05.2016 — 10:55

Artikkelen er lagt til i din leseliste.

Kinas eksport sank i april med nesten 2 prosent målt i dollar, i forhold til samme måned året før, viser ferske tall fra kinesisk tolladministrasjon. Målt i den lokale valuten yuan, steg eksporten med 4,1 prosent, skriver Bloomberg News.

Importen sank mer enn det ekspertene hadde regnet med, med 11 prosent. Dermed har importen sunket hver eneste måned i 18 måneder på rad.

Ifølge NTB reflekterer den reduserte eksporten svak etterspørsel globalt, mens nedgangen i importen viser at den innenlandske etterspørselen også svikter. Begge deler viser at myndighetenes forsøk på å få fart på økonomien ikke lykkes, skriver nyhetsbyrået.

- Kinas eksport holdt seg positiv i april, men veksten er blåst opp av fallende valuta, skriver Bloomberg Intelligence-analytikerne Tom Orlik and Fielding Chen i et notat.

- Myndighetene vil sannsynligvis sitte på gjerdet før de bestemmer seg for ytterligere stimuli, fortsatte de.

Lausund have to pay 11 million in damages – Sunnmørsposten

Steinar Lausund and company FB AS is ordered to pay over 11 million to Your Living AS after the housing project Storfjord Allé was sold in 2012. Norconsult must pay 6.7 million because they vouched that the ground conditions were not preclude for planning permission.

Project: Storfjord Alle

it was in 2008 by Lausund purchased the undeveloped area on Wood Neset Alesund. At about 20 acres he planned to build townhouses, villas and flats for sale.

A total of 64 residential units, according to zoning.

Searched municipality

Via the holding company is Steinar Lausund (Chairman) together with his spouse owns all shares in FB Development (FBU).

In 2008, it submitted an application to Aalesund municipality to dig out of bog and replace it with rock masses. Busengdal Transport AS were engaged in the project.

In November, the municipality ready signal and permission for digging down to bedrock and mass replacement of 1 meter above the ground. It took lots of replacement throughout 2010 and the work ending in December was resumed in summer 2011.

doubted soil conditions

A clerk at the municipality expressed doubts as to whether the property was suitable for development because of excessive moisture in the ground.

Steinar Lausund discussed this with Busengdal, and the following was written to the presidency:

– We will debunk this assertion then we summer / fall of 2009 completed culvert trench from this area and even down to the next marshland. In this way, all water Depleted and we have replaced mass in substantially the entire area up to 6 meters high. The area will therefore perpetuity be a dry area with excellent qualities to build a residential neighborhood.

Basic interruption

A few days later it happened a reason violating property. Lausund explained in court that a smaller area where there had been mass replacement “daughter” one meter.

Lausund brought in a geotechnical assessment of ground conditions, and an expert was on inspection of Norconsult.

According Sunnmøre district Court was not expert unknown in the neighborhood.

a few years before, he had been involved in a shallow survey Norconsult had on the neighboring plot in west commissioned by Grønmyr kindergarten.

Myrlag

the expert wrote a note to the FBU that Norconsult after two inspections could ascertain that reason indeed been good along with the impression they had received for their own research on nursery site.

– the whole area was originally covered with a mighty myrlag which overlies a layer of clay with varying thickness. What that is under the clay layer, is not proven by Most Eins empty, but the kindergarten the lot we had indications that clay layer had a thickness of 2-5 meters with a thin layer of firmer masses just above the mountain.

Norconsult recommended control measurements. The results were worrisome, according to the judgment.

Sale construction project to Your Home

Ålesund municipality gave 2 July 2012 building permits for row of houses H (six linked houses) and row of houses G (four terraced houses) . Six new terraced houses received a building permit on December 3, 2012.

Construction work on G and H started in August 2012.

FBU and Lausund sold project Storfjord Alle to Your Living AS 20.6 million in November 2012.

in addition, paid Din Bolig AS roughly 7.5 million for costs incurred six homes.

News with the demolition of several houses

Closing Date was set for 1 December 2012. In september 2013 was row of houses H completed as frameworks.

20. September undertook Busengdal ramming ground right up to the houses. A few days later it was discovered large sentence damage to the two houses farthest north.

The situation was discussed and it was noted that the damage was so great that one could not rule out the demolition of several houses.

Your Living notified injury insurance . And eventually the company came with a claim against Lausund and FBU.

Lausund stated that they had dealt with the technical expertise and that Norconsult had “recovered” area. An expert from the insurance company was hired.

The conclusion was that the damage resulted sentence (see fact box) in building foundations. The insurance company rejected that Busengdal be held accountable.

fracture underground

Multiconsult was set to assess the damage. They concluded that the injuries had occurred as a consequence of the breach in the underground, most likely in stone embankment. The embankment was closed for almost heavy with too steep inclination.

Your Living AS ended up suing Busengdal, FB Development and Norconsult.

The reason sentence injuries were central during the trial. It was also revealed damage in spring 2015 at the foundations of houses F5 and F6 in the area.

According to the court was due to conditions in the area difficult. It will readily occur sentences by drainage channels out of the area.

– Thought he got the building site

Since clay layer is variable in thickness, so there may be skewed phrases pose challenges at homes.

the court concludes that the injuries during the first two houses are phrases in clay masses under stone embankment which the buildings stand on, possibly in combination with a smaller ground failure.

Sunnmøre District Court believes Din Bolig AS had reason to believe that they had bought a building site where the buildings could be put on compressed fillings when the sentences were done. As the case appeared to them, it was natural to conclude that subsidence measurements were performed as recommended in the paper of Norconsult.

Information Duty

Sunnmøre District Court refer to the information requirement for selling after dependent. Specifically, it means that the seller is responsible for ensuring that information is given to the buyer.

Sunnmøre District Court agrees with Your Home in the FBU be blamed for their failure to inform the development, and the need for several measurements Norconsult took up in 2011 and 12.

Lausund believed Norconsult had “recovered the area” but had claimed the verdict no explanation why Norconsult nevertheless recommended sentence measurements within an area that was “recovered” .

the court’s stance is that the FBU in Lausund acted with gross negligence when he was not informed about the “stated concerns relating to soil conditions”, it says in the judgment.

there is also recorded several basic violation of property in FBU’s ownership.

Norconsult judged because they faced authorities vouched that the ground conditions were not preclude that it could be granted building permission.

Lawyer Ole-Reinhart Notø assisted FB Development and Lausund in court. He tells Sunnmørsposten that it is too early to say whether they want to appeal the ruling.

– But it will not surprise me if that happens, says Notø.

Notø are aware that there were objections to the launching, when Lausund sold in 2012.

– at the time of sale, there was nothing wrong with the site, and Lausund acted in good faith, says Notø.

it had been him (sentences) two years earlier, but it had filled in and been promised that the sentences would decline. The building permit was issued, then the conditions for the problems ceased, believes Notø.

Six homes were listed, and there had been no problems around these. According to the lawyer is the core of the matter that Norconsult both had said that the sentences would decline, and that it was given the go-ahead.

– Lausund had no reason to believe that not things were okay.

– So who has not done his job here?

– If Norconsult was concerned problems with reason, then they should have said that “we give no declaration before it is made new measurements “. FBU has not acted wrongful believes Notø.

Disagree point

Lawyer Steffent Kvisler for Norconsult says that he has not yet been read the judgment carefully, but will come back to it.

Norconsult must pay 6.7 million in damages because they vouched that the ground conditions were not preclude a building permit.

– Norconsult disagrees with the judgment on that point. Further comments we have to come back to, say Kvisler.

FB AS have to pay 11 million in damages – Sunnmørsposten

Steinar Lausund and company FB AS is ordered to pay over 11 million to Your Living AS after the housing project Storfjord Allé was sold in 2012. Norconsult must pay 6.7 million because they vouched that the ground conditions were not preclude for planning permission.

Project: Storfjord Alle

it was in 2008 by Lausund purchased the undeveloped area on Wood Neset Alesund. At about 20 acres he planned to build townhouses, villas and flats for sale.

A total of 64 residential units, according to zoning.

Searched municipality

Via the holding company is Steinar Lausund (Chairman) together with his spouse owns all shares in FB Development (FBU).

In 2008, it submitted an application to Aalesund municipality to dig out of bog and replace it with rock masses. Busengdal Transport AS were engaged in the project.

In November, the municipality ready signal and permission for digging down to bedrock and mass replacement of 1 meter above the ground. It took lots of replacement throughout 2010 and the work ending in December was resumed in summer 2011.

doubted soil conditions

A clerk at the municipality expressed doubts as to whether the property was suitable for development because of excessive moisture in the ground.

Steinar Lausund discussed this with Busengdal, and the following was written to the presidency:

– We will debunk this assertion then we summer / fall of 2009 completed culvert trench from this area and even down to the next marshland. In this way, all water Depleted and we have replaced mass in substantially the entire area up to 6 meters high. The area will therefore perpetuity be a dry area with excellent qualities to build a residential neighborhood.

Basic interruption

A few days later it happened a reason violating property. Lausund explained in court that a smaller area where there had been mass replacement “daughter” one meter.

Lausund brought in a geotechnical assessment of ground conditions, and an expert was on inspection of Norconsult.

According Sunnmøre district Court was not expert unknown in the neighborhood.

a few years before, he had been involved in a shallow survey Norconsult had on the neighboring plot in west commissioned by Grønmyr kindergarten.

Myrlag

the expert wrote a note to the FBU that Norconsult after two inspections could ascertain that reason indeed been good along with the impression they had received for their own research on nursery site.

– the whole area was originally covered with a mighty myrlag which overlies a layer of clay with varying thickness. What that is under the clay layer, is not proven by Most Eins empty, but the kindergarten the lot we had indications that clay layer had a thickness of 2-5 meters with a thin layer of firmer masses just above the mountain.

Norconsult recommended control measurements. The results were worrisome, according to the judgment.

Sale construction project to Your Home

Ålesund municipality gave 2 July 2012 building permits for row of houses H (six linked houses) and row of houses G (four terraced houses) . Six new terraced houses received a building permit on December 3, 2012.

Construction work on G and H started in August 2012.

FBU and Lausund sold project Storfjord Alle to Your Living AS 20.6 million in November 2012.

in addition, paid Din Bolig AS roughly 7.5 million for costs incurred six homes.

News with the demolition of several houses

Closing Date was set for 1 December 2012. In september 2013 was row of houses H completed as frameworks.

20. September undertook Busengdal ramming ground right up to the houses. A few days later it was discovered large sentence damage to the two houses farthest north.

The situation was discussed and it was noted that the damage was so great that one could not rule out the demolition of several houses.

Your Living notified injury insurance . And eventually the company came with a claim against Lausund and FBU.

Lausund stated that they had dealt with the technical expertise and that Norconsult had “recovered” area. An expert from the insurance company was hired.

The conclusion was that the damage resulted sentence (see fact box) in building foundations. The insurance company rejected that Busengdal be held accountable.

fracture underground

Multiconsult was set to assess the damage. They concluded that the injuries had occurred as a consequence of the breach in the underground, most likely in stone embankment. The embankment was closed for almost heavy with too steep inclination.

Your Living AS ended up suing Busengdal, FB Development and Norconsult.

The reason sentence injuries were central during the trial. It was also revealed damage in spring 2015 at the foundations of houses F5 and F6 in the area.

According to the court was due to conditions in the area difficult. It will readily occur sentences by drainage channels out of the area.

– Thought he got the building site

Since clay layer is variable in thickness, so there may be skewed phrases pose challenges at homes.

the court concludes that the injuries during the first two houses are phrases in clay masses under stone embankment which the buildings stand on, possibly in combination with a smaller ground failure.

Sunnmøre District Court believes Din Bolig AS had reason to believe that they had bought a building site where the buildings could be put on compressed fillings when the sentences were done. As the case appeared to them, it was natural to conclude that subsidence measurements were performed as recommended in the paper of Norconsult.

Information Duty

Sunnmøre District Court refer to the information requirement for selling after dependent. Specifically, it means that the seller is responsible for ensuring that information is given to the buyer.

Sunnmøre District Court agrees with Your Home in the FBU be blamed for their failure to inform the development, and the need for several measurements Norconsult took up in 2011 and 12.

Lausund believed Norconsult had “recovered the area” but had claimed the verdict no explanation why Norconsult nevertheless recommended sentence measurements within an area that was “recovered” .

the court’s stance is that the FBU in Lausund acted with gross negligence when he was not informed about the “stated concerns relating to soil conditions”, it says in the judgment.

there is also recorded several basic violation of property in FBU’s ownership.

Norconsult judged because they faced authorities vouched that the ground conditions were not preclude that it could be granted building permission.

Lawyer Ole-Reinhart Notø assisted FB Development and Lausund in court. He tells Sunnmørsposten that it is too early to say whether they want to appeal the ruling.

– But it will not surprise me if that happens, says Notø.

Notø are aware that there were objections to the launching, when Lausund sold in 2012.

– at the time of sale, there was nothing wrong with the site, and Lausund acted in good faith, says Notø.

it had been him (sentences) two years earlier, but it had filled in and been promised that the sentences would decline. The building permit was issued, then the conditions for the problems ceased, believes Notø.

Six homes were listed, and there had been no problems around these. According to the lawyer is the core of the matter that Norconsult both had said that the sentences would decline, and that it was given the go-ahead.

– Lausund had no reason to believe that not things were okay.

– So who has not done his job here?

– If Norconsult was concerned problems with reason, then they should have said that “we give no declaration before it is made new measurements “. FBU has not acted wrongful believes Notø.

Disagree point

Lawyer Steffent Kvisler for Norconsult says that he has not yet been read the judgment carefully, but will come back to it.

Norconsult must pay 6.7 million in damages because they vouched that the ground conditions were not preclude a building permit.

– Norconsult disagrees with the judgment on that point. Further comments we have to come back to, say Kvisler.

Corruption Accusations, newspaper controversy and a protest resignation of Freedom Committee – journalist

Leif Steinholt is a journalist in Helgelands Blad and has been a member of the Press Freedom of choice since 2010. Last week, he chose to resign in protest. He raises critical questions about the committee’s rebuke of “systematic unfair and unfounded delaying tactics and access denial” in Alstahaug municipality in Nordland.

The local controversy involves suspicions of corruption in connection with a disputed hotel project in the municipal center Sandnessjøen where Helgelands Sheet located.

In the neighboring town of Mosjoen published competitor Helgelenders. It was this newspaper, and especially journalist Jill Mari Erichsen , which put a critical spotlight on hotels matter. The concerns that the mayor of Alstadhaug municipality signed an agreement for a new hotel building that should have given one developer major benefits.

Freedom Committee, which is run under the auspices of the Norwegian Press Association, used the case as an example of the government sabotages transparency. You can read more about Hotel matter in the sample collection of examples from last fall (p. 11-13).

Called coverage media scandal

Steinholt’s longstanding leader of Helgeland and Salten Journalists and has also been deputy to the Norwegian Union of Journalist National Board. His own newspaper and Helgelenders went slaughter each other in their coverage of the hotel project.

Helgelands Blad thinks there was evidence of some of the accusations of corruption. Editorialized March 2, 2015 came the newspaper with this power salvo against competitor:

“journalism practiced by Helgelenders in this case represents a low point, as the editors of the newspaper still chooses to remain thick and thin with. Until any new information brought forward in public, we regard the whole affair as a media scandal. “

Erichsen about Steinholt: Went behind my back

the local controversy also led to Helgelands Blad was fouled in the Press Council. In light of the harsh accusations in the same leader believed PFU that the complainant, a real estate investor who is closely related to actors in the hotel case, should have been published a response.

Therefore leaving Steinholt selection

in its decision to withdraw from the Press Freedom selection shows Steinholt why he did not report manufacture of hotel matter to vote with their own knowledge of the case.

“Without going into detail, I believe that the arrived gave reason to question how the report describes several facts. I also questioned the evidence base for the crisp description of Alstahaug municipality management. “

The journalist was given access to Stein Holts resignation last week.

You can read it in its entirety here .

Last December 2015 sent Steinholt a six-page memo to committee chair Siri Gedde-Dahl about what he had found out about the case. He writes that she asked him to prepare a new and shorter note which concentrated on two aspects: Transparency The process and the alleged disclosure of a cooperation agreement between the Scandic Seven Sisters and Alstahaug municipality.

“These would be sent Helgelenders journalist and the county governor of Nordland for contradiction. The process I experienced further was, from my standpoint, a strange affair, “writes Steinholt.

Felt suspicion

Steinholt sent new requests for public disclosure committee in February and March this year. The committee decided to close the case and stated that their report stands up well. In sum believes Steinholt that his questions and objections have not been commented on adequately from the committee leadership and management of the Norwegian Press Association.

“In addition, I felt a general suspicion of my motive. If any of the committee is not sitting on significant information which I have not been informed, it is impossible for me to understand that so categorically rejects nuance anything in the report. “

Steinholt claims that he has received negative reactions that he went into the matter, and that several have questioned what is his real motive. He confirmed that he was critical of parts of the competitor Helgelenders coverage, but that the topic for him is how a case is presented in a report by the Freedom Committee.

With a certain reluctance

He said he was also accused of having gone behind the backs of a colleague and behaved ukollegialt.

“I realize it is special that a journalist verify a case documents that include another journalist transparency complaints. I’ve done that with a certain reluctance, since I have seen for myself that it would be able to get negative reactions. Yet, I am of the opinion that journalists are people with power, partly because we can set the agenda for public debate, and that we therefore have to withstand a scrutinizing eye. “

Steinholt also clarifies that he does not have interest in being the municipality’s lawyer, and that he has never claimed that it has everything its on dry ground.

– Feels impossible

he believes that if this had been about a great and heavy rikssak covered by Aftenposten or VG – and not a cause very few have heard of in the provinces somewhere – would things have been different.

“no matter – as this has evolved, it feels impossible for me to join the Freedom Committee further “, concludes the journalist in Helgeland Sheet.

Only focus on transparency

Geddes-Dahl explains that the Committee perceives that the incident in Helgelenders has great social significance. The Committee obtained the history of Helgelenders journalist, sent her version of the municipality’s administrative management and asked for feedback from those who were criticized.

– This was not the substance of the case, but if it had been difficult to access. We adjusted the text somewhat after input from the Mayor of the municipality, and we restored his views where there was strong disagreement between the journalist and chief administrative officer.

Steinholt was out on maternity leave and was therefore not involved in creating the report, but did it for review before it was published. When he reacted in several formulations. This led the Commission chairman took several new checking phones to people who knew the case and adjusted the text somewhat.

Steinholt was according Gedde-Dahl still not satisfied. A few weeks after the report was released, he gave the new message that he meant the pool was too critical of the municipality’s handling of transparency requirements from Helgelenders.

Geddes-Dahl says she reviewed the case again:

– I went through this point by point and asked Steinholt create a tighter note which could be sent both journalist (Erichsen, editor.) and county, which had handled the complaints. He did. I forwarded and received an answer. This documented not that our formulations was wrong, and then we could not do more.

Steinholt sent ever new inquiries, and finally asked Gedde-Dahl General Kjersti Loken Stavrum in Norwegian Press Association to take the case.

Stavrum said to the journalist that she underwent all the documents.

– There was a lingering mail exchange with Steinholt. Eventually we had to just observe that we had different views.

Thus sent Steinholt resignation letter.

Got offered footnote

– You might municipality has delayed, but from the documentation I have seen, it does not appear that this relationship is as serious as described in report. It is a deliberate misrepresentation to say that the Committee’s description of the case purely on transparency. It contains an unbalanced, twisted and skjeiv presentation of facts, which support the main conclusion, says Steinholt to journalist.

– Could not you just expressed a dissenting opinion and remains in committee?

– I did offer to bring in a footnote. But I do not think that the committee went deep enough into it I made. In addition, it is difficult to continue when I am faced with a high degree of suspicion of my motives. From my side, the focus has been only cases presented in the report.

Steinholt adding that he thinks it’s sad to leave the selection, which he believes makes a very important job.