Maternal deaths in Iceland over 25 years.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageMaternal death, during pregnancy or within 42 and 365 days from the end of pregnancy, was evaluated for a small high-income nation with comprehensive healthcare.Cases were identified using record linkage by running national census information on all deaths of women aged 15-49 years during 1985-2009 against the national birth register and computerized hospital admission files for pregnancy-related diagnoses as well as actual case records where needed. Death certificates and hospital records were reviewed.Thirty deaths were identified; 26 at ≥22 weeks (= birth) and four earlier in pregnancy. For 107 871 deliveries, the overall mortality was 27.8/100 000. There were five direct deaths (4.6/100 000 deliveries), five indirect deaths (4.6/100 000 deliveries) and 19 coincidental deaths (17.6/100 000 deliveries). Using WHO criteria (direct and indirect in pregnancy or at ≤42 days postpartum) the ratio was 5.6/100 000 deliveries (95% confidence interval 1.1-10.1) and 5.5/100 000 live births (maternal mortality ratio, based on six deaths). Direct deaths were caused by sepsis, severe preeclampsia and choriocarcinoma, indirect by suicide, pre-existing cardiac and diabetic illness. No woman died of postpartum hemorrhage, anesthesia or ectopic pregnancy. Suboptimal care occurred.Maternal mortality in Iceland over a 25-year period up to the end of year 2010 was low, between 5 and 6/100 000 births. A comprehensive national healthcare system with accessible antenatal care in a society with good general living conditions and universal education probably contributed to this

Chart of part of New South Wales, with plans of the harbours [cartographic material] /

Insets: Moreton Bay and Brisbane River, 1825 -- Port Phillip and Western Port -- Port Macquarie -- Twofold Bay -- Port Hunter -- Botany Bay -- [Broken Bay] --The harbour of Port Stephens / by J. Bingle -- The entrance of Port Hunter / by J. Bingle -- The harbour of Port Jackson -- General map of Australia.; Map extending from Moreton Bay to Port Phillip showing nine counties in N.S.W., and roads. Relief shown by hachures.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.map-rm1528

Maternal geographic residence, local health service supply and birth outcomes.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageTo describe pregnancy complications, mode of delivery and neonatal outcomes by mother's residence.Register-based cohort study.Geographical regions of Iceland.Live singleton births from 1 January 2000 to 31 December 2009 (n = 40 982) and stillbirths ≥22 weeks or weighing ≥500 g (n = 145).Logistic regression was used to explore differences in outcomes by area of residence while controlling for potential confounders. Maternal residence was classified according to distance from Capital Area and availability of local health services.Preterm birth, low birthweight, perinatal death, gestational diabetes and hypertension.Of the 40 982 infants of the study population 26 255 (64.1%) were born to mothers residing in the Capital Area and 14 727 (35.9%) to mothers living outside the Capital Area. Infants outside the Capital Area were more likely to have been delivered by cesarean section (adjusted odds ratio 1.28; 95% CI 1.21-1.36). A lower prevalence of gestational diabetes (adjusted odds ratio 0.68; 95% CI 0.59-0.78), hypertension (adjusted odds ratio 0.82; 95% CI 0.71-0.94) as well as congenital malformations (adjusted odds ratio 0.55; 95% CI 0.48-0.63) was observed outside the Capital Area. We observed neither differences in mean birthweight, gestation length nor rate of preterm birth or low birthweight across Capital Area and non-Capital Area. The odds of perinatal deaths were significantly higher (adjusted odds ratio 1.87; 95% CI 1.18-2.95) outside the Capital Area in the second half of the study period.Lower prevalence of gestational diabetes and hypertension outside the Capital Area may be an indication of underreporting and/or lower diagnostic activity.Rannis - the Icelandic Centre for Research R10-0008 201

Risk factors and health during pregnancy among women previously exposed to sexual violence.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageTo determine whether women exposed to sexual violence in adolescence or adulthood are at increased risk of adverse maternal characteristics during subsequent pregnancies.Register-based cohort study.Iceland.We identified 586 women who attended a Rape Trauma Service (RTS) between 1993 and 2008 and all subsequent births of these women up to April 2011 (n = 915). These pregnancies were compared with 1641 randomly selected pregnancies of women who had not attended the RTS and who gave birth during the same calendar month.Information on maternal smoking, body mass index and illicit drug use was obtained from maternal charts. We used Poisson regression to obtain multivariable adjusted relative risks (aRR) with 95% CI contrasting prevalence of outcomes in the two groups.Characteristics and risk factors during pregnancy, including maternal smoking, body mass index, weight gain during pregnancy, illicit drug use.Compared with unexposed women, sexually assaulted women were younger and more often primiparous in subsequent pregnancy, more likely not to be employed (7.8% vs. 4.3%; aRR 2.42, 95% CI 1.49-3.94), not cohabiting (45.6% vs. 14.2%; aRR 2.15, 95% CI 1.75-2.65), smokers (45.4% vs. 13.5%; aRR 2.68, 95% CI 2.25-3.20), and more likely to have used illicit drugs during pregnancy (3.4% vs. 0.4%; aRR 6.27, 95% CI 2.13-18.43). Exposed primiparas were more likely to be obese (15.5% vs. 12.3%; aRR 1.56, 95% CI 1.15-2.12).Women with a history of sexual violence are more likely to have risk factors during pregnancy that may affect maternal health and fetal development.Icelandic Research Fund for Graduate Students (Rannis) Landspitali University Hospital Research Fun

Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence

Background: There is a scarcity of data on the association of sexual violence and women's subsequent obstetric outcomes. Our aim was to investigate whether women exposed to sexual violence as teenagers (12–19 years of age) or adults present with different obstetric outcomes than women with no record of such violence. Methods: We linked detailed prospectively collected information on women attending a Rape Trauma Service (RTS) to the Icelandic Medical Birth Registry (IBR). Women who attended the RTS in 1993–2010 and delivered (on average 5.8 years later) at least one singleton infant in Iceland through 2012 formed our exposed cohort (n = 1068). For each exposed woman's delivery, nine deliveries by women with no RTS attendance were randomly selected from the IBR (n = 9126) matched on age, parity, and year and season of delivery. Information on smoking and Body mass index (BMI) was available for a sub-sample (n = 792 exposed and n = 1416 non-exposed women). Poisson regression models were used to estimate Relative Risks (RR) with 95% confidence intervals (CI). Results: Compared with non-exposed women, exposed women presented with increased risks of maternal distress during labor and delivery (RR 1.68, 95% CI 1.01–2.79), prolonged first stage of labor (RR 1.40, 95% CI 1.03–1.88), antepartum bleeding (RR 1.95, 95% CI 1.22–3.07) and emergency instrumental delivery (RR 1.16, 95% CI 1.00–1.34). Slightly higher risks were seen for women assaulted as teenagers. Overall, we did not observe differences between the groups regarding the risk of elective cesarean section (RR 0.86, 95% CI 0.61–1.21), except for a reduced risk among those assaulted as teenagers (RR 0.56, 95% CI 0.34–0.93). Adjusting for maternal smoking and BMI in a sub-sample did not substantially affect point estimates. Conclusion: Our prospective data suggest that women with a history of sexual assault, particularly as teenagers, are at increased risks of some adverse obstetric outcomes

Comparison of delivery interventions among women exposed versus non-exposed to sexual violence: Stratified by age at rape trauma consultation.

<p>Comparison of delivery interventions among women exposed versus non-exposed to sexual violence: Stratified by age at rape trauma consultation.</p