Perceived Stigmatization of Children with Speech-Language Impairment and Their Parents

Objective: Developmental disorders in childhood are generally assumed to have stigmatizing effects. The goal of the present study was to assess whether parents of children with speech-language impairment perceive stigmatization of their child or themselves and which variables influence the degree of negative labeling. Subjects and Methods: The study was based on 362 questionnaires completed by parents of children with speech-language impairment. The questionnaires concerned perceived stigmatization by other children, other adults and family members as a result of the child's developmental problems. Results: In our sample, about 50% of the parents reported negative labeling of their child and about 30% felt they were involved in the stigmatizing process. Parents whose children also had behavioral problems more often reported negative labeling than parents whose children did not. Conclusion: The findings suggest that parents of children with speech-language disorders often perceive stigmatization of their children or themselves. In counseling such families, professionals should therefore address stigmatization and its consequences as a separate and important issue. Copyright (c) 2008 S. Karger AG, Base

Breech presentation and delivery in singleton term pregnancies in Finland

The cesarean section rate is increasing worldwide and breech presentation is with approximately 17 % one of the major indications for elective cesarean sections. Cesarean section might be a life-saving procedure for mother and child during labor, but is also a major procedure with possible complications and adverse long-term effects for future pregnancies. Breech presentation occurs in 2-3 % of term pregnancies. The safety of vaginal breech delivery has been questioned for a long time, as a trial of vaginal breech labor is associated with an increased adverse short-term outcome. The study was designed to evaluate the potential pathophysiology of breech presentation itself, to look for unidentified risk factors associated with adverse perinatal outcome in vaginal breech deliveryand to investigate if a trial of vaginal labor at term with the fetus in breech position, is associated with adverse neurodevelopmental outcome in the children at the age of four. The breech presentation rate at term in Finland is 2.2 %. Breech presentation is compared with vertex presentation associated with a higher stillbirth rate Breech presentation is compared with vertex presentation associated with a higher stillbirth rate, fetal growth restriction, oligohydramnios, gestational diabetes, congenital fetal abnormalities and a previous cesarean section. The perinatal outcome in induced deliveries compared to spontaneous breech deliveries did not show differences. However, a trial of induced breech labor was associated with a higher intrapartum cesarean section rate compared to spontaneous breech labor. An active second delivery stage lasting less than 40 minutes protects from adverse perinatal outcome. A higher intrapartum cesarean delivery rate of at least 24 % was also associated with a lower rate of adverse outcome. Epidural anesthesia, instead, was associated with a higher risk for adverse neonatal outcome. The study results confirmed fetal growth restriction as a risk factor for adverse perinatal outcome in vaginal breech labor. In addition we found that oligohydramnios, a previous cesarean section, gestational diabetes, epidural anesthesia and nulliparity are associated with a higher risk for adverse peri- and neonatal outcome. The neurological development of children at the age of four years, which were born after a trial of vaginal labor with the fetus in breech presentation, compared to those born by elective cesarean section with the fetus in breech presentation. In conclusion our studies showed that breech presentation at term is more often associated with other clinical factors that are per se markers for possible adverse obstetric risks. We showed that an active second delivery stage lasting less than 40 minutes or a higher intrapartum cesarean section rate of at least 25 % have a protective influence on fetal outcome in a trial of vaginal labor with the fetus in breech presentation. Adverse neonatal outcome in vaginal breech delivery was associated with oligohydramnios, fetal growth restriction, gestational diabetes, previous cesarean delivery, epidural anesthesia and nulliparity. An induction of labor while the fetus is in breech presentation is feasible. There were no differences in the neurological development of children born after a trial of vaginal breech labor at term compared to children, who were born by elective cesarean section while the fetus was in breech presentation.Keisarileikkausten määrä on kasvanut kuluneen kolmenkymmenen vuoden aikana kaikissa kehittyneissä maissa ja nykyisin jopa joka viides synnytys maailmanlaajuisesti on keisarileikkaus. Suomessa keisarileikkausten määrä kaikista synnytyksistä oli 15% vuonna 2015. Kansainvälisten julkaisujen mukaan noin joka viides suunniteltu keisarileikkaus tehdään sikiön perätarjonnan vuoksi. Perätarjonta todetaan noin 2–4 %:ssa täysiaikaisista yksisikiöisistä raskauksista. Suurimmassa osassa tälle ei ole löydettävissä varsinaista rakenteellista tai muuta selittävää syytä. Perustuen laajaan monikeskustutkimukseen, monissa maissa suositellaan perätarjonnassa olevan täysiaikaisen sikiön synnytystavaksi yksinomaan suunniteltua keisarileikkausta. Suomessakin keisarileikkausta voidaan pitää perätarjontasynnytyksen hyvänä hoitomuotona, vaikka myös alatiesynnytys on mahdollista toteuttaa nykyobstetriikan keinoin turvallisesti. Tämä edellyttää huolellista potilasvalintaa ja valmistelua, hyvää yhteisymmärrystä synnyttäjän kanssa, sikiön voinnin tarkkaa seurantaa ja valmiutta tarpeen tullen hoitaa synnytys viivyttelemättä keisarileikkauksella. Tutkimuksen tavoitteena oli selvittää liittyykö sikiön perätarjontaan itsessään riskitekijöitä ja voidaanko perätilasynnytys turvallisesti käynnistää. Lisäksi tavoitteena oli selvittää alatiesynnytykseen liittyviä riskejä, jos sikiö on perätarjonnassa sekä perätilassa syntyneiden lasten lyhyen ja pitkän aikavälin terveyttä. Terveyden ja hyvinvoinnin laitoksen synnytysrekisterin avulla vertasimme perätilalle ja raivotarjonnalle mahdollisesti altistavia sikiöön liittyviä riskitekijöitä. Totesimme, että sikiön epämuodostuma, kohtukuolema, sikiön kasvun hitaus, lapsiveden niukkuus ja äidin aikaisempi keisarileikkaus liittyvät perätarjontaan. Helsingin yliopistollisessa sairaalassa vuosien 2011 ja 2013 välillä kerätty aineisto selvitti synnytyksen käynnistyksen tehokkuutta ja turvallisuutta kun sikiö on perätarjonnassa. Tutkimuksen perusteella käynnistetty perätilasynnytys on yhtä turvallinen kuin spontaanisti käynnistynyt perätilasynnytys, mutta käynnistäminen lisää keisarileikkausten määrää. Helsingin yliopistosairaaloiden (2008 - 2015) ja syntymärekisterin (2004 - 2014) aineistoon perustuen totesimme että epiduraalipuudutus, ensisynnytys, sikiön kasvun hitaus, lapsiveden niukkuus, aikaisempi keisarileikkaus, raskausdiabetes, pitkittynyt ponnistusvaihe (yli 40 minuuttia) ja päivystyskeisarileikkausten osuuden jääminen alle 25% ovat riskitekijöitä perätilassa syntyneiden lasten vaikeaan sairastavuuteen. Terveyden ja hyvinvoinnin laitoksen syntymärekisterin sekä hoito- ja poistoilmoitusrekisterin avulla vertailimme perätilassa ja raivotarjonnassa syntyneiden lasten pitkän aikavälin terveyttä. Molemmissa ryhmissä lapset olivat yhtä terveitä neljän seurannan aikana. Yhteenvetona voidaan todeta, että sikiön perätarjontaan itsessään liittyy lasten vaikeaan sairastavuuteen riskitekijöitä. Perätilasynnytyksen käynnistäminen on kuitenkin turvallista. Perätarjontaisen alatiesynnytyksen suunnittelu vaatii potilaiden tarkkaa valintaa ja heidän synnytystään täytyy valvoa ja hoitaa erityisen tarkasti. Neljän vuoden iässä perätilassa alateitse täysiaikaisena syntyneet lapset ovat yhtä terveitä kuin takaraivotarjonnassa alateitse täysiaikaisena syntyneet lapset

Neonatal outcome in vaginal breech labor at 32+0-36+0 weeks of gestation : a nationwide, population-based record linkage study

Background In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries. Design A retrospective register-based study. Setting Maternity hospitals in Finland, 2004-2017. Participants The study population included 762 preterm breech deliveries at 32 + 0-36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section. Methods The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes. Outcome measures Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes. Results A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08-5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40-0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33-0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19-0.48). Conclusion Vaginal breech labor at 32 + 0-36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.Peer reviewe

Risk factors for adverse outcomes in vaginal preterm breech labor

cited By 0Purpose To assess the risk factors for adverse outcomes in attempted vaginal preterm breech deliveries. Methods A retrospective case-control study, including 2312 preterm breech deliveries (24 + 0 to 36 + 6 gestational weeks) from 2004 to 2018 in Finland. The preterm breech fetuses with adverse outcomes born vaginally or by emergency cesarean section were compared with the fetuses without adverse outcomes with the same gestational age. A multivariable logistic regression analysis was used to calculate the risk factors for adverse outcomes (umbilical arterial pH below 7, 5-min Apgar score below 4, intrapartum stillbirth and neonatal death <28 days of age). Results Adverse outcome in vaginal preterm breech delivery was associated with maternal obesity (aOR 32.19, CI 2.97-348.65), smoking (aOR 2.29, CI 1.12-4.72), congenital anomalies (aOR 4.50, 1.56-12.96), preterm premature rupture of membranes (aOR 1.87, CI 1.00-3.49), oligohydramnios (28-32 weeks of gestation: aOR 6.50, CI 2.00-21.11, 33-36 weeks of gestation: aOR 19.06, CI 7.15-50.85), epidural anesthesia in vaginal birth (aOR 2.44, CI 1.19-5.01), and fetal growth below the second standard deviation (28-32 weeks of gestation: aOR 5.89, CI 1.00-34.74, 33-36 weeks of gestation: aOR 12.27, CI 2.81-53.66). Conclusion The study shows that for each subcategory of preterm birth, there are different risk factors for adverse neonatal outcomes in planned vaginal breech delivery. Due to the extraordinary increased risk of adverse outcomes, we would recommend a planned cesarean section in very preterm breech presentation (28 + 0 to 32 + 6 weeks) with severe maternal obesity, oligohydramnios, or fetal growth restriction and in moderate to late preterm breech presentation (33 + 0 to 36 + 6 weeks) with oligohydramnios or fetal growth restriction.Peer reviewe

Congenital anomalies in breech presentation : A nationwide record linkage study

Our study aimed to determine if congenital anomalies are associated with breech presentation at delivery. We conducted a nationwide, retrospective population-based record linkage study and analyzed all singleton births in Finland from 1996 to 2016 using the mandatory health register data collected by the Finnish Institute for Health and Welfare. We compared all major congenital anomalies detected during pregnancy, birth, or the first year of life according to the fetus's presentation at the time of delivery using X-2-square statistic and Student's t test. We adjusted the results for known risk factors for congenital anomalies to estimate adjusted odds ratios and 95% confidence intervals. Fetuses in breech presentation at delivery had an increased risk for congenital anomalies (6.5%) compared with fetuses in cephalic presentation (3.6%), P <.001. Breech presentation was associated with nearly all types of examined congenital anomalies. The strongest associations were observed with congenital deformities of the hip, the central nervous system, the respiratory system, and the musculoskeletal system. Our study supports the theory that breech presentation is, in many cases, a symptom of a fundamental problem in fetal morphogenesis or function. Neonates born in the breech presentation have a higher risk of congenital anomalies and should undergo a postnatal screening.Peer reviewe

Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth : a national cohort study

The objective of this retrospective, nationwide Finnish population-based cohort study was to determine whether there is an association between preterm caesarean breech delivery in the first pregnancy and maternal and neonatal morbidity in the subsequent pregnancy and delivery. We identified all singleton preterm breech birth in Finland from 2000 to 2017 (n = 1259) and constructed a data set of the first two deliveries for these women. We compared outcomes of the following pregnancy and delivery among women with a previous preterm caesarean breech section with the outcomes of women with one previous vaginal preterm breech birth. p Value, odds ratio, and adjusted odds ratio were calculated. Neonates of women with a previous caesarean preterm breech delivery had an increased risk for arterial umbilical cord pH below seven (1.2% versus 0%; p value .024) and a higher rate of neonatal intensive care unit admission [22.9% versus 15% adjusted OR 1.57 (1.13-2.18); p valuePeer reviewe

Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery : a nationwide, population-based record linkage study

Publisher Copyright: © 2021, The Author(s).Purpose: To assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth. Methods: This retrospective record linkage study evaluated the risks of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities among preterm children born after an attempted vaginal breech delivery. The control group comprised children born in a cephalic presentation at the same gestational age. This study included 23 803 singleton deliveries at gestational weeks 24 + 0–36 + 6 between 2004 and 2014. Results: From 1629 women that underwent a trial of vaginal breech delivery, 1122 (66.3%) were converted to emergency cesarean sections. At extremely preterm and very preterm gestations (weeks 24 + 0—31 + 6), no association between a trial of vaginal breech delivery and neurodevelopmental delay occurred. At gestational weeks 32 + 0—36 + 6, the risks of visual disability (aOR 1.67, CI 1.07—2.60) and autism spectrum disorders (aOR 2.28, CI 1.14—4.56) were increased after an attempted vaginal breech delivery as compared to vaginal cephalic delivery. Conclusion: A trial of vaginal breech delivery at extremely preterm and very preterm gestations appears not to increase the risk of adverse neurodevelopmental outcomes at the age of four. In moderate to late preterm births, a trial of vaginal breech delivery was associated with an increased risk of visual impairment and autism spectrum disorders compared to children born in cephalic presentation. A trial of vaginal preterm breech delivery requires distinctive consideration and careful patient selection.Peer reviewe

Term cesarean breech delivery in the first pregnancy is associated with an increased risk for maternal and neonatal morbidity in the subsequent delivery: a national cohort study

Purpose To determine whether there is an association between term cesarean breech delivery in the first pregnancy and maternal and neonatal morbidities in the subsequent pregnancy and delivery. Methods We conducted a retrospective, nationwide Finnish population-based cohort study, including all deliveries from January 2000 to December 2017. We included all women with the first two consecutive singleton deliveries of which the first one was a breech delivery regardless of mode of delivery (n = 11,953), and constructed a data set in which the first two deliveries for these women were connected. The outcomes of the second delivery of the women with a first pregnancy that resulted in cesarean breech delivery at term were compared with women whose first pregnancy resulted in a vaginal breech delivery at term. P-value, odds ratio, and adjusted odds ratio were calculated. Results Neonates of a subsequent delivery after cesarean breech delivery had an increased risk for arterial umbilical cord pH below seven, a higher rate of a 5 min APGAR score <7 and a higher rate of neonatal intensive care unit admission. The women with a history of cesarean section with the fetus in breech presentation were more often in need of a blood transfusion and suffered more often a uterus rupture. In this group, the second delivery was more often a planned cesarean section, an emergency cesarean section, or an instrumental vaginal delivery. Conclusions Primary cesarean breech section in the first pregnancy is associated with adverse neonatal and maternal outcomes in the subsequent delivery.Peer reviewe

A comparison of risk factors for breech presentation in preterm and term labor : a nationwide, population-based case-control study

Purpose To determine if the common risks for breech presentation at term labor are also eligible in preterm labor. Methods A Finnish cross-sectional study included 737,788 singleton births (24-42 gestational weeks) during 2004-2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation. Results The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24-27 to 2.5% in term pregnancies. In gestational weeks 24-27, preterm premature rupture of membranes was associated with breech presentation. In 28-31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32-36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile. Conclusion Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.Peer reviewe

Fetofetaalisen transfuusio-oireyhtymän laserhoito

Teema : sikiölääketiede. English summaryPeer reviewe