Sikiön voinnin seuranta synnytyksen aikana

English summaryPeer reviewe

Obstetric and perinatal health outcomes related to schizophrenia : A national register-based follow-up study among Finnish women born between 1965 and 1980 and their offspring

Background: This national register-based study assesses obstetric and perinatal health outcomes in women with schizophrenia and their offspring. Methods: Using the Care Register for Health Care, we identified Finnish women who were born in 19651980 and diagnosed with schizophrenia. For each case, five age-and place-of-birth-matched controls were obtained from the Central Population Register of Finland. They were followed from the day when the disorder was diagnosed in specialized health-care (the index day) until 31.12.2013. Information related to births was obtained from the Medical Birth Register and the Register of Congenital Malformations. We focused on singleton pregnancies that led to a delivery after the index day. We restricted the analysis of deliveries in controls to those that occurred after the index day of the case. Maternal age, marital status, smoking status, sex of the newborn, and parity were used as covariates in adjusted models. Results: We identified 1162 singleton births among women with schizophrenia and 4683 among controls. Schizophrenic women had a 1.4-fold increased risk of induction of labor, delivery by cesarean section, and delivery by elective cesarean section. Regarding offspring, the risk of premature birth and the risk of low Apgar score at 1 min ( Conclusions: Schizophrenia associates with some specific delivery methods, but delivery complications are rare and their prevalence does not differ from that observed among community women. Maternal schizophrenia associates with some negative perinatal health outcomes of the offspring. (c) 2018 Elsevier Masson SAS. All rights reserved.Peer reviewe

Schizophrenia and pregnancy: a national register-based follow-up study among Finnish women born between 1965 and 1980

To assess psychosocial and somatic risk factors related to pregnancy, and pregnancy-related complications or disorders in women with schizophrenia compared to population controls. In this register-based cohort study, we identified all Finnish women who were born in 1965–1980 and diagnosed with schizophrenia in psychiatric care before 31 December 2013. For each case, five age- and place-of-birth matched controls were randomly selected. They were followed from the day when the disorder was diagnosed in specialized health care till the end of 2013. The mean follow-up time was 14.0 + 6.91 vs. 14.3 + 6.89 years. Altogether, 1162 singleton pregnancies were found among affected women and 4683 among controls. Affected women were significantly older and more often single; their body mass index before pregnancy was significantly higher, and they smoked significantly more often both in the beginning of pregnancy and after the first trimester than controls. They showed a significantly higher odds for pathologic oral glucose tolerance test (odds ratio (OR) 1.66, 95% confidence interval (95% CI) 1.27–2.17), initiation of insulin treatment (OR 1.84, 95% CI 1.15–2.93), fast fetal growth (OR 1.62, 95% CI 1.03–2.52), premature contractions (OR 2.42, 95% CI 1.31–4.49), hypertension (OR 1.81, 95% CI 1.01–3.27), and pregnancy-related hospitalizations (OR 1.97, 95% CI 1.66–2.33). Suspected damage to the fetus from alcohol/drugs was significantly more common among affected women than controls. Women with schizophrenia have higher prevalence of psychosocial and somatic risk factors related to pregnancy, as well as pregnancy-related complications and disorders than non-affected women.Peer reviewe

Maternal schizophrenia and out-of-home placements of offspring : A national follow-up study among Finnish women born 1965-1980 and their children

Schizophrenia may affect a mother's ability to parent. We investigated out-of-home placements among children with a biological mother having schizophrenia, and their relation to maternal characteristics and adverse perinatal health outcomes of the offspring. For each Finnish woman born between 1 JAN 1965 - 31 DEC 1980 and diagnosed with schizophrenia before 31 DEC 2013 (n = 5214), five matched controls were randomly selected from the Finnish Central Population Register. Children born to these women were identified and followed till 31 DEC 2013. The Child Welfare Register, the Medical Birth Register and the Register of Congenital Malformations were used to gather information. Altogether 35.1% of children with an affected mother and 3.2% of control children were placed out of home during the follow-up. The incidence rate ratio (IRR) of out-of-home placement among children with an affected mother was 12.6 (95% confidence interval (CI) 10.80-13.46) when children with a non-affected mother served as a reference. Single motherhood (IRR 2.2, 95% CI 1.88-2.60) and maternal smoking (IRR 1.9, 95% CL 1.68-2.16), but not an adverse perinatal outcome of the offspring, increased the risk of out-of-home placement. To conclude, maternal schizophrenia is a strong risk factor for placement of children in out-of-home care.Peer reviewe

Schizophrenia and induced abortions : A national register-based follow-up study among Finnish women born between 1965-1980 with schizophrenia or schizoaffective disorder

Background: The objectives of this study were to investigate, in women with schizophrenia or schizoaffective disorder, the number and incidence of induced abortions (= pregnancy terminations performed by a physician), their demographic characteristics, use of contraceptives, plus indications of and complications related to pregnancy termination. Methods: Using the Care Register for Health Care, we identified Finnish women born between the years 19651980 who were diagnosed with either schizophrenia or schizoaffective disorder during the follow-up period ending 31.122013. For each case, five age- and place-of-birth- matched controls were obtained from the Population Register of Finland. Information about births and induced abortions were obtained from the Medical Birth Register and the Induced Abortion Register. Results: The number and incidence of induced abortions per 1000 follow-up years did not differ between cases and their controls. However, due to fewer pregnancies, cases exhibited an over 2-fold increased risk of pregnancy termination (RR 228; 95% CI 2.20-2.36). Cases were younger, were more often without a partner at the time of induced abortion, and their pregnancies resulted more often from a lack of contraception. Among cases, the indication for pregnancy termination was more often mother-to-be's medical condition. Induced abortions after 12 weeks gestation were more common among cases. However, cases had no more complications related to termination. Conclusions: The incidence of induced abortions among Finnish women with schizophrenia or schizoaffective disorder is similar to the general population, but their risk per pregnancy over two-fold. They need effective, affordable family planning services and long-term premeditated contraception. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Maternal schizophrenia and out-of-home placements of offspring: A national follow-up study among Finnish women born 1965–1980 and their children

Schizophrenia may affect a mother's ability to parent. We investigated out-of-home placements among children with a biological mother having schizophrenia, and their relation to maternal characteristics and adverse perinatal health outcomes of the offspring. For each Finnish woman born between 1 JAN 1965 – 31 DEC 1980 and diagnosed with schizophrenia before 31 DEC 2013 (n = 5214), five matched controls were randomly selected from the Finnish Central Population Register. Children born to these women were identified and followed till 31 DEC 2013. The Child Welfare Register, the Medical Birth Register and the Register of Congenital Malformations were used to gather information. Altogether 35.1% of children with an affected mother and 3.2% of control children were placed out of home during the follow-up. The incidence rate ratio (IRR) of out-of-home placement among children with an affected mother was 12.6 (95% confidence interval (CI) 10.80–13.46) when children with a non-affected mother served as a reference. Single motherhood (IRR 2.2, 95% Cl 1.88–2.60) and maternal smoking (IRR 1.9, 95% Cl 1.68–2.16), but not an adverse perinatal outcome of the offspring, increased the risk of out-of-home placement. To conclude, maternal schizophrenia is a strong risk factor for placement of children in out-of-home care.</p

Vastasyntyneiden GBS-taudin ehkäisy – asiantuntijaryhmän suositus

B-ryhmän beetahemolyyttinen streptokokki (GBS) on vastasyntyneiden yleisin bakteremian ja meningiitin aiheuttaja. Suuri osa vastasyntyneiden varhaisista GBS-infektioista voidaan ehkäistä antamalla synnytyksenaikainen mikrobilääkeprofylaksi loppuraskauden GBS-seulonnassa positiiviseksi osoitetuille synnyttäjille. Jos GBS-seulontaviljelyä ei ole tehty, infektioriski arvioidaan synnytyksen käynnistymisen yhteydessä

Invasive Group B Streptococcal Infections in Finland: A Population-based Study

We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2–3.0/100,000 population). We found 32–38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6–0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease

Peripartum Ultrasound-Guided Drainage of Cystic Fetal Sacrococcygeal Teratoma for the Prevention of the Labor Dystocia: A Report of Two Cases

Fetal sacrococcygeal teratoma (SCT) is the most common tumor in the neonatal period and is easily detected by modern ultrasound techniques, mostly during the second-trimester screening. It can cause significant fetal/neonatal morbidity and mortality due to its size, vascular loading, possible rupture, and labor dystocia. Mostly cystic teratomas have favorable prognosis, but if untreated in utero, they may rupture or cause labor obstruction. Cesarean delivery, especially with the vertical incision, increases significantly maternal morbidity due to the hemorrhage and the risk of the uterine rupture in the subsequent pregnancies. The authors report in details two SCT cases with uncomplicated vaginal delivery after peripartum ultrasound-guided drainage of the cystic teratoma. We conclude that the percutaneous emptying of the cystic SCT is an easy, encouraging, safe, and efficient procedure and enables normal vaginal delivery, thus avoiding labor dystocia and possible complications of the cesarean delivery and the risk of tumor rupture