Synnytyksen käynnistäminen, kun raskaus on täysiaikainen

•Synnytyksistä 20–30 % alkaa käynnistyksellä, ja käynnistysten osuus on jatkuvasti kasvanut. •Synnytys käynnistetään lääketieteellisestä syystä, kun raskauden jatkamisen riskit ovat suuremmat kuin käynnistykseen liittyvät riskit. •Käynnistykseen liittyy lisääntynyt pitkittyneen synnytyksen ja päivystyskeisarileikkauksen riski. •Kohdunkaula kypsytetään lääkkeellisesti misoprostolilla tai mekaanisesti laajentamalla balonkimenetelmällä vaiheeseen, jossa lapsivesikalvojen puhkaisu on mahdollinen. Tarvittaessa käytetään oksitosiinia supistusten aloittamiseksi tai voimistamiseksi. •Lääkkeellisen ja mekaanisen käynnistysmenetelmän välillä ei ole todettu eroja tehossa, keisarileikkausten määrissä, infektioissa tai vastasyntyneen voinnissa.Peer reviewe

Correction to: Maternal complications in twin pregnancies in Finland during 1987–2014 : a retrospective study

An amendment to this paper has been published and can be accessed via the original article

Perinatal outcomes in Finnish twins : a retrospective study

Background To establish the changes in perinatal morbidity and mortality in twin pregnancies in Finland, a retrospective register research was conducted. Our extensive data from a 28-year study period provide important information on the outcome of twin pregnancies in Finland that has previously not been reported to this extent. Methods All 23,498 twin pregnancies with 46,996 children born in Finland during 1987-2014 were included in the study. Data were gathered from the Medical Birth Register and the Hospital Discharge Register (Finnish Institute for Health and Welfare, Finland) regarding perinatal mortality (PNM) and morbidity. For statistical analysis, binomial regression analysis and crosstabs were performed. The results are expressed in means, percentages and ranges with comparison to singletons when appropriate. Odds ratios from binomial regression analysis are reported. A p-value Results There were 46,363 liveborn and 633 stillborn twins in Finland during 1987-2014. Perinatal mortality decreased markedly, from 45.1 to 6.5 per 1000 for twin A and from 54.1 to 11.9 per 1000 for twin B during the study period. Yet, the PNM difference between twin A and B remained. Early neonatal mortality did not differ between twins, but has decreased in both. Asphyxia, respiratory distress syndrome, need for antibiotics and Neonatal Intensive Care Unit (NICU) stay were markedly more common in twin B. Conclusions In Finland, PNM and early neonatal mortality in twins decreased significantly during 1987-2014 and are nowadays very low. However, twin B still faces more complications. The outline provided may be used to further improve the monitoring and thus perinatal outcome of twins, especially twin B.Peer reviewe

Perinatal outcomes in Finnish twins : a retrospective study

Background To establish the changes in perinatal morbidity and mortality in twin pregnancies in Finland, a retrospective register research was conducted. Our extensive data from a 28-year study period provide important information on the outcome of twin pregnancies in Finland that has previously not been reported to this extent. Methods All 23,498 twin pregnancies with 46,996 children born in Finland during 1987-2014 were included in the study. Data were gathered from the Medical Birth Register and the Hospital Discharge Register (Finnish Institute for Health and Welfare, Finland) regarding perinatal mortality (PNM) and morbidity. For statistical analysis, binomial regression analysis and crosstabs were performed. The results are expressed in means, percentages and ranges with comparison to singletons when appropriate. Odds ratios from binomial regression analysis are reported. A p-value Results There were 46,363 liveborn and 633 stillborn twins in Finland during 1987-2014. Perinatal mortality decreased markedly, from 45.1 to 6.5 per 1000 for twin A and from 54.1 to 11.9 per 1000 for twin B during the study period. Yet, the PNM difference between twin A and B remained. Early neonatal mortality did not differ between twins, but has decreased in both. Asphyxia, respiratory distress syndrome, need for antibiotics and Neonatal Intensive Care Unit (NICU) stay were markedly more common in twin B. Conclusions In Finland, PNM and early neonatal mortality in twins decreased significantly during 1987-2014 and are nowadays very low. However, twin B still faces more complications. The outline provided may be used to further improve the monitoring and thus perinatal outcome of twins, especially twin B.Peer reviewe

Correction to: Perinatal outcomes in Finnish twins : a retrospective study

An amendment to this paper has been published and can be accessed via the original article

Perinatal outcome of dichorionic and monochorionic-diamniotic Finnish twins : a historical cohort study

Introduction Although the perinatal mortality of monochorionic twins has been reported to be higher, the role of chorionicity is debated and data from Finland are still lacking. To examine the effect of chorionicity on the main outcome measures, perinatal and neonatal mortality and neonatal morbidity of Finnish twins, a comprehensive population-based historical cohort study was performed at Helsinki University Hospitals. Material and methods All 1034 dichorionic and monochorionic-diamniotic twin pregnancies managed at Helsinki University Hospital area during 2006, 2010, 2014 and 2018 were collected from patient databases. Information on chorionicity was retrieved from ultrasound reports and all relevant clinical information from patient records. Differences in perinatal and neonatal mortality and neonatal morbidity were analyzed by performing group comparisons between the twins and chorionicity. The role of chorionicity was also assessed in logistic regression analyses. Results There were 1034 dichorionic-diamniotic (DCDA, n = 789, 76.3%, 95% confidence interval [CI] 73.6-78.9) and monochorionic-diamniotic (MCDA, n = 245, 23.7%, 95% CI 21.4-26.0) twin pregnancies during the studied years. Most (n = 580, 56.1%, 95% CI 52.8-59.2) twins were born at term, but 151 (61.6%, 95% CI 55.8-67.3) of MCDA twins were preterm and had lower birthweight and Apgar scores and higher risk of death of one twin. Perinatal and neonatal mortality did not differ between twins A and B, but the immediate outcome of twin B was worse, with lower arterial pH and Apgar scores and increased need of neonatal intensive care unit treatment. Conclusions Chorionicity contributes to the perinatal and neonatal outcome in favor of dichorionic twins. This disadvantage of MCDA twinning is likely explained by earlier gestational age at birth and inequal placental sharing. Irrespective of chorionicity, twin B faces more complications.Peer reviewe

Raskaudenaikainen parvorokkovirusinfektio

•Parvorokko on erityisesti 3–15-vuotiailla lapsilla yleinen, viruksen (B19V) aiheuttama infektiotauti. •Tautia esiintyy etenkin keväisin, suurempina epidemioina muutaman vuoden välein. •Suomalaisista lisääntymisikäisistä naisista noin 60 % on IgG-vasta-ainepositiivisia ja siten immuuneja ¬parvorokolle. •Alkuraskauden aikainen tauti voi johtaa sikiön anemiaan ja hydropsiin. Jos äiti infektoituu ensimmäisellä raskauspuoliskolla, sikiön menettämisen riski on noin 10 % tavallista suurempi. •Parvorokko tulisi huomioida erityisesti raskaana olevien päiväkotityöntekijöiden työsuojelussa.Peer reviewe

Urgent EMS managed out-of-hospital delivery dispatches in Helsinki

Background: The aim of this study was to examine Helsinki Emergency Medical Services (EMS) and hospital records to determine the incidence and possible complications of out-of-hospital deliveries managed by EMS in Helsinki. Methods: We retrospectively analysed all urgent ambulance dispatches relating to childbirth in Helsinki from January 1, 2010 to December 31, 2014 with further analysis of hospital records for the out-of-hospital deliveries. Patients were divided in to two groups: those who delivered before reaching hospital and those who did not deliver before reaching hospital and differences between groups were analysed. Deliveries with gestational age of at least 22 + 0 weeks were considered as births in statistical analysis as this is the current national practice. Results: There were 799 urgent dispatches during the study period. In 102 (12.8 %) of these delivery took place before reaching the hospital. The incidence of EMS managed out-of-hospital delivery was found to be 3.0/1000 births. The annual number of out-of-hospital deliveries attended by EMS increased from 15 in 2010 to 28 in 2014. No stillbirths were reported. Neither maternal or perinatal deaths nor major maternal complications were noted in the study population. Discussion: Out-of-hospital deliveries represent a small minority of EMS calls and remain a challenge to maintaining professional capabilities. Small sample size might have limited the ability of the study to pick up rare complications. Conclusions: The amount of out-of-hospital deliveries in Helsinki increased during the five-year study period. There were no maternal or perinatal mortality or major complications resulting in long-term sequelae associated with the EMS-managed out-of-hospital births.Peer reviewe