Kun synnyttäjä toivoo keisarileikkausta

•Keisarileikkausten määrä on viime vuosikymmeninä lisääntynyt, maailmalla huomattavasti enemmän kuin Suomessa. •Suomessa merkittävin syy keisarileikkaustoiveeseen on synnytyspelko. •Leikkaustoiveeseen tulee suhtautua vakavasti ja tarjota mahdollisuus keskusteluun. •Keisarileikkaukseen ei koskaan tulisi päätyä ilman synnytyspelon asianmukaista hoitoa ja päätöksenteon tukea. •Hyvällä synnytyspelon hoidolla suurin osa keisarileikkaustoiveista väistyy, mutta ketään ei tule kuitenkaan painostaa eikä pakottaa synnyttämään alateitse. •Suunniteltuun keisarileikkaukseen liittyy vastasyntyneen hengitysvaikeuksien suurentunut riski. •Joka neljännessä keisarileikkauksessa äidille tulee jokin komplikaatio.Peer reviewe

Rising trends in the incidence of shoulder dystocia and development of a novel shoulder dystocia risk score tool : a nationwide population-based study of 800 484 Finnish deliveries

Introduction Shoulder dystocia has remained an unpredictable and feared emergency in obstetrics. Some risk factors have been identified but nevertheless there is a lack of risk evaluation tools in clinical practice. The aim of this study was to evaluate the incidence and risk factors of shoulder dystocia in the Finnish population and to develop a shoulder dystocia risk score tool. Material and methods This retrospective, population-based study included all deliveries in Finland between 2004 and 2017 (n = 800 484). The annual numbers of shoulder dystocia diagnoses were gathered from nationwide Finnish Medical Birth Register and Hospital Discharge Register. The incidence of shoulder dystocia was calculated in subgroups according to the mode of delivery, maternal diabetes status, body mass index (BMI), age, parity and gestational age. Based on these numbers, a shoulder dystocia risk score tool was created. Results The overall incidence of shoulder dystocia was 0.18%. It increased significantly during the study period from 0.10% to 0.32% (P = 40 years and gestational age >= 41 weeks were associated with higher shoulder dystocia risk compared with non-diabetic, non-obese and younger women with spontaneous deliveries before 41 weeks of gestation. In our risk score tool, cases with shoulder dystocia had a significantly higher number of risk points than those without it (15.2 vs 10.4, P = 18 points (relative risk 9.54, 95% confidence interval 8.61-10.57). Conclusions The incidence of shoulder dystocia in Finland increased during the study period but it is still low compared with previous studies from other countries. In clinical daily practice, the new shoulder dystocia risk score tool helps to evaluate the individual risk profile of the parturient. According to this risk score tool, the highest risk was found with the combination of instrumental vaginal delivery, maternal diabetes, BMI >= 25, age >= 40 years and gestational age >= 41 weeks.Peer reviewe

Traumaattisesta synnytyksestä toipuminen

Vertaisarvioitu.Suurimmalle osalle naisista synnytys on positiivinen kokemus. Kuitenkin 1-3 %:lle kehittyy traumaperäinen stressihäiriö (PTSD) synnytyksen jälkeen. Riskiryhmissä PTSD:n esiintyvyys on jopa 16 %. Synnytykseen liittyvien tekijöiden lisäksi myös aiemmat ongelmat ja traumakokemukset voivat vaikuttaa huonon synnytyskokemuksen ja PTSD:n kehittymiseen. Synnytys voidaan kokea traumaattisena, vaikka se olisi lääketieteellisesti ongelmaton. Siksi synnytyskokemusta on tärkeää seuloa systemaattisesti esimerkiksi synnytyskokemus-VAS (visual analog scale) -seulonnalla. Kun huono synnytyskokemus tunnistetaan nopeasti ja synnyttänyttä autetaan käsittelemään tapahtunutta, voidaan ehkäistä mahdollisen PTSD:n kehittyminen. Traumatisoituneiden tunnistamisessa voi käyttää apuvälineitä esimerkiksi TES-lomaketta. PTSD tulee hoitaa ajoissa muun muassa äidin henkisen hyvinvoinnin, parisuhteen ja varhaisen vuorovaikutuksen ongelmien estämiseksi. Sen hoitoon tarvitaan psykoterapiaa

Fear of childbirth after medical versus surgical abortion. Population-based register study from Finland

Introduction To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy. Material and methods This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester ( Results The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P <.001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. Conclusions One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.Peer reviewe

Cross-sectional study of the proportion of antibiotic use during childbirth in full-term deliveries in Finland

Peer reviewe

Quantitative insights into effects of intrapartum antibiotics and birth mode on infant gut microbiota in relation to well-being during the first year of life

Birth mode and maternal intrapartum (IP) antibiotics affect infants' gut microbiota development, but their relative contribution to absolute bacterial abundances and infant health has not been studied. We compared the effects of Cesarean section (CS) delivery and IP antibiotics on infant gut microbiota development and well-being over the first year. We focused on 92 healthy infants born between gestational weeks 37-42 vaginally without antibiotics (N = 26), with IP penicillin (N = 13) or cephalosporin (N = 7) or by CS with IP cephalosporin (N = 33) or other antibiotics (N = 13). Composition and temporal development analysis of the gut microbiota concentrated on 5 time points during the first year of life using 165 rRNA gene amplicon sequencing, integrated with qPCR to obtain absolute abundance estimates. A mediation analysis was carried out to identify taxa linked to gastrointestinal function and discomfort (crying, defecation frequency, and signs of gastrointestinal symptoms), and birth interventions. Based on absolute abundance estimates, the depletion of Bacteroides spp. was found specifically in CS birth, while decreased bifidobacteria and increased Bacilli were common in CS birth and exposure to IP antibiotics in vaginal delivery. The abundances of numerous taxa differed between the birth modes among cephalosporin-exposed infants. Penicillin had a milder impact on the infant gut microbiota than cephalosporin. CS birth and maternal IP antibiotics had both specific and overlapping effects on infants' gut microbiota development. The resulting deviations in the gut microbiota are associated with increased defecation rate, flatulence, perceived stomach pain, and intensity of crying in infancy.Peer reviewe

Changes in emotions and personal goals in primiparous pregnant women during group intervention for fear of childbirth

The changes in emotions, subjective fear of childbirth, and personal goals were examined during a group intervention to treat fear of childbirth (FOC). The objective was to gain a more detailed understanding of the changes occurring during the group intervention of FOC. The changes in emotions, subjective FOC, and personal goals were studied in primiparous pregnant women with severe FOC participating in a group intervention (n = 105). The group intervention contained six sessions during pregnancy and one after childbirth. At every session, the participants filled in a questionnaire regarding their experiences of current positive and negative emotions and the subjective FOC. The participants also set and reported their personal goals in their preparation for childbirth and parenthood. The negative emotions decreased from the beginning of the intervention. The change became significant after the fourth session. The amount of positive emotions increased but became statistically significant only after the delivery. The subjective FOC decreased significantly from the beginning of the intervention. Personal goals shifted from being mainly self-related to being mostly related to parenthood. The group intervention decreased FOC and promoted changes in emotions and personal goals that foster emotional preparedness for childbirth. It seems that the decrease in FOC was made possible through gaining a better capacity to regulate emotions, especially negative emotions. As negative emotions and fear decreased, personal goals simultaneously changed in the direction known to be adaptive for the new life situation as a parent of a newborn.Peer reviewe

Complement activation and regulation in preeclamptic placenta

Lokki Anna Inkeri1,2,3; Heikkinen-Eloranta Jenni1,4; Jarva Hanna2,3,5; Saisto Terhi4; Lokki Marja-Liisa6; Laivuori Hannele1,4; and Meri Seppo2,3,5.Peer reviewe