No correlation between rates of caesarean section and perinatal mortality in Iceland

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Caesarean section rates have increased over the past decades without a concomitant decrease in perinatal mortality. In Iceland the same trend has been seen while at the same time perinatal mortality rate has remained low. Most caesarean sections are done at term. Crude perinatal mortality rates give limited information about whether the increase in section rates leads to a lower perinatal death rate among term non-malformed singleton infants. The relation between caesarean section and perinatal mortality rates in singleton, non-malformed infants of birthweight > or =2500 g in Iceland during 1989-2003 was studied. MATERIALS AND METHODS: Information about gestational length, birthweight, parity, onset of labour and previous caesarean section was collected on all singleton births > or =2500 g from the Icelandic Birth Registration and from maternity case records. The same data were obtained for all perinatal deaths > or =2500 g excluding malformed infants irrespective of mode of delivery. The caesarean section and perinatal mortality rates were calculated and the relation between these evaluated by Pearson s correlation coefficient. RESULTS: The total number of deliveries in the study period was 64514 and the mean perinatal mortality rate 6.4/1000 (range: 3.6-9.2/1000). A significant increase was found in the overall caesarean section rate, from 11.6% to 18.2% (p or =2500 g and 8332 were born by caesarean section. There were 111 perinatal deaths among this cohort giving a mean perinatal mortality rate (PNMR) of 1.8/1000 (range 0.8-4.1/1000). While for singleton non-malformed infants the caesarean section rate increased from 10.4% to 16.7% (p or =2500 g was found in this population with a prior low perinatal mortality, neither among primi- nor multiparous women.Ágrip Inngangur: Tíðni fæðinga með keisaraskurði hefur víða margfaldast undanfarna áratugi án þess að burðarmálsdauði (BMD) hafi lækkað á sama tíma. Á Íslandi hefur keisaraskurðum fjölgað verulega og burðarmálsdauði haldist lágur. Óvíst er um tengsl þar á milli. Flestir keisaraskurðir eru gerðir hjá konum við fulla meðgöngu. Börn sem deyja á burðarmálstíma eru einkum fyrirburar og heildartölur um BMD gefa takmarkaða mynd af því hvort fjölgun keisaraskurða skili sér í færri dauðsföllum barna sem hafa náð eðlilegri fæðingarþyngd. Tilgangur rannsóknarinnar var að meta hugsanleg tengsl keisaraskurða við burðarmálsdauða hjá einburum sem vógu ≥2500 g við fæðingu. Efniviður og aðferðir: Upplýsingar um meðgöngu­lengd, þyngd barns, fjölda barna, upphaf fæðingar og fyrri keisaraskurði kvenna sem fóru í keis­ara­skurð á rannsóknartímanum (1989-2003) voru fengn­ar úr Fæðingaskráningunni og sjúkraskrám. Af þeim voru allar konur með einbura ≥2500 g valdar í rannsóknarhópinn. Sömu upplýsingar voru fengnar um einbura 2≥2500 g án alvarlegra van­skapnaða sem dóu á burðarmálstíma, óháð fæð­ingarmáta. Breytingar á tíðni keisaraskurða og BMD voru metnar með Pearsons fylgnistuðli. Niðurstöður: Alls fæddu 64514 konur 65619 börn árin 1989-2003. Þar af dóu 419 börn á burð­ar­málstíma. BMD breyttist ekki marktækt á rannsóknartíma og var að meðaltali 6,4/1000 (bil: 3,6-9,2/1000). Heildartíðni keisaraskurða hækk­aði marktækt úr 11,6% í 18,2% (p2500 g. Tíðni keis­ara­skurða í rannsóknarhópnum jókst úr 10,4% í 16,7% (p<0,001). Ekki var marktæk fylgni við BMD í þessum hópi, en meðaltalstíðni BMD var 1,8/1000 (bil: 0,8-4,1/1000). Meðal frumbyrja jókst keisaratíðnin úr 12% í 18%, einnig án fylgni við BMD (meðaltal 0,6/1000). Ályktanir: Fjölgun keisaraskurða við fæðingu einbura með fæðingarþyngd ≥2500 g hefur ekki leitt til marktækrar fækkunar dauðsfalla hjá þess­um hópi barna á síðastliðnum 15 árum

Maternal age and risk of cesarean section in women with induced labor at term - a Nordic register-based study

Abstract Introduction Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on cesarean section at term among nulliparous and multiparous women without previous cesarean section. Material and methods We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on cesarean section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term and no previous cesarean section. Confounders comprised country, time-period and gestational age. Results In nulliparous women with induced labor the rate of cesarean section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared to women aged 25-29 years, the corresponding relative risk were 0.60 (95% confidence interval (CI); 0.57 to 0.64) and 1.72 (95% CI; 1.66 to 1.79). In multiparous induced women the risk of cesarean section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared to women aged 25-29 years, the relative risk were 0.86 (95% CI; 0.54 to 1.37) and 1.98 (95% CI; 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period and gestational age on risk for cesarean section. Conclusions Advanced maternal age is associated with increased risk of cesarean section in women undergoing labor induction with a single cephalic presentation at term without a previous cesarean section. The absolute risk of cesarean section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor.Peer reviewe

Protect maternity services in Iceland [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Á síðustu Læknadögum var haldið málþingið: „Hvernig verður þjónustan við fæðandi konur á Íslandi í framtíðinni“? Fjallað var um breytingar á fæðingaþjónustu á síðustu áratugum og framtíðina í ljósi þróunar og krafna um sparnað í heilbrigðiskerfinu. Ný skýrsla Ljósmæðrafélagsins1 var kynnt, en í henni er yfirlit yfir grunnþætti barneignaþjónustunnar; meðgönguvernd, fæðingahjálp og sængurlegu í heilbrigðisumdæmum landsins, og spáð í framtíðina. Gildi meðgönguverndar fyrir allar konur er óumdeilanlegt og heimaþjónusta ljósmæðra í sængurlegu hefur reynst vel. Skýrslan er mikilvægt innlegg fyrir ákvarðanatöku um úrbætur í framtíð

Protect maternity services in Iceland [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Á síðustu Læknadögum var haldið málþingið: „Hvernig verður þjónustan við fæðandi konur á Íslandi í framtíðinni“? Fjallað var um breytingar á fæðingaþjónustu á síðustu áratugum og framtíðina í ljósi þróunar og krafna um sparnað í heilbrigðiskerfinu. Ný skýrsla Ljósmæðrafélagsins1 var kynnt, en í henni er yfirlit yfir grunnþætti barneignaþjónustunnar; meðgönguvernd, fæðingahjálp og sængurlegu í heilbrigðisumdæmum landsins, og spáð í framtíðina. Gildi meðgönguverndar fyrir allar konur er óumdeilanlegt og heimaþjónusta ljósmæðra í sængurlegu hefur reynst vel. Skýrslan er mikilvægt innlegg fyrir ákvarðanatöku um úrbætur í framtíð

Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013 : A cross-sectional study

Objective To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. Design Register-based cross-sectional study. Population All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. Methods Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). Results The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82–2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750–999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. Conclusions Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital.Objective. To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. Design. Register-based cross-sectional study. Population. All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. Methods. Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). Results. The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. Conclusions. Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital.Peer reviewe

No correlation between rates of caesarean section and perinatal mortality in Iceland

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Caesarean section rates have increased over the past decades without a concomitant decrease in perinatal mortality. In Iceland the same trend has been seen while at the same time perinatal mortality rate has remained low. Most caesarean sections are done at term. Crude perinatal mortality rates give limited information about whether the increase in section rates leads to a lower perinatal death rate among term non-malformed singleton infants. The relation between caesarean section and perinatal mortality rates in singleton, non-malformed infants of birthweight > or =2500 g in Iceland during 1989-2003 was studied. MATERIALS AND METHODS: Information about gestational length, birthweight, parity, onset of labour and previous caesarean section was collected on all singleton births > or =2500 g from the Icelandic Birth Registration and from maternity case records. The same data were obtained for all perinatal deaths > or =2500 g excluding malformed infants irrespective of mode of delivery. The caesarean section and perinatal mortality rates were calculated and the relation between these evaluated by Pearson s correlation coefficient. RESULTS: The total number of deliveries in the study period was 64514 and the mean perinatal mortality rate 6.4/1000 (range: 3.6-9.2/1000). A significant increase was found in the overall caesarean section rate, from 11.6% to 18.2% (p or =2500 g and 8332 were born by caesarean section. There were 111 perinatal deaths among this cohort giving a mean perinatal mortality rate (PNMR) of 1.8/1000 (range 0.8-4.1/1000). While for singleton non-malformed infants the caesarean section rate increased from 10.4% to 16.7% (p or =2500 g was found in this population with a prior low perinatal mortality, neither among primi- nor multiparous women.Ágrip Inngangur: Tíðni fæðinga með keisaraskurði hefur víða margfaldast undanfarna áratugi án þess að burðarmálsdauði (BMD) hafi lækkað á sama tíma. Á Íslandi hefur keisaraskurðum fjölgað verulega og burðarmálsdauði haldist lágur. Óvíst er um tengsl þar á milli. Flestir keisaraskurðir eru gerðir hjá konum við fulla meðgöngu. Börn sem deyja á burðarmálstíma eru einkum fyrirburar og heildartölur um BMD gefa takmarkaða mynd af því hvort fjölgun keisaraskurða skili sér í færri dauðsföllum barna sem hafa náð eðlilegri fæðingarþyngd. Tilgangur rannsóknarinnar var að meta hugsanleg tengsl keisaraskurða við burðarmálsdauða hjá einburum sem vógu ≥2500 g við fæðingu. Efniviður og aðferðir: Upplýsingar um meðgöngu­lengd, þyngd barns, fjölda barna, upphaf fæðingar og fyrri keisaraskurði kvenna sem fóru í keis­ara­skurð á rannsóknartímanum (1989-2003) voru fengn­ar úr Fæðingaskráningunni og sjúkraskrám. Af þeim voru allar konur með einbura ≥2500 g valdar í rannsóknarhópinn. Sömu upplýsingar voru fengnar um einbura 2≥2500 g án alvarlegra van­skapnaða sem dóu á burðarmálstíma, óháð fæð­ingarmáta. Breytingar á tíðni keisaraskurða og BMD voru metnar með Pearsons fylgnistuðli. Niðurstöður: Alls fæddu 64514 konur 65619 börn árin 1989-2003. Þar af dóu 419 börn á burð­ar­málstíma. BMD breyttist ekki marktækt á rannsóknartíma og var að meðaltali 6,4/1000 (bil: 3,6-9,2/1000). Heildartíðni keisaraskurða hækk­aði marktækt úr 11,6% í 18,2% (p2500 g. Tíðni keis­ara­skurða í rannsóknarhópnum jókst úr 10,4% í 16,7% (p<0,001). Ekki var marktæk fylgni við BMD í þessum hópi, en meðaltalstíðni BMD var 1,8/1000 (bil: 0,8-4,1/1000). Meðal frumbyrja jókst keisaratíðnin úr 12% í 18%, einnig án fylgni við BMD (meðaltal 0,6/1000). Ályktanir: Fjölgun keisaraskurða við fæðingu einbura með fæðingarþyngd ≥2500 g hefur ekki leitt til marktækrar fækkunar dauðsfalla hjá þess­um hópi barna á síðastliðnum 15 árum

Árangur kembileitar að sárasótt í þungun

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Sárasóttarsýking á meðgöngu getur valdið fósturlátum, andvana fæðingum og meðfæddri sárasótt, með alvarlegum afleiðingum fyrir barnið. Koma má í veg fyrir slíkt með greiningu og meðferð snemma á meðgöngu. Á Íslandi hefur lengi verið leitað að sárasótt við fyrstu mæðraskoðun. Ef meta á hagkvæmni þessarar kembileitar er nauðsyn að vita hversu margar þungaðar konur finnast með áður óþekkta sárasótt. Á árunum 1979-1987 reyndist VDRL jákvætt í 98 meðgöngum. Þar af greindust þrjár konur (ein aðflutt) með áður óþekkta sárasótt. Þær voru einkennalausar, fengu meðferð og fæddu heilbrigð börn. Reiknuð tíðni nýgreindrar sárasóttar á meðgöngu var 7,9/100.000 fæðingar. Í fimm meðgöngum voru blóðvatnspróf jákvæð en smit var áður þekkt. Ekki var samband milli jákvæðni VDRL prófs og fyrri meðgöngusögu eða aldurs. Samkvæmt upplýsingum frá barnadeildum landsins og Landlæknisembættinu fæddist ekkert barn með meðfædda sárasótt á þessum níu árum. Þetta bendir til þess að kembileit að sárasótt í þungun sé árangursrík

Árangur kembileitar að sárasótt í þungun

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Sárasóttarsýking á meðgöngu getur valdið fósturlátum, andvana fæðingum og meðfæddri sárasótt, með alvarlegum afleiðingum fyrir barnið. Koma má í veg fyrir slíkt með greiningu og meðferð snemma á meðgöngu. Á Íslandi hefur lengi verið leitað að sárasótt við fyrstu mæðraskoðun. Ef meta á hagkvæmni þessarar kembileitar er nauðsyn að vita hversu margar þungaðar konur finnast með áður óþekkta sárasótt. Á árunum 1979-1987 reyndist VDRL jákvætt í 98 meðgöngum. Þar af greindust þrjár konur (ein aðflutt) með áður óþekkta sárasótt. Þær voru einkennalausar, fengu meðferð og fæddu heilbrigð börn. Reiknuð tíðni nýgreindrar sárasóttar á meðgöngu var 7,9/100.000 fæðingar. Í fimm meðgöngum voru blóðvatnspróf jákvæð en smit var áður þekkt. Ekki var samband milli jákvæðni VDRL prófs og fyrri meðgöngusögu eða aldurs. Samkvæmt upplýsingum frá barnadeildum landsins og Landlæknisembættinu fæddist ekkert barn með meðfædda sárasótt á þessum níu árum. Þetta bendir til þess að kembileit að sárasótt í þungun sé árangursrík

Cesarean birth, obstetric emergencies, and adverse neonatal outcomes in Iceland during a period of increasing labor induction.

To access publisher's full text version of this article click on the hyperlink belowBackground: The rate of labor induction has risen steeply throughout the world. This project aimed to estimate changes in the rates of adverse maternal and neonatal outcomes in Iceland between 1997 and 2018, and to assess whether the changes can be explained by an increased rate of labor induction. Methods: Singleton live births, occurring between 1997 and 2018, that did not start by prelabor cesarean, were identified from the Icelandic Medical Birth Register (n = 85 971). Rates of intrapartum cesarean birth (CB), obstetric emergencies, and neonatal outcomes were calculated, and adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated with log-binomial regression (reference: 1997-2001). Adjustments were made for: (a) maternal characteristics, and (b) labor induction and gestational age. Results: The rate of labor induction increased from 13.6% in the period 1997-2001 to 28.1% in the period 2014-2018. The rate of intrapartum CB decreased between the periods of 1997-2001 and 2014-2018 for both primiparous (aRR 0.76, 95% CI: 0.69 to 0.84) and multiparous women (aRR 0.55, 95% CI: 0.49 to 0.63). The rate of obstetric emergencies and adverse neonatal outcomes also decreased between these time periods. Adjusting for labor induction did not attenuate these associations. Conclusions: The rates of adverse maternal outcomes and adverse neonatal outcomes decreased over the study period. However, there was no evidence that this decrease could be explained by the increased rate of labor induction. Keywords: cesarean; labor induction; neonatal outcome; obstetric emergencies.Icelandic Research Fun

The Robson 10-group classification in Iceland: Obstetric interventions and outcomes.

To access publisher's full text version of this article click on the hyperlink belowBACKGROUND: Rising cesarean rates call for studies on which subgroups of women contribute to the rising rates, both in countries with high and low rates. This study investigated the cesarean rates and contributing groups in Iceland using the Robson 10-group classification system. METHODS: This study included all births in Iceland from 1997 to 2015, identified from the Icelandic Medical Birth Registry (81 839). The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed for each year, and the distribution of other outcomes was calculated for each Robson group. RESULTS: The overall cesarean rate in the population was 16.4%. Robson groups 1 (28.7%) and 3 (38.0%) (spontaneous term births) were the largest groups, and groups 2b (0.4%) and 4b (0.7%) (prelabor cesareans) were small. The cesarean rate in group 5 (prior cesarean) was 55.5%. Group 5 was the largest contributing group to the overall cesarean rate (31.2%), followed by groups 1 (17.1%) and 2a (11.0%). The size of groups 2a (RR 1.04 [95% CI 1.01-1.08]) and 4a (RR 1.04 [95% CI 1.01-1.07]) (induced labors) increased over time, whereas their cesarean rates were stable (group 2a: P = 0.08) or decreased (group 4a: RR 0.95 [95% CI 0.91-0.98]). CONCLUSIONS: In comparison with countries with high cesarean rates, the prelabor cesarean groups (singleton term pregnancies) in Iceland were small, and in women with a previous cesarean, the cesarean rate was low. The size of the labor induction group increased, yet the cesarean rate in this group did not increase