Decreasing mortality during pregnancy and for a year after while mortality after termination of pregnancy remains high: a population-based register study of pregnancy-associated deaths in Finland 2001-2012

OBJECTIVE

To investigate mortality in the non-pregnant fertile female population, and mortality during pregnancy and up to 1 year after the end of pregnancy, in Finland from 2001 to 2012 and compare the results with those of 1987-2000.

DESIGN

Retrospective cohort study.

SETTING

Finland.

POPULATION

10 427 deceased women of reproductive age (15-49).

METHODS

Pregnancy outcomes were categorised into: ongoing pregnancy or birth, miscarriage or ectopic pregnancy and termination of pregnancy. Mortality was calculated per 100 000 pregnancies. The mortality rate of the non-pregnant female population of fertile age was calculated per 100 000 person-years, and the results were compared with those of 1987-2000.

MAIN OUTCOME MEASURES

Pregnancy-associated mortality during pregnancy and up to 1 year after the end of pregnancy. Mortality of non-pregnant, fertile-age, female population.

RESULTS

The age-adjusted mortality rate during pregnancy and within 1 year after the end of pregnancy was 28.4/100 000 pregnancies, and it had significantly decreased compared with the period 1987-2000 [risk ratio (RR) 0.75 (95% CI, 0.65-0.88)]. Mortality in non-pregnant fertile-age females was 48.1/100 000 person-years. Mortality for diseases and medical conditions during and after pregnancy decreased by 26% [RR 0.74 (95% CI, 0.59-0.92)] and for external causes by 23% [RR 0.77 (95% CI, 0.62-0.95)]. The mortality rate for suicides was 3.3/100 000 in ongoing pregnancies and pregnancies ending in birth while it was 21.8/100 000 after termination of pregnancy and 10.2/100 000 among non-pregnant women.

CONCLUSIONS

In comparison with earlier decades, pregnancy-associated mortality has decreased in Finland.

TWEETABLE ABSTRACT

Mortality decreases among pregnant women and within 1 year after pregnancy in Finland.

Foley catheter induction of labor as an outpatient procedure

OBJECTIVE

The aim of our study was to introduce outpatient induction of labor by Foley catheter, and to compare outcomes and preferences between in-patients and outpatients.

STUDY DESIGN

This clinical cohort study was conducted in Helsinki University Hospital between January 2011 and January 2012. A total of 485 women scheduled for induction of labor by Foley catheter were included. The main outcome measures were cesarean delivery rate, and maternal and neonatal infectious morbidity. Maternal satisfaction of outpatients was measured after delivery.

RESULTS

Two hundred and four (42.1%) women were managed as outpatients and 281 (57.9%) women as in-patients. The rates of cesarean delivery, and maternal or neonatal infections did not differ between outpatients and in-patients. Of the outpatients, 85.3% were satisfied.

CONCLUSION

Induction of labor by Foley catheter appears suitable for outpatients, and resulted in no differences in cesarean delivery or infection rates compared with in-patients. Most women were satisfied with the outpatient induction.

Pregnancy-associated recurrent liver necrosis in patient with antiphospholipid syndrome

The presence of antiphospholipid antibodies is associated with thromboembolic events, thrombocytopenia and numerous pregnancy complications such as recurrent miscarriage, preeclampsia and HELLP syndrome. This condition is known as the antiphospholipid syndrome (APS). We describe a rare case of recurrent liver necrosis postpartum in two consecutive pregnancies of woman with systemic lupus erythematosus (SLE) and positive antiphospholipid antibodies (aPL) who underwent complete recovery.

Overlap technique improves results of primary surgery after obstetric anal sphincter tear

PURPOSE

This study was designed to evaluate prospectively the results of the overlap technique in primary sphincter reconstruction after obstetric tear.

METHODS

Obstetric tears in 44 women were operated on with primary overlap reconstruction. These women were investigated six to nine months after the operation. Results were compared with those of a historical control group of 52 women whose obstetric sphincter rupture had been treated with the end-to-end technique.

RESULTS

The overlap group had significantly more incontinence symptoms after delivery and repair of the sphincter tear than before delivery (P < 0.0001); however, their incontinence symptoms were significantly fewer than those of the end-to-end group (P = 0.004). The prevalence of persistent rupture of the external anal sphincter was significantly lower in the overlap group (6/44, 13.6 percent) than in the end-to-end group (39/52, 75 percent; P < 0.0001). Internal anal sphincter rupture occurred in 5 patients (11.4 percent) in the overlap group and in 40 patients (76.9 percent) in the end-to-end group (P < 0.0001).

CONCLUSIONS

The overlap technique should be adopted as the method of choice for primary sphincter repair after obstetric tear.

Variations in the thrombomodulin and endothelial protein C receptor genes in couples with recurrent miscarriage

BACKGROUND

Recurrent miscarriage (RM) has been suggested to be caused by mutations in genes coding for various coagulation factors resulting in thrombophilia. Mouse models indicate that genes involved in the protein C anticoagulant pathway are essential for normal embryonic development. Loss of function of two of these genes, thrombomodulin (TM) and endothelial protein C receptor (EPCR), causes embryonic lethality in mice. The aim of this study was to determine whether variations in the human TM or EPCR genes are associated with an increased risk for RM.

METHODS

Forty-six RM patients and 191 controls were screened for mutations in TM and EPCR using denaturing high-performance liquid chromatography (DHPLC). The partners of 40 RM patients were also screened.

RESULTS

One exonic and one intronic variation in TM and two exonic and two intronic sequences in EPCR were detected. Four variants were common in both patients and controls. A previously identified truncating mutation in EPCR, suggested to have a role in pregnancy complications, was identified in two patients and one control. A novel deletion in the 3'UTR region of TM was detected, but its significance remains unsolved.

CONCLUSIONS

These data suggest that mutations in the TM or EPCR genes are not a major cause of RM, although they may exert a modifier effect in combination with other variants.

Treatment of acute pulmonary embolism during pregnancy with low molecular weight heparin: three case reports

We report three patients who presented with acute pulmonary embolism (PE) at gestational weeks 13-19. The diagnosis was based on spiral computer tomography of the lungs. In one of the cases, PE was submassive with signs of right ventricle overload. All of the patients were treated with low molecular weight heparin enoxaparine with an initial dose of 1 mg/kg twice daily during 1 month, and therafter with a reduced dose (80%). The target anti-activated factor X levels 3 h after injection were easily kept in the therapeutic range (0.5-0.9 IU/ml). In all cases, the symptoms were relieved within 4 days and no thrombotic or bleeding complications were observed during the rest of the pregnancy. We conclude that low molecular weight heparin seems to be an efficient and practical treatment of PE during pregnancy.

Declining induced abortion rate in Finland: data quality of the Finnish abortion register

BACKGROUND

Induced abortion rates have declined in Finland since 1973. A possible explanation offered has been that of deteriorating data collection.

METHODS

To assess the completeness of the Register, we compared the information from a consecutive sample of hospital records (N = 482) to the Finnish Abortion Register in 18 hospitals in three counties. A smaller consecutive sample (N = 345) was collected from the same hospitals to assess the validity of the Register information.

RESULTS

Only five abortions (1 percent) found in the hospitals were not reported in the Abortion Register. A total of 95 percent of all the length of pregnancy (definition problems), the classification of the abortion procedure, and social class (out-of-date classifications). Furthermore, early complications were poorly reported.

CONCLUSIONS

The data from the Finnish Abortion Register are a reliable source for monitoring trends in the abortion rate and its variation by subgroups, but are an unreliable source for the study of the medical aspects of induced abortion.