Amniotic fluid embolism is one of the least frequent complications of parturition, but the most dangerous of all. 38 cases of fatal amniotic fluid embolism were diagnosed in Sweden during the years 1951-1980, i.e. 1 case for every 83,000 live births. The proportion of amniotic fluid embolism in maternal mortality as a whole increased from 1.2 to 16.5% during this period. Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure. The main symptoms were cardiovascular shock with right heart strain, and hemorrhage with pathologic proteolysis. Four cases of presumed amniotic fluid embolism with survival of the patient were diagnosed during the years 1972-1980--a case fatality rate of 66% (4/12).
The Rönnskär smelter in Skellefteå, Sweden, produces significant environmental pollutants, such as lead, arsenic, copper, cadmium and sulphur dioxide. The purpose of the present study was to determine whether children born to women living near the smelter during pregnancy had an increased risk of childhood cancer. The study group consisted of children born between 1961 and 1990 in the municipality of Skellefteå and parish of Holmsund. Through linkage to the Swedish Cancer Registry cancer diagnoses in the study group were obtained and compared with the expected ones based on the national incidence rates. Thirteen cases of childhood cancer were identified among children born in the vicinity of the smelter against 6.7 expected (SIR 195, 95%CI 88-300). Among distant born the observed number of cases (n = 42) was similar to that expected (n = 41.8).
OBJECTIVES: The aim of the study was to investigate whether factors of pregnancy and birth influence the risk of malignancy in the offspring. METHODS: Data on all deliveries (248,701 births) in two counties in Sweden 1955-90 were extracted from two birth registries. The follow-up period closed at the end of 1994 and the subjects were followed up to early middle-age at most (39 years). Incidence rates of malignancy were obtained from the Cancer Register 1958-1994. Standardized incidence ratios (SIR) and relative risks (RR) were calculated. RESULTS: Overall, few associations were detected. A significantly increased standardized incidence ratio (SIR) of 50.00 (95% CI = 13.45-99.99) was found for the relationship between Down's syndrome and lymphatic leukaemia. Elder maternal age (> or =35 years) and lymphatic leukaemia were associated with a significantly enhanced risk (SIR = 2.00; 95% CI, 1.16-3.20). Maternal age 25-34 years, compared to younger age, was associated with a reduced risk of cervical cancer (RR = 0.47; 95% CI = 0.26-0.86). CONCLUSIONS: Although some associations, the consistent pattern of non-association indicated a low impact of intrauterine environment or changed genetic material on the future development of malignancy in the offspring up to early middle-age.
BACKGROUND: Perinatal deaths have been more difficult to prevent than infant deaths in low- income countries due to its close relation to poor maternal outcome. The aim of the study was to perform a comprehensive population-based analysis of perinatal mortality in a high mortality setting and to determine the impact of midwifery-assisted home deliveries. METHOD: The study design was a community-based cohort study. In all, 4876 perinatal deaths were recorded among 116 211 newborns in the districts of Sundsvall and Skellefteâ in northern Sweden during the years 1831-1899. Relative risks, 95% CI, population attributable proportions and prevented fractions were calculated. RESULTS: The overall perinatal mortality rate was 42.0 per 1000 births. A previous stillbirth represented one of the most important risk factors (RR = 3.25, 95% CI : 2.97-3.56), with a population attributable proportion of 7%. Two or more previous stillbirths gave an RR of 8.50 (95% CI : 7.58-9.53) and a population attributable proportion of 4%. There was an increased risk of perinatal mortality for mothers over 35 years old, the primiparous and the unmarried, while grandparous women had a higher perinatal mortality that was accounted for completely by a poor history of previous stillbirths and infant deaths among these women. The children of crofters, farmers and workers had higher perinatal mortality, but area had no significant impact. During the years 1881-1890 and 1891-1899, the prevented fractions of midwifery were 15% and 32%, respectively. CONCLUSION: Poor reproductive history, particularly previously high perinatal mortality, is associated with high perinatal mortality. Midwifery-assisted at home deliveries successfully reduced perinatal mortality.
OBJECTIVE: To describe the utilization of health care services, based on number of outpatient visits and readmissions, by mothers and newborns following discharge postnatally after having received various types of maternity care. DESIGN: The design was a cohort of Swedish women giving birth at full term. All together, 773 women and 782 newborns were followed using questionnaires, registry data, and medical chart notes. The information served as a basis for analyzing utilization of health care services during the first 28 days post-delivery. RESULTS: Of the women, 15% sought medical care and 1.7% were readmitted, whereas 17% of the newborns received medical care and 2.9% were readmitted. At 6 months, about half were exclusively being breastfed. There was no difference in need to seek health care or breastfeeding outcome owing to type of maternity care. CONCLUSION: Mothers with newborns sought care relatively frequently but rarely needed to be readmitted after discharge from the maternity care. The risk of readmission during the first month after childbirth was not greater for mothers and children who received care through the family suite or early discharge programs.
The objective was to evaluate the rates of congenital malformation in children born in a population living around a smelter and to employees at the smelter, in a community in northern Sweden. By means of record linkage of the birth register and various registers of congenital malformations, a retrospective study of a birth cohort according to place of parental residence and employment was carried out to assess rates of congenital malformation occurring between 1973-1990. Neither a general, nor specific, significantly increased risk of congenital malformation was seen in the 2724 children born to women living close to the smelter or to employees of the smelter compared with the 15191 children in the reference population. No increased risk could be ascertained although there are reservations concerning the small sample size of the study group.