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Accidental out-of-hospital births in Finland: incidence and geographical distribution 1963-1995.

https://arctichealth.org/en/permalink/ahliterature202145
Source
Acta Obstet Gynecol Scand. 1999 May;78(5):372-8
Publication Type
Article
Date
May-1999
Author
K. Viisainen
M. Gissler
A L Hartikainen
E. Hemminki
Author Affiliation
STAKES (National Research and Development Centre for Welfare and Health), University of Helsinki, Department of Public Health, Finland.
Source
Acta Obstet Gynecol Scand. 1999 May;78(5):372-8
Date
May-1999
Language
English
Publication Type
Article
Keywords
Adult
Birth weight
Delivery Rooms - statistics & numerical data
Delivery, obstetric - statistics & numerical data
Female
Finland
Gestational Age
Hospitals - standards
Hospitals, Maternity - statistics & numerical data
Humans
Incidence
Infant, Newborn
Obstetrics and Gynecology Department, Hospital - statistics & numerical data
Parity
Pregnancy
Prenatal Care
Rural Health Services - statistics & numerical data
Urban Health Services - statistics & numerical data
Abstract
The study aims to describe the incidence and geographical distribution of accidental out-of-hospital births (accidental births) in Finland in relation to the changes in the hospital network, and to compare the perinatal outcomes of accidental births and all hospital births.
Data for the incidence and distribution analyses of accidental births were obtained from the official statistics between 1962 and 1973 and from the national Medical Birth Registry (MBR) in 1992-1993. The infant outcomes were analyzed for the MBR data in 1991-1995.
Between 1963 and 1975 the central hospital network expanded and by 1975 they covered 72% of births. The number of small maternity units has decreased since 1963. The incidence of accidental births decreased between 1963 and 1973, from 1.3 to 0.4 per 1000 births, and rose by the 1990s to 1/1000. In the 1990s the parity adjusted risk of an accidental birth was higher for residents of northern than of southern Finland, OR 2.51 (CI 1.75-3.60), and for residents of rural compared to urban municipalities, OR 3.26 (CI 2.48-4.27). The birthweight adjusted risk for a perinatal death was higher in accidental births than in hospital births, OR 3.11 (CI 1.42-6.84).
A temporal correlation between closing of small hospitals and an increase in accidental birth rates was detected. Due to the poor infant outcomes of accidental births, centralization policies should include measures to their prevention.
PubMed ID
10326879 View in PubMed
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Births in Norwegian midwife-led birth units 2008-10; a population-based study.

https://arctichealth.org/en/permalink/ahliterature296870
Source
Tidsskr Nor Laegeforen. 2018 06 12; 138(10):
Publication Type
Comparative Study
Journal Article
Date
06-12-2018
Author
Pål Øian
Olaug Margrete Askeland
Inger Elise Engelund
Brit Roland
Marta Ebbing
Source
Tidsskr Nor Laegeforen. 2018 06 12; 138(10):
Date
06-12-2018
Language
English
Norwegian
Publication Type
Comparative Study
Journal Article
Keywords
Apgar score
Birthing Centers - statistics & numerical data
Delivery Rooms - statistics & numerical data
Delivery, obstetric - statistics & numerical data
Female
Humans
Midwifery
Norway
Parity
Patient Transfer - statistics & numerical data
Posture
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy Outcome - epidemiology
Registries
Risk
Abstract
Fødestuene utgjør en del av en differensiert og desentralisert fødselsomsorg i Norge. Hensikten med studien var å undersøke forekomst og karakteristika ved planlagte og ikke-planlagte fødestuefødsler og årsaker til overflytting samt resultater for mor og barn.
I perioden 2008-10 ble et tilleggsskjema til rutinemeldingen til Medisinsk fødselsregister fortløpende utfylt av jordmor for 2 514 av i alt 2 556 (98,4 %) fødestuefødsler og for 220 fødsler som var planlagt i fødestue, men der fødselen foregikk andre steder. Data fra tilleggsskjema ble så koblet med rutinedata i Medisinsk fødselsregister og resultater fra fødestuefødsler sammenlignet med resultater fra en lavrisikofødepopulasjon i sykehus.
Av de 2 514 fødestuefødslene var 2 320 (92,3 %) planlagt å foregå der, mens 194 (7,7 %) ikke var det. Ved planlagt fødestuefødsel ble totalt 6,9 % overflyttet til sykehus under fødsel, hvorav 19,5 % blant førstegangsfødende. Det var 0,4 % operative vaginale fødsler ved vanlige fødestuer, 3,5 % ved forsterkede fødestuer og 12,7 % ved fødsler overflyttet fra fødestue til sykehus. Blant barn født i fødestue hadde 0,6 % apgarskår
Notes
CommentIn: Tidsskr Nor Laegeforen. 2018 Jun 12;138(10): PMID 29893095
PubMed ID
29893109 View in PubMed
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Does allocation of low risk parturient women to a separate maternity unit decrease the risk of emergency cesarean section?

https://arctichealth.org/en/permalink/ahliterature97330
Source
Acta Obstet Gynecol Scand. 2010 Jun;89(6):813-6
Publication Type
Article
Date
Jun-2010
Author
Britt-Ingjerd Nesheim
Anne Eskild
Leif Gjessing
Author Affiliation
Department of Obstetrics and Gynecology, Oslo University Hospital Ulleval, Oslo, Norway. b.i.nesheim@medisin.uio.no
Source
Acta Obstet Gynecol Scand. 2010 Jun;89(6):813-6
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section - statistics & numerical data
Delivery Rooms - statistics & numerical data
Delivery, obstetric - statistics & numerical data
Female
Hospital Units - statistics & numerical data
Hospitals, University - statistics & numerical data
Humans
Norway
Patient Selection
Pregnancy
Registries
Risk factors
Abstract
OBJECTIVE: To study whether the selection of low risk parturient women into a separate maternity unit leads to a lower risk of emergency cesarean section, compared to giving birth in a unit with mixed cases. DESIGN: Hospital based registry study. SETTING: Maternity units in two university hospitals in Oslo, Norway. POPULATION: All low risk parturient women with attempted vaginal deliveries in the years 2001-2003, a total number of 11,686 deliveries. METHODS: Data were obtained from standardized patient records and risks of cesarean section were estimated as odds ratios. MAIN OUTCOME MEASURES: Emergency cesarean section risk. RESULTS: Compared with women giving birth in a unit with mixed cases, women giving birth in a maternity unit with low risk cases only had a higher risk of emergency cesarean section (OR 1.4; 95% CI 1.2-1.6). CONCLUSIONS: Giving birth in a low risk maternity unit is associated with a higher risk of cesarean section for low risk parturient women compared with giving birth in a maternity unit with mixed cases.
PubMed ID
20397761 View in PubMed
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[Obstetric departments, delivery units and births in Norway in the 1990s]

https://arctichealth.org/en/permalink/ahliterature58539
Source
Tidsskr Nor Laegeforen. 2001 Nov 10;121(27):3208-12
Publication Type
Article
Date
Nov-10-2001
Author
S T Nilsen
A K Daltveit
L M Irgens
Author Affiliation
Kvinneklinikken, Haukeland Sykehus 5021 Bergen. steinil@online.no
Source
Tidsskr Nor Laegeforen. 2001 Nov 10;121(27):3208-12
Date
Nov-10-2001
Language
Norwegian
Publication Type
Article
Keywords
Birthing Centers - statistics & numerical data
Delivery Rooms - statistics & numerical data
Female
Home Childbirth
Humans
Infant, Newborn
Norway - epidemiology
Obstetrics and Gynecology Department, Hospital - statistics & numerical data
Pregnancy
PubMed ID
11876148 View in PubMed
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Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia.

https://arctichealth.org/en/permalink/ahliterature191285
Source
CMAJ. 2002 Feb 5;166(3):315-23
Publication Type
Article
Date
Feb-5-2002
Author
Patricia A Janssen
Shoo K Lee
Elizabeth M Ryan
Duncan J Etches
Duncan F Farquharson
Donlim Peacock
Michael C Klein
Author Affiliation
Centre for Community Health and Health Evaluation Research, BC Research Institute for Children's and Women's Health, Vancouver. pjanssen@interchange.ubc.ca
Source
CMAJ. 2002 Feb 5;166(3):315-23
Date
Feb-5-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - epidemiology
Chi-Square Distribution
Delivery Rooms - statistics & numerical data
Female
Home Childbirth - statistics & numerical data
Humans
Logistic Models
Midwifery - legislation & jurisprudence
Pregnancy
Pregnancy Outcome - epidemiology
Prospective Studies
Risk factors
Abstract
The choice to give birth at home with a regulated midwife in attendance became available to expectant women in British Columbia in 1998. The purpose of this study was to evaluate the safety of home birth by comparing perinatal outcomes for planned home births attended by regulated midwives with those for planned hospital births.
We compared the outcomes of 862 planned home births attended by midwives with those of planned hospital births attended by either midwives (n = 571) or physicians (n = 743). Comparison subjects who were similar in their obstetric risk status were selected from hospitals in which the midwives who were conducting the home births had hospital privileges. Our study population included all home births that occurred between Jan. 1, 1998, and Dec. 31, 1999.
Women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician. After adjustment for maternal age, lone parent status, income quintile, use of any versus no substances and parity, women in the home birth group were less likely to have epidural analgesia (odds ratio 0.20, 95% confidence interval [CI] 0.14-0.27), be induced, have their labours augmented with oxytocin or prostaglandins, or have an episiotomy. Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences. The adjusted odds ratio for cesarean section in the home birth group compared with physician-attended hospital births was 0.3 (95% CI 0.22-0.43). Rates of perinatal mortality, 5-minute Apgar scores, meconium aspiration syndrome or need for transfer to a different hospital for specialized newborn care were very similar for the home birth group and for births in hospital attended by a physician. The adjusted odds ratio for Apgar scores lower than 7 at 5 minutes in the home birth group compared with physician-attended hospital births was 0.84 (95% CI 0.32-2.19).
There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife. The rates of some adverse outcomes were too low for us to draw statistical comparisons, and ongoing evaluation of home birth is warranted.
Notes
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Cites: BMJ. 1996 Nov 23;313(7068):1309-138942693
Cites: Birth. 1994 Sep;21(3):141-87857456
Cites: Birth. 1991 Mar;18(1):14-92006954
Cites: Med J Aust. 1990 Dec 3-17;153(11-12):672-82246990
Cites: Can J Public Health. 2000 Jan-Feb;91(1):I5-1110765581
Cites: Pediatrics. 2000 Jan;105(1 Pt 1):1-710617696
Cites: Pract Midwife. 1999 Jul-Aug;2(7):35-910481690
Cites: BMJ. 1998 Aug 8;317(7155):384-89694754
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Comment In: CMAJ. 2002 Jun 11;166(12):1509; author reply 151112074109
Comment In: CMAJ. 2002 Feb 5;166(3):335-611868643
Comment In: CMAJ. 2002 Jun 11;166(12):1509; author reply 151112074108
Comment In: CMAJ. 2002 Jun 11;166(12):1510; author reply 151112074113
Comment In: CMAJ. 2002 Jun 11;166(12):1510; author reply 151112074112
Comment In: CMAJ. 2002 Jun 11;166(12):1509-10; author reply 151112074107
Comment In: CMAJ. 2002 Jun 11;166(12):1509; author reply 151112074110
Comment In: CMAJ. 2002 Jun 11;166(12):1510-1; author reply 151112074111
PubMed ID
11868639 View in PubMed
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Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model.

https://arctichealth.org/en/permalink/ahliterature270506
Source
Eur J Obstet Gynecol Reprod Biol. 2015 May;188:88-94
Publication Type
Article
Date
May-2015
Author
Marie C Fagerberg
Karel Maršál
Karin Källén
Source
Eur J Obstet Gynecol Reprod Biol. 2015 May;188:88-94
Date
May-2015
Language
English
Publication Type
Article
Keywords
Adult
Area Under Curve
Body Height
Cesarean Section - statistics & numerical data
Delivery Rooms - statistics & numerical data
Female
Forecasting
Humans
Logistic Models
Multivariate Analysis
Pregnancy
Pregnancy Complications - surgery
ROC Curve
Registries
Sweden
Trial of Labor
Vaginal Birth after Cesarean - statistics & numerical data
Young Adult
Abstract
We aimed to validate a widely used US prediction model for vaginal birth after cesarean (Grobman et al. [8]) and modify it to suit Swedish conditions.
Women having experienced one cesarean section and at least one subsequent delivery (n=49,472) in the Swedish Medical Birth Registry 1992-2011 were randomly divided into two data sets. In the development data set, variables associated with successful trial of labor were identified using multiple logistic regression. The predictive ability of the estimates previously published by Grobman et al., and of our modified and new estimates, respectively, was then evaluated using the validation data set. The accuracy of the models for prediction of vaginal birth after cesarean was measured by area under the receiver operating characteristics curve.
For maternal age, body mass index, prior vaginal delivery, and prior labor arrest, the odds ratio estimates for vaginal birth after cesarean were similar to those previously published. The prediction accuracy increased when information on indication for the previous cesarean section was added (from area under the receiver operating characteristics curve=0.69-0.71), and increased further when maternal height and delivery unit cesarean section rates were included (area under the receiver operating characteristics curve=0.74). The correlation between the individual predicted vaginal birth after cesarean probability and the observed trial of labor success rate was high in all the respective predicted probability decentiles.
Customization of prediction models for vaginal birth after cesarean is of considerable value. Choosing relevant indicators for a Swedish setting made it possible to achieve excellent prediction accuracy for success in trial of labor after cesarean. During the delicate process of counseling about preferred delivery mode after one cesarean section, considering the results of our study may facilitate the choice between a trial of labor or an elective repeat cesarean section.
PubMed ID
25801723 View in PubMed
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The rate of obstetric anal sphincter injuries in Finnish obstetric units as a patient safety indicator.

https://arctichealth.org/en/permalink/ahliterature115713
Source
Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(1):33-8
Publication Type
Article
Date
Jul-2013
Author
Aura Pyykönen
Mika Gissler
Maija Jakobsson
Lasse Lehtonen
Anna-Maija Tapper
Author Affiliation
Department of Obstetrics and Gynaecology, Helsinki University Hospital, PO Box 140, FIN-00029 HUS, Finland. aura.pyykonen@helsinki.fi
Source
Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(1):33-8
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Anal Canal - injuries
Delivery Rooms - statistics & numerical data
Delivery, Obstetric - adverse effects
Female
Finland - epidemiology
Humans
Logistic Models
Maternal Age
Obstetric Labor Complications - epidemiology
Parity
Patient Safety - statistics & numerical data
Pregnancy
Abstract
To study whether there are significant differences in the rate of obstetric anal sphincter injuries (OASIS) between the different sized delivery units in Finland.
The study was performed as a population based registry study in Finland, including all births (294725) between 2006 and 2010. All the Finnish delivery units (34) were categorized by the number of annual deliveries and the OASIS rate was then compared between the different sized delivery units using a logistic regression analysis adjusting for maternal age and parity. The Robson ten group classification was used for more accurate comparison.
The OASIS rate was significantly elevated, both in the largest units with 5000 annual deliveries or more (OR 1.46, 95% CI 1.11-1.92) and in the smallest units with less than 500 annual deliveries (OR 1.33, 95% CI 1.22-1.45). In the Robson's group 1 (primiparous, single cephalic term pregnancy, spontaneous labour) the risk for OASIS was the highest in the largest units (OR 1.44, 95% CI 1.28-1.61) while in the Robson's group 3 (multiparous, single cephalic term pregnancy, spontaneous labour) the highest risk was found in the smallest units (OR 2.90, 95% CI 1.68-5.02).
There is significant inter-hospital variation in OASIS rates suggesting significant differences in obstetric practices. Robson's ten group classification should be used to enhance the inter-hospital comparison.
PubMed ID
23474118 View in PubMed
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Severe and fatal obstetric injury claims in relation to labor unit volume.

https://arctichealth.org/en/permalink/ahliterature264001
Source
Acta Obstet Gynecol Scand. 2015 May;94(5):534-41
Publication Type
Article
Date
May-2015
Author
Maria Milland
Kim L Mikkelsen
Jens K Christoffersen
Morten Hedegaard
Source
Acta Obstet Gynecol Scand. 2015 May;94(5):534-41
Date
May-2015
Language
English
Publication Type
Article
Keywords
Birth Injuries - mortality
Compensation and Redress
Delivery Rooms - statistics & numerical data
Delivery, Obstetric - adverse effects - mortality - statistics & numerical data
Denmark - epidemiology
Female
Humans
Incidence
Infant, Newborn
Insurance Claim Review
Outcome Assessment (Health Care)
Pregnancy
Registries
Abstract
To assess possible association between the incidence of approved claims for severe and fatal obstetric injuries and delivery volume in Denmark.
A nationwide panel study of labor units.
Claimants seeking financial compensation due to injuries occurring in labor units in 1995-2012.
Exposure information regarding the annual number of deliveries per labor unit was retrieved from the Danish National Birth Register. Outcome information was retrieved from the Danish Patient Compensation Association. Exposure was categorized in delivery volume quintiles as annual volume per labor unit: (10-1377), (1378-2016), (2017-2801), (2802-3861), (3862-6659).
Five primary measures of outcome were used. Incidence rate ratios of (A) Submitted claims, (B) Approved claims, (C) Approved severe injury claims (120% degree of disability), (D) Approved fatal injury claims, and (C+D) Combined.
1 151 734 deliveries in 51 labor units and 1872 submitted claims were included. The incidence rate ratios of approved claims overall, of approved fatal injury claims, and of approved severe and fatal injuries combined increased significantly with decreasing annual delivery volume. Face value incidence rate ratios of approved severe injuries increased with decreasing labor unit volume, but the association did not reach statistical significance.
High volume labor units appear associated with fewer approved and fewer fatal injury claims compared with units with less volume. The findings support the development towards consolidation of units in Denmark. A suggested option would be to tailor obstetric patient safety initiatives according to the delivery volume of individual labor units.
PubMed ID
25659972 View in PubMed
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[Statistical study of workload at a birthing unit]

https://arctichealth.org/en/permalink/ahliterature64546
Source
Ugeskr Laeger. 1995 Oct 30;157(44):6133-7
Publication Type
Article
Date
Oct-30-1995
Author
A T Andersen
N U Grove
B F Nielsen
Author Affiliation
Institut for Matematisk Modellering, Danmarks Tekniske Universitet, Lyngby.
Source
Ugeskr Laeger. 1995 Oct 30;157(44):6133-7
Date
Oct-30-1995
Language
Danish
Publication Type
Article
Keywords
Delivery Rooms - statistics & numerical data
Denmark - epidemiology
English Abstract
Female
Hospitals, County - statistics & numerical data
Humans
Models, Statistical
Obstetric Labor Complications - epidemiology
Patient Admission
Pregnancy
Workload
Abstract
The work consists of a statistical study of the workload on a labour ward. This included a study of the admission/birth frequency and an investigation of the factors that influenced the process of admissions and the time spent on the ward. Also the relation between the number of midwives and women in labour present on the ward was investigated. It was found that the variation in the number of spontaneous admissions/births could be described reasonably well by a Poisson distribution. A simple statistical model was proposed to calculate the number of midwives necessary at any given birth frequency. For a specific choice of parameters the model fitted the actual distribution very well. The relative frequency of complications was highest for women with no previous births and smallest for women with one previous birth. The time spent on the labour ward depended significantly on the number of times the woman had given birth before and on whether the present delivery was complicated.
PubMed ID
7483090 View in PubMed
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10 records – page 1 of 1.