Mortality, major neurological handicaps--including mental retardation, cerebral palsy and epilepsy--educational subnormality and height at 14 years of age were studied by birth weight percentiles in a birth cohort of 12 000 children from northern Finland. Infant mortality was significantly higher below the mean -2 SD, 10th and 25th percentiles, than in the median class, from 25th to 75th percentiles, but mortality from one to 14 years only in the lowest weight class. Educational subnormality, including mental retardation +/- some other handicap, was highly significantly more frequent in all the percentile classes lower than the median class but showed no significant tendency to be less frequent in the percentiles over the median. It was also highly significantly more frequent among the preterm than the term infant. The number of children with a major neurological handicap but normal school performance did not vary significantly by birth weight percentiles or by gestational age. Height at 14 years increased significantly by birth weight percentiles. The height of the boys with birth weight mean - and +2 SD was nevertheless within the 25th-75th percentiles for height at 14 years in general, while the height of the girls came close to these percentile limits. The preterm infants were significantly shorter than the term infants at 14 years.
AIMS: To investigate the morphology of the optic disc and retinal vessels in children with surgically treated hydrocephalus. METHODS: A prospective, population-based study was performed in 69 children (median age 9.6 years) with early surgically treated hydrocephalus. All children were examined by ophthalmoscopy. Additionally, optic disc and retinal vessel morphology was evaluated in 55 children by digital image analysis of ocular fundus photographs. RESULTS: Optic atrophy was found in 10 of 69 children (14%). In comparison with a reference group, the median optic-disc area was significantly smaller (p = 0.013) in the children with hydrocephalus. There was no corresponding difference in cup area, so the rim area was significantly smaller in the hydrocephalic children (p = 0.002). Children with hydrocephalus had an abnormal retinal vascular pattern, with significantly straighter retinal arteries and fewer central vessel branching points compared with controls (p
This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.
PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2001. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. In 2000 and 2001, Oklahoma again reported these data, increasing the number of reporting areas to 49. RESULTS: A total of 853,485 legal induced abortions were reported to CDC for 2001 from 49 reporting areas, representing a 0.5% decrease from the 857,475 legal induced abortions reported by the same 49 reporting areas for 2000. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2001, compared with 245 reported for 2000. This represents a 0.4% increase in the abortion ratio. The abortion rate was 16 per 1,000 women aged 15-44 years for 2001, the same as for 2000. For both the 48 and 49 reporting areas, the abortion rate remained relatively constant during 1997-2001. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%) and aged 15 weeks' gestation, including 4.3% at 16-20 weeks and 1.4% at > or =21 weeks. A total of 35 reporting areas submitted data stating that they performed medical (nonsurgical) procedures, making up 2.9% of all reported procedures from the 45 areas with adequate reporting on type of procedure. In 2000 (the most recent year for which data are available), 11 women died as a result of complications from known legal induced abortion. No deaths were associated with known illegal abortion. INTERPRETATION: During 1990-1997, the number of legal induced abortions gradually declined. When the same 48 reporting areas are compared, the number of abortions decreased during 1996-2001. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly. In 2000, as in previous years, deaths related to legal induced abortions occurred rarely (less than one death per 100,000 abortions). PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.
During pregnancy, the information needs of patients are high and effective information sharing between patients and health care providers is of particular importance. We conducted a randomized controlled trial to evaluate the effect of providing pregnant women with secure access to their antenatal health records on their uptake of, and satisfaction with, relevant information.
Women presenting to a primary care maternity centre before 28 weeks' gestation were randomized to receive access either to a secure website with links to general pregnancy health information alone (GI group) or to the same website with access to their own antenatal health record (PI group). Primary outcomes included frequency of use, and satisfaction with and perceived usefulness of the web-based information.
We approached 199 women regarding participation in the study; 193 agreed to participate, and 97 were randomized to the PI group and 96 to the GI group. The mean number of log-ins to the website in the PI group subsequently was almost six times the number of log-ins in the GI group (10.4 +/- 17.8 vs. 1.8 +/- 1.4; P
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.
Cadmium, zinc, and copper from placental tissue and blood samples at the first trimester (n = 64) and at term (n = 152) were analyzed; the welfare of newborns and placental 7-ethoxycoumarin O-deethylase (ECOD) activities in vitro were determined. The study material was collected from Finland, Estonia, and Russia. The results demonstrate that Cd starts to accumulate in the placenta during the first trimester and that Zn and Cu contents were significantly higher at the first trimester than at term. Among nonsmokers a negative correlation was found between placental Cu content and birth weight of neonates. Among smokers a positive correlation between placental Zn content and birth weight and ECOD activity was found. The birth weights correlated inversely with the length of time the mothers smoked. The highest Cd concentrations were detected in the samples collected from St. Petersburg. The data demonstrate an inverse accumulation of Zn and Cd throughout the pregnancy in the placenta and maternal blood samples. Zn may act as a positive marker or even an enzymatic enhancement for the human placental vital functions. Smoking, parity, age, and especially the place of residence affect the Cd, Zn, and Cu contents and ratios in placenta and mother's blood.
OBJECTIVE: To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates. DESIGN: Comparison of data from the DBR and the European Youth Heart Study (EYHS). SETTING: Schools in Odense, Denmark. POPULATION: A total of 1271 and 678 mothers of school children participated with information in the accuracy studies of BW and GA, respectively. The reliability sample of BW was composed of 359 women. METHOD: The agreement between the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland-Altman's plots. The misclassification of the various BW and GA categories were also estimated. MAIN OUTCOME MEASURES: Differences between recalled and registered BW and GA. RESULTS: There was high agreement between recalled and registered BW (MD =-0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression revealed that the most important variables in the discordance between recalled and registered BW were ethnicity and parity. Maternal recall of BW was highly reliable (MD =-5.5 g; ICC = 0.93), and reliability remained high across subgroups. CONCLUSION: Maternal recall of BW and GA seems to be sufficiently accurate for clinical and epidemiological use.
OBJECTIVE: Fetal urine production at different gestational ages has been evaluated using ultrasound in several previous studies. In a recent study, we investigated the accuracy when estimating the bladder volume using the conventional ultrasound technique and found a total variability of 17.3-10.9% for bladder volumes of 5-40 mL. The variability is mainly caused by: (i) inappropriate image selection (the 'freezing error') and (ii) limitations when measuring on the frozen image (the 'frozen error'). The aim of this study was to reduce the total error by reducing the 'freezing' and the 'frozen error'. To this end, we used a modified manual ultrasound technique (adding a 'rocking' motion to the conventional method) and digitized the selected image. METHODS: Two patients for each gestational week from 24 to 40 weeks were selected. The fetal urinary bladder was examined with ultrasound three times within 1 min and documented on videotape. The volume, as assessed by the longitudinal section of the recorded bladder images, stored in digitized form, was evaluated on three occasions with > 24 h in between. The mean and variability (standard deviation, SD) were estimated. RESULTS: For fetal bladder volumes between 5 and 40 mL, the 'freezing error' (SD), the 'frozen error' and the 'total error' were 11.7-5.1%, 8.0-3.0% and 14.2-5.9%, respectively. Comparing the present with a previous study, when selecting images and assessing bladder volumes repeatedly within 1 min, SD was 12.9-5.5% vs. 17.3-10.9%. CONCLUSIONS: Using a modified ultrasound technique, the variability in fetal bladder volume estimation can be reduced.
In nuclei of hepatocytes of human embryos from the 18th to 40th week of antenatal development the activity of synthesis enzymes lowers: thymidine kinase is 7 times at low, uridine kinase - 11 times as low. In parallel during the same period a decrease in the activity of nucleases drops: DNase - by 15 times, RNase - by 11 times. The activity of these enzymes in the liver of adult persons (22-35 years old) is similar to their activity in the liver of human embryo to the moment of birth.