Obstetric care, pregnancy risk factors and perinatal outcome in the province of Uusimaa, Finland, in 1980-1981.

Abstract

The study was carried out in order to learn about the present state of obstetric care and perinatal outcome in the province of Uusimaa, Finland. The material consisted of 29,061 pregnant women, including 313 multiple pregnancies and 29,374 newborn infants born in the years 1980 and 1981. The information gathered was mostly retrospective. The overall frequency of LBW children was 3.9 percent, of very LBW children 0.8, of preterm children 5.8, of very preterm children 0.7, and of post-term children 4.7 percent. The overall frequency of neonatal transfers to a pediatric ward was 8.6 percent. Centralization of high risk deliveries has increased in Uusimaa since 1975, as judged by the frequencies of LBW children born at the two largest delivery units and four district hospitals. Almost 95 percent of mothers-to-be began their antenatal classes before 16 weeks of gestation. Late admission to antenatal care after week 15 was an independent risk factor for unfavorable pregnancy outcome. The cesarean section rate was 16.5 percent. The frequencies were highest at the State Maternity Hospital (19.7%) and Helsinki University Central Hospital (18.2%). The frequency varied largely in district hospitals (5.9-16.3%). This resulted partly from different indications for cesarean sections in these hospitals. The mean age of the parturients was 28.5 years. The best pregnancy outcome was observed in women aged 25-29 years. Almost half of the parturients were primiparous, and only 4.0 percent were quadri- or grand multiparous. Secundiparous women had the best pregnancy outcome. Terti-parity or more was not a risk factor per se; the difference in the frequency of unfavorable outcome between secundiparas and terti-paras or more disappeared after those with unsuccessful histories were excluded, while the difference still remained significant between primi- and secundiparas. Of all pregnant women, 23 percent had experienced one and 6.4 percent several spontaneous or legally induced abortions. The effect of the number of abortions on the frequency of preterm and very preterm deliveries was linear both in singleton and multiple pregnancies. Almost 70 percent of the parturients belonged to the two highest social classes and 86 percent were married. Children of married women from higher social classes had the best perinatal outcome. Unmarried women from lower social classes more often had 'behavioral' risk factors--they were more often heavy smokers, were uncertain about the dates, had had two or more abortions and neglected maternity care.(ABSTRACT TRUNCATED AT 400 WORDS)