Ansa Aitokallio-Tallberg

Cesarean delivery in Finland: maternal complications and obstetric risk factors

Objective. To assess the rate of maternal complications related to cesarean section (CS) and to compare morbidity between elective, emergency and crash‐emergency CS. To establish risk factors associated with maternal CS morbidity. Design. A prospective multicenter cohort study. Setting. Twelve delivery units in Finland. Population. Women delivering by CS (n = 2,496) during a 6 months period in the study hospitals. Methods. Data on pregnant women, CS, and maternal recovery during the hospital stay was collected prospectively on report forms. The complication rates by different CSs were calculated, and factors associated with morbidity were analyzed by odds ratios (OR). Main outcome measures. Maternal complication rates in different types of CS. The association of risk factors with morbidity. Results. About 27% of women delivering by CS had complications; 10% had severe complications. The complication rate was higher in emergency CS than in elective CS, and highest in crash‐emergency CS. Significant independent risk factors for maternal morbidity were emergency CS and crash‐emergency CS compared to elective CS (OR 1.8; 95% confidence interval (CI) 1.5–2.2), pre‐eclampsia (OR 1.5; CI 1.1–2.0), maternal obesity (OR 1.4; CI 1.1–1.8) and maternal increasing age (OR 1.1; CI 1.03–1.2 per each 5 years). Conclusions. Maternal complications are frequent in CS, and although performing CS electively reduces the occurrence of complications, the frequency is still high. The complication rate depends on the degree of emergency, and increases with maternal obesity, older age and pre‐eclampsia.

Diagnosis and treatment of severe hemolytic disease of the fetus and newborn: a 10-year nationwide retrospective study.

Outcome after intrauterine transfusions due to severe hemolytic disease of the fetus and newborn.

Foley Catheter or Oral Misoprostol for Induction of Labor in Women with Term Premature Rupture of Membranes: A Randomized Multicenter Trial

Objectives To compare the Foley catheter and misoprostol for induction of labor in term women with premature rupture of membranes. Study Design A randomized controlled trial was performed in three university hospitals in Finland between March 2012 and September 2014. A total of 202 term women with ruptured membranes >18 hours, singleton pregnancies in cephalic presentation, unfavorable cervix, and no prior cesarean section were enrolled. Participants were randomly allocated to induction of labor by Foley catheter or oral misoprostol in a 1:1 ratio. All women received prophylactic antibiotics. The main outcomes were cesarean section and maternal and neonatal infections. Results Labor induction by Foley catheter or misoprostol showed no difference in cesarean delivery rates (23.6 vs. 18.2%; odds ratio [OR], 1.39; 95% confidence interval [CI], 0.69-2.82; p = 0.36), maternal intrapartum infections (2.2 vs. 2%; OR, 1.12; 95% CI, 0.15-8.9; p = 1.00), postpartum infections (1.1 vs. 2.0%; OR, 0.55; 95% CI, 0.05-6.18; p = 1.00), or neonatal infections (1.1 vs. 5.1%; OR, 0.21; 95% CI, 0.24-1.87; p = 0.22). The total time from induction to delivery was similar (1,311 vs. 1,435 minutes; p = 0.31) in the two groups. Conclusions Foley catheter or misoprostol can both be used for induction of labor in women with term premature rupture of membranes.

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.

Management of prolonged pregnancy by induction with a Foley catheter

To describe labor outcomes in women with prolonged pregnancy and induction of labor with a Foley catheter, as compared with women with spontaneous onset of labor.

Effect of interleukin 2 on urinary excretion of degradation products of prostacyclin and thromboxane A2 in patients with ovarian cancer

We studied the effect of intraperitoneal recombinant interleukin 2 (rIL-2) on the production of prostacyclin (PGI2) and thromboxane A2 (TxA2) in six patients with metastatic ovarian malignancy. Time-span urine samples collected before and after 17 intraperitoneal instillations of IL-2 (6 x 10(5) IU m-2) were assessed for 2,3-dinor-6-keto-prostaglandin F1 alpha (dinor-6-keto; a metabolite reflecting the in vivo product of PGI2) and 2,3-dinor-thromboxane B2 (dinor-TxB2; a metabolite reflecting the production of TxA2). Analysis was by high-pressure liquid chromatography, followed by radioimmunoassay. Recombinant IL-2 administration was accompanied by a significant rise (85%; P < 0.02) in the output of dinor-6-keto within the first 2 h, and this elevation persisted for up to 6 h. Moreover, output of dinor-TxB2 also rose; this rise (30%) was significant (P < 0.02) 6 h after the instillation. These effects may, in some yet unknown manner, prove significant in the anti-cancer action of rIL-2.

Urinary 6-keto-prostaglandin F1a in patients with gynaecological tumours.

The production of the antiaggregatory and vasodilatory prostacyclin (PGI2) in patients with gynaecological tumours was studied by assaying urinary 6-keto-prostaglandin F1a (= 6-keto-PGF1a), a hydration product of PGI2), by radioimmunoassay following high performance liquid chromatography (HPLC) in 59 patients with gynaecological tumours and 12 non-tumourous control women. Urinary 6-keto-PGF1a excretion in patients with cervical cancer (28.3 +/- 3.6 pmol/mmol creatinine, mean +/- S.E., n = 12), endometrial cancer (22.8 +/- 3.7 pmol/mmol creatinine, n = 12, uterine fibroids (26.0 +/- 3.5 pmol/mmol creatinine, n = 12) benign ovarian cysts (22.4 +/- 1.8 pmol/mmol creatinine, n = 12) did not differ from that in the control women (29.9 +/- 3.6 pmol/mmol creatinine, n = 12). However, patients with ovarian cancer excreted increased amounts of 6-keto-PGF1a (55.4 +/- 10.4 pmol/mmol creatinine, n = 11, P less than 0.05), although this bore no relation to tumour histology, clinical stage or the outcome of the patients. Thus, ovarian cancer is accompanied by increased PGI2 production, perhaps in the kidneys and/or in the cancer tissue.

Amniotic lamellar body counts determined with the SysmexR XE-2100 analyzer to predict fetal lung maturity during diabetic and other complicated pregnancies

Abstract Objective. The detection of amniotic lamellar bodies (LB) has been shown to be a rapid and simple way to assess fetal lung maturity (FLM). The maturity thresholds for LB vary due to different factors, one being the type of particle-count analyser used. Material and methods. The SysmexR XE-2100 hematological analyser was evaluated in determination of amniotic LB counts and compared with lecithin/sphingomyelin (L/S) and phosphatidylglycerol (PG) determination. We analysed 132 amniotic samples from a total of 109 mothers (71 diabetic) with 112 infants. Results. The correlation between the LB counts obtained with the SysmexR XE-2100 and our reference thin layer chromatography (TLC) phospholipid method was good. Samples with low L/S ratio (≤2.0) and no PG (i.e. premature fetal lung status), had low LB counts (n = 18, mean 8500/uL, range 1000–26000), whereas 51 samples with mature fetal lung status had high LB counts (mean 63600/uL, range 20,000–139,000). In all our four cases of respiratory distress syndrome the LB counts were low (range 1000 – 28000/uL). The reference values for FLM determination were established: ≤6000/uL for immature, values between 7000 and 35,000/uL for borderline results and >35,000/uL for mature. Conclusions. The amniotic LB count analysis with SysmexR XE-2100 has many advantages being a repeatable, inexpensive and quantitative method with a very short turn-around time. Consequently, our routine is to perform LB counts initially from all amniotic samples and only borderline LB results are analysed with TLC.