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M Gissler

Publications and source records attributed to M Gissler.

51 records · Page 3Linked to original sources
PubMed1996

Epidural analgesia as a risk factor for operative delivery.

OBJECTIVE: To study the relationship between epidural analgesia and instrumental and non-elective cesarean delivery in the 1990s in Finland. METHODS: The data was extracted from a nationwide birth register in 1991-1993. To adjust for other factors, hospital-based analyses were made separately for different types of hospitals and in individual-based analyses logistic regression was used. RESULTS: In the hospital-based analyses there was no systematic correlation between rates of epidural analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates and different types of hospitals suggests that the contradictory findings in the hospital and individual-based analyses are partly due to selection bias, and partly to different hospital policies. CONCLUSIONS: The results in previous studies and our results suggest that epidural analgesia is a risk factor for an operative delivery, but not a sufficient one, and its impact is likely to be modified by other obstetric practices and interventions.

Analgesia, Epidural↗
PubMed1996

The danger of overmatching in studies of the perinatal mortality and birthweight of infants born after assisted conception.

OBJECTIVE: To examine the impact of gestation length and plurality on short-term outcome of in vitro fertilization (IVF)-children. STUDY DESIGN: A register study using the Finnish Medical Birth Register for 1991-1993 (N = 194 383 newborns, of which 1335 were IVF-newborns). RESULTS: For IVF-newborns, a high proportion of multiple births (27%, odds ratio (OR) 19.67 compared with non-IVF births), low birth weight infants (30%, OR 7.94), and perinatal deaths (2.9%, OR 4.17) was found. The mothers' background did not explain the increased risks. After adjusting for gestation length and/or plurality, the odds ratios decreased significantly. CONCLUSION: Because of the high risk of plurality and premature births, matching the control group by gestation length and/or the number of multiples births may yield misleading results on the total health impact of IVF, and therefore it should be avoided.

Birth Weight↗
PubMed1996

Declining induced abortion rate in Finland: data quality of the Finnish abortion register.

BACKGROUND: Induced abortion rates have declined in Finland since 1973. A possible explanation offered has been that of deteriorating data collection. METHODS: To assess the completeness of the Register, we compared the information from a consecutive sample of hospital records (N = 482) to the Finnish Abortion Register in 18 hospitals in three counties. A smaller consecutive sample (N = 345) was collected from the same hospitals to assess the validity of the Register information. RESULTS: Only five abortions (1 percent) found in the hospitals were not reported in the Abortion Register. A total of 95 percent of all the length of pregnancy (definition problems), the classification of the abortion procedure, and social class (out-of-date classifications). Furthermore, early complications were poorly reported. CONCLUSIONS: The data from the Finnish Abortion Register are a reliable source for monitoring trends in the abortion rate and its variation by subgroups, but are an unreliable source for the study of the medical aspects of induced abortion.

Abortion, Induced↗
PubMed1996

Births by younger and older mothers in a population with late and regulated childbearing: Finland 1991.

PURPOSES: The aims of this study were: first, to ascertain the characteristics of younger and older mothers in the Finnish population; second, to assess the health conditions pertaining to births and newborns according to maternal age groups. METHODS: The data, 26,373 primiparous and 38,895 multiparous women, came from the 1991 nationwide Finnish birth register, and was completed using death and education registers. The younger (< 18 and 18-19 year olds) and older (35-39 and 40 and over) mothers were compared to 20-34 year olds. Infant outcomes were studied by adjusting for mothers' social and obstetric background characteristics by using stepwise logistic regression. RESULTS: Births were rare among women younger than 18 years or 40 years or older. Younger primiparous mothers (less than 20 years) were less often married, more often had a lower social class background, and tended to live in Northern Finland and used antenatal care somewhat less. Their pregnancies, giving birth and infant outcomes were similar to those of 20-34 years old mothers. Most older mothers were women having their families late, rather than having big families. Older primiparas (35 years or older) were less likely to be married, were more often highly educated and lived in urban areas and in the most southern county. Older mothers had more problems during pregnancy and labor, and their infant outcomes were worse. CONCLUSIONS: Our study supports the notion that for young mothers giving birth is a social rather than a medical problem, whereas the reverse is true for older mothers. However, perinatal results for most older mothers are good.

Adolescent↗
PubMed1995

In-vitro fertilization pregnancies and perinatal health in Finland 1991-1993.

In 1993, in Finland at least 0.7% of all pregnancies ending in birth were assisted by in-vitro fertilization (IVF). The purpose of this study was to compare IVF mothers with other mothers, and the perinatal health and health care costs of IVF infants to those of other infants. The main source of information was the Medical Birth Register for 1991-1993 (n = 19,1712 pregnancies, of which 1015 were started by IVF). IVF mothers were more often older, married and primiparas. They started antenatal care earlier, had more visits than other mothers and more than 50% were hospitalized during their pregnancy. Every fourth IVF pregnancy was a multiple one. Both IVF singletons and multiples had poorer health than other infants. The new practice of implanting fewer embryos than before was introduced in 1992-1993, and a 50% decrease in triplet rate was found. At the same time, a somewhat better outcome for IVF newborns was found. However, every fourth child was still preterm or weighed < 2500 g. The health care costs for one IVF newborn from induction of pregnancy until the age of 7 days was 5.4-fold compared to other newborns. The subsequent health of IVF children has to be further studied to more fully assess the health impact of IVF.

Female↗
PubMed1995

Data quality after restructuring a national medical registry.

The validity of the 1991 Finnish Medical Birth Registry data was assessed, with special emphasis on the effects of changes made to the data collection form in 1990. Data abstracted from medical records for all births occurring in 49 hospitals during a five-day sample period (n = 865) were compared to the register information. Good or satisfactory validity was found for 32 of 33 variables, when minor error was tolerated in variables with continuous scales. For diagnoses and procedures, recorded in check-box format, satisfactory validity was found for 10 of 45 variables. Validity could not be assessed for 18 variables because of insufficient number of cases (13 items) or definition problems (5 items). When the results were compared to a 1987 data quality study, many of the variables that had been changed to the check-box format showed improvement in validity. In addition, in some cases a small change in question alternatives or instructions caused a noticeable change in validity.

Abstracting and Indexing↗
PubMed1994

Amount of antenatal care and infant outcome.

The connection between the amount of antenatal care and pregnancy outcome was studied using the 1987 Finnish Medical Birth Registry. A total of 57,108 women were included in the analysis. The timing of initiation of antenatal care and the relative number of antenatal visits (adjusted by gestation length), were used as measures of amount of antenatal care. Nine outcome variables measuring infant health and interventions were studied. Logistic regression was used to adjust for differences in maternal background characteristics. Women beginning antenatal care after the 16th week of gestation had the poorest outcome. Early attending multiparous women had a higher risk of low birthweight, premature infants, caesarean section and instrumental delivery than did those with average timing of their first attendance. For primigravidas, the increased risk was of prematurity only. A U-shaped curve was found for most of the outcome variables in regard to relative number of visits. The women with many visits had the poorest outcome, and also the highest rates of caesarean section and induction of labour. One reason for the unexpectedly high risks for early attenders may be connected with the content of antenatal care. In Finland, it might be possible to reduce the total number of antenatal visits without having any negative effect on infant health.

Birth Weight↗
PubMed1994

Impact of induced abortions and statistical definitions on perinatal mortality figures.

Two problems originating from the advanced use of medical technology in screening for malformations and in the care of preterm and low birthweight infants are presented: the impact of the increasing number of induced medical abortions and the differences in statistical definitions on perinatal mortality (PNM) figures. Data on 186,562 births registered in the Finnish Medical Birth Registry between 1987 and 1989 were studied, and 65,554 medical abortions (of which 1647 were performed after the sixteenth week of gestation) registered in the Abortion Registry between 1985 and 1990. A 115% increase in abortions for medical reasons in the period 1985-1990 was found. It was estimated that the trend accounted for up to one-third of the decline in PNM rate during that time. The perinatal mortality rate was strongly influenced by very small infants. The application of the Finnish version of the International Classification of Diseases, Ninth Revision (ICD-9) (including all livebirths and using both birthweight of 500 g and gestational age of 22 weeks as the criteria) resulted in PNM rates which were about 5% higher than according to ICD-9. We suggest that the impact of medical abortions on perinatal statistics has reduced the value of the perinatal mortality rate as an indicator of the standard of care.

Abortion, Induced↗
PubMed1994

Variation in obstetric care within and between hospital levels in Finland.

OBJECTIVE: In obstetrics, both area and hospital variation has previously been documented for operative procedures, but not for other treatments or diagnostic procedures. This study investigated the extent of variation in care during pregnancy, at birth and after birth. DESIGN AND METHODS: The variation was studied by hospitals (n = 52) by hospital level. To account for differences in women's background characteristics, logistic regression analyses were done. The data came from the 1991 Finnish Birth Register which records data on all births (n = 64,171). RESULTS: All interventions and care practices studied varied notably from one hospital to another, with the variation usually being greater within hospitals of the same level than between hospitals of different levels. Each of the seven non-operative interventions showed a larger variation than did each of the four operative interventions. Standardisation for mothers' background characteristics did not eliminate this variation. Some interventions, but not all, were clustered in the same hospitals. CONCLUSIONS: Such large variation indicates a need for further studies on the benefits of obstetric interventions and of care practices, and on better application of research results to obstetric care.

Female↗
PubMed1994

Birth outcomes by level of obstetric care in Finland: a catchment area based analysis.

STUDY OBJECTIVE: To study whether hospitals of different levels are equally safe places to give birth in a regionalised system of care. DESIGN: This was a population based, cross sectional survey comparing birth outcomes in nationwide catchment areas of different levels of hospital care. All women and low risk women were examined separately. SETTING AND SUBJECTS: The study population comprised all women who gave birth in Finland in 1987-88. The data were obtained from the Finnish Medical Registry, complemented by official data. MAIN RESULTS: No statistically significant differences were found in crude or birthweight specific perinatal mortality rates between the catchment areas, nor did the other outcomes studied favour tertiary care compared with other levels of care in the area based analysis. CONCLUSIONS: In a regionalised system of birth care with a proper referral system, small local hospitals are as safe places to give birth as tertiary care hospitals.

Catchment Area, Health↗
PubMed1993

Quantity and targetting of antenatal care in Finland.

The paper describes the timing of starting antenatal care and the number of visits and their variation measured against women's background characteristics in Finland. The main data source was the 1987 nationwide Medical Birth Registry, while some data were from published statistics and the 1988-90 Medical Birth Registries. These registries cover all antenatal visits, over 80% of which were to special out-patient maternity centers. In 1987, women started antenatal care early (22% before the eighth and 4% in the 16th or later gestation weeks), and the number of visits was high (mean 15.2 visits). Use of antenatal services has been high at least since the early 1970s. Women coming early (< 8 weeks) and at average time (8-12 weeks) were similar to each other, but women coming late (> 12 weeks) were more often socially disadvantaged and had had more previous births, both in analyses stratified by parity, and in logistic regression analyses adjusting for various confounders. When the relative numbers of visits adjusted for gestation length were considered, the differences between the women with many and few visits were similar to the differences between early and late comers. Timing of starting antenatal care did not correlate with the pregnancy outcome. Women having many visits, adjusted for gestation, had poorer outcomes than women with average visits, and women with few visits were in between.

Adult↗
PubMed1979

Tangential orientation and spatial order in dendrites of cat auditory cortex: a computer microscope study of Golgi-impregnated material.

In the tangential plane (parallel to the pial surface) dendrites in the primary auditory cortex (A1) of cat were found to exhibit preferentially oriented growth. This was shown by means of a computer microscope study of Golgi-Cox stained neurons as seen in 100 micrometers and 300 micrometers thick tangential sections. Two techniques were used to represent the 3-dimensional structure of dendrites: the "dendritic stick" and the "dendritic trumpet". The former dismembers a dendrite into its individual segments; the latter considers a dendrite as an entity and represents it by its centroid, its moments and the spatial dispersionof its branches. Both statistical and Fourier analyses of the data show that within the tangential plane there is a significant and consistent orientation of the dendritic sticks in a dorso-ventral direction which seems correlated with the cortical isofrequency contours observed in electrophysiological maps of the A1 region. The dendritic trumpet analyses also show a distinctly non-random vertical distribution of pyramidal cell basal dendrites but not of stellate cell dendrites.

Animals↗