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Biomedical subjects

E Hemminki

Publications and source records attributed to E Hemminki.

At least 163 records · Page 9Linked to original sources
PubMed1986

The timing of hospital admission and progress of labour.

We set out to study the relationship between the timing of hospital admission and the progress of labour. In all there were 591 healthy primiparous women with normal pregnancies and who anticipated normal deliveries; 436 of them had come because of contractions. When the intrinsic speed of labour (estimated from the status of the cervix at the time of admission in relation to the duration of regular contractions) was allowed for, women coming early (regular contractions for 4 h or less before admission) as compared to those coming late stayed longer in the hospital before delivery but had a shorter total length of labour. They had more interventions during labour, more caesarean sections, longer postpartum hospital stay, and their children had more diagnoses of difficult delivery. Women who came because of ruptured membranes without contractions had shorter labours, more interventions during labour, longer postpartum stay and their children had more discharge diagnoses and longer hospital stay than women coming late. This study suggests that too early admission to the hospital may negatively affect the progress of labour, and controlled trials are needed to confirm or to disprove this suggestion.

Adult↗
PubMed1986

Caesarean section as a risk factor for malformations--a negative finding.

The question whether Caesarean section is a risk factor for malformations was examined among 35,865 children born in 1959-65 and included in the US Collaborative Perinatal Project; 1,407 children were subsequent children of mothers who had a Caesarean section for the previous birth (exposed). The rate of malformed children was about the same in the exposed and non-exposed groups, and the rate of children with major malformations was only slightly higher in the exposed group (risk ratio was 1.1, ie not statistically significant). Multiple variable adjustment for potentially confounding factors further reduced the risk ratios. Caesarean section did not appear to be a risk factor in this population, but further studies covering more recent times and including fetal deaths are needed.

Cesarean Section↗
PubMed1986

Effects of cesarean section on fertility and abortions.

The impact of cesarean section on subsequent fertility and abortions was studied by comparing cohorts of women from two populations with unequal rates of cesarean section. After excluding women with strong confounding factors, all primiparae having had a cesarean section in 1973 and 1976 and matched controls were identified from the Swedish Birth Registry. The subsequent births in the next five and eight years were sought from the same registry and subsequent spontaneous abortions from the Hospital Inpatient Discharge Registry. There were fewer second children, subsequent children and twin deliveries in the cesarean section groups than in the control groups. The ratio of spontaneous abortions to births was somewhat higher in the cesarean section groups, but the difference was not statistically significant. Regardless of the different rates of cesarean section in the two populations, the 1973 and 1976 cohorts were similar. Apparently the findings were due not only to selection in the first cesarean section but possibly also to the operation itself.

Abortion, Spontaneous↗
PubMed1985

Ambulation versus oxytocin in protracted labour: a pilot study.

We compared ambulation with oxytocin in the treatment of protracted labour with a randomized, controlled trial of 57 patients. Sixty percent of the women in the ambulant group delivered their babies without oxytocin. In the ambulant group, the mean length of the second stage of labour was shorter and the women themselves held relatively positive views on their experiences. In the oxytocin group, on the other hand, the women experienced stronger contractions before pushing and also suffered from more excessively strong contractions. Our trial included too few women to judge which treatment is better for the infant's health. Nevertheless, the women's opinions and the quality of their contractions demonstrate that more attention should be paid to ambulation as a treatment for protracted labour.

Adult↗
PubMed1985

Cesarean section and subsequent fertility: results from the 1982 National Survey of Family Growth.

The purpose of this article was to examine the question of fertility after a cesarean section. The study design is that of a retrospective cohort study with matched pairs, using the cross-sectional interview data of the 1982 National Survey of Family Growth. The subsequent fertility of 406 women who had had their first delivery by cesarean section is compared with that of 406 matched control women. Using any of several measures, women who had had a cesarean section had lower fertility. The difference in fertility seemed to result largely from difficulties in having children after a cesarean section, rather than lessened desire for children. Sterilizations were more frequent and performed earlier among women who had had a cesarean section than among the control women.

Attitude to Health↗
PubMed1985

Perinatal mortality distributed by type of hospital in the Central Hospital District of Helsinki, Finland.

In Finland as in many other countries, perinatal mortality is higher in those institutions having a higher level of care. To explain this phenomenon, mortality by weight groups was studied in different hospitals in the Central Hospital District of Helsinki in Finland in 1977-81. Among infants weighing less than 2 500 g, perinatal mortality was higher in the local hospital than in the university hospital, the higher mortality being due to the higher rate of stillborn infants. Among babies weighing over 2 500 g, the mortality was lower in local hospitals than in the university hospital. Further studies to explain the higher mortality of infants weighing over 2 500 g in the university hospital are needed.

Birth Weight↗
PubMed1984

Diuretics in pregnancy: a case study of a worthless therapy.

In the 1960s and 1970s diuretics were used during pregnancy to prevent and treat toxemia, but this therapy is now widely condemned as ineffective and harmful. The purpose of this paper was to study this example, to learn from it and to help to prevent further such examples. Data sources included selected articles in medical journals and text-books; in Finland drug catalogues, handbooks, unpublished sales data and interviews and questionnaires to physicians; in Sweden drug catalogues and sales data; controlled clinical trials were also analyzed. Analysis of the controlled clinical trials suggested that the whole episode of wide-spread diuretic use in pregnancy could have been avoided, if the available information had been used. A reason for the neglect of the critical information was apparently that the use of diuretics was in accordance with the common medical reasoning which values changes in clinical signs rather than looking for better health indicators. Use of diuretics was condemned in Finland later than, for example, in the United States, and decline in use occurred prior to the warnings in the local literature. Changes in practice seem to have occurred hierarchially and locally: opinions of a few leading obstetricians were crucial and they were rapidly and effectively disseminated to the providers of antenatal care in the domain of each obstetrician. This hierarchial dissemination of information has profound consequences for the attempts of understanding and influencing the prescribing habits of physicians.

Adolescent↗
PubMed1984

Trade names and generic names. Problems for prescribing physicians.

Drugs are marketed with generic and trade names. Our purpose was to study whether this dual name system causes problems to physicians. We interviewed 102 Finnish physicians to find out how well they recalled the composition of combination drugs, and connected the corresponding generic and trade names. The generic name of the given trade-names were known on average by 83% of the physicians who had recently prescribed them, but knowledge of the combination drugs was poor. When generic names were given, on average 9% of the physicians who had prescribed them could mention the corresponding trade names. A multitude of names causes information problems, with possible clinical consequences. From the information point of view, one naming system would be desirable.

Drug Combinations↗
PubMed1983

Ambulation and delayed amniotomy in the first stage of labor.

Our purpose was to study the feasibility and results of encouraging ambulation during the first stage of labor in routine obstetric practice. Six-hundred and thirty low risk mothers with intact membranes were randomized into an ambulant and a control group. The results in the ambulant group were not better than in the control group. Our study suggests that, in principle ambulation may be beneficial, but that the concomitant changes in practice should be different from those in our study.

Adult↗
PubMed1983

Obstetric practice in Finland, 1950-1980. Changes in technology and its relation to health.

The purposes of the paper are to describe changes in the technologic methods used in Finnish obstetric practice and to relate them to some measures of infant and mother health. Antenatal care in Finland still largely retains its original low-technology character, but changes toward more technology-oriented care can be seen. The management of labor and deliveries changed dramatically in the latter half of the 1960s and in the 1970s. More and more births occurred in large, specialized hospitals instead of in small, local hospitals. Electronic fetal monitoring, drug treatment of labor (oxytocin and analgesia), deliveries with instruments, and cesarean sections became common. Comparisons of perinatal mortality by county and by hospital suggest that the correlations between the technologic methods studied, especially cesarean sections, and decreasing perinatal mortality probably do not reflect direct causal relationships.

Delivery, Obstetric↗
PubMed1982

Problems in the measurement of psychotropic drug consumption.

Two problems of measuring psychotropic drug use are described and illustrated using sales of psychotropic drugs in Finland and Norway. Classifying psychotropic drugs is a problem because the meaning of psychotropic drugs is not clear on a theoretical or practical level. In particular, the role of hidden psychotropic drugs--psychotropics included in combination products--is noted. Previous studies comparing the Nordic countries did not include combination products. Because a notable proportion of psychotropic substances sold in Finland were combination products, the inclusion of hidden psychotropic drugs affected the comparative levels of psychotropic drug use in Norway and Finland. Another problem in measuring psychotropic drug use is the unit of measurement. Traditional units of measurement, including defined daily dose (DDD), are discussed, and a new unit called the defined exposure dose (DED) is introduced. DED estimates the potential chemical exposure of the population to drugs. Sales of psychotropics in numbers of DDD/ and DED/ 1000 inhabitants/day in Finland and Norway from 1962 to 1978 were compared. Sales appeared to be much higher when DEDs were used. Irrespective of the unit used, sales were greater in Finland than Norway. Methods used to measure psychotropic drug use can affect conclusions drawn. The choice of unit of measurement should depend on the problem being studied, data source, and available resources. The concept of DED merits further investigation.

Drug Prescriptions↗