Fear of childbirth after induced abortion in primiparous women: Population-based register study from Finland.

INTRODUCTION: Fear of childbirth (FOC) is a common obstetrical challenge that complicates about every 10th pregnancy. Background factors of FOC are diverse. We evaluated the association of induced abortion (IA) and FOC in subsequent pregnancy. MATERIAL AND METHODS: Population-based register study based on three Finnish national registers: the Register of Induced Abortions, the Medical Birth Register and the Hospital Discharge Register. The study cases were primigravid women undergoing an IA in 2000-2015 and subsequent pregnancy ending in live singleton birth up to 2017. Each case had three controls, matched by age and residential area, whose first pregnancy ended in a live birth. The main outcome was the incidence of FOC in the subsequent pregnancy. In a secondary analysis, we assessed other risk factors for FOC. RESULTS: The study cohort consisted of 21 455 women and 63 425 controls. Altogether, 4.2% of women had a diagnosis of FOC. The incidence was higher in women with a history of IA than in controls (5.6% vs 3.7%, P < 0.001). A history of IA was associated with higher odds for FOC: adjusted odds ratio [aOR] 1.20 with 95% confidence interval (CI) 1.11-1.30. In addition, a history of psychiatric diagnosis (aOR 3.48, 95% CI 3.15-3.83), high maternal age, 30-39 years old (aOR 1.55, 95% CI 1.43-1.67; P < 0.001) and ≥40 years old (aOR 3.00, 95% CI 2.37-3.77; P < 0.001) and smoking (aOR 1.20, 95% CI 1.11-1.31; P < 0.001) were associated with increased odds for FOC. Women living in densely populated or rural areas and those with lower socioeconomic class had lower odds for FOC. CONCLUSIONS: A history of IA is associated with increased odds for FOC in subsequent pregnancy. However, the associations of FOC with a history of psychiatric diagnosis and elevated maternal age (especially ≥40 years old) are more pronounced.

FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors.

BACKGROUND: Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH). METHODS: A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics. RESULTS: Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38-4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06-7.83) and with a large uterus ≥500 g (OR 2.88, 95% CI 1.05-7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17-117.88). CONCLUSIONS: FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.

National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000-2005.

BACKGROUND: Complications of laparoscopic hysterectomy (LH) have been evaluated with particular focus on quantities of urinary tract injuries. An earlier survey in the 1990s on LH in Finland indicated a decreasing trend in complications; our aim was to evaluate the current complications and hysterectomy trends. METHODS: All hysterectomies in Finland performed for benign indication from 2000 to 2005 (n = 56 130) were included, data were obtained from the Finnish hospital care register. All major complications reported on LH were analysed; the data were collected retrospectively from the Patient Insurance Centre. RESULTS: In 2000, the proportion of abdominal hysterectomy (AH) was 38%, vaginal hysterectomy (VH) 37% and LH 25%, whereas in 2005, the proportions were 26%, 45% and 29%, respectively. The overall incidence of major complications in LHs from 1992 to 1999 (LH n = 13 885) was 1.8% and from 2000 to 2005 (LH n = 13 942) it decreased to 1.0%. During the same time, urinary tract injuries decreased from 1.4% to 0.7%; in detail ureteral injuries decreased from 0.9% to 0.3%. CONCLUSIONS: Laparoscopic and VHs have become more common in Finland than AH. Continuous instruction and training of the Finnish gynaecological surgeons has helped to diminish major complication rates and it seems that in LH, a plateau on the learning curve has been reached.