Marja Kaijomaa - Academia.edu (original) (raw)

Papers by Marja Kaijomaa

European journal of midwifery, Jul 2, 2024

Research Square (Research Square), Apr 3, 2024

Purpose: Cesarean section is the most common surgery performed on women. According to the enhance... more Purpose: Cesarean section is the most common surgery performed on women. According to the enhanced recovery recommendation, early urinary catheter removal and early mobilization are essential elements of postoperative care. The issue of catheter therapy length is still controversial but early mobilization is known to improve the overall postoperative recovery. This study aimed to analyze the possible interaction of these elements and whether the use of urinary catheter itself affects the time of postoperative mobilization. Methods: This retrospective case-control study consisted of cases enrolled in a study concerning early post-operative catheter removal (8-12 hours) and the subsequent patients not in the study as their controls. Apart from the time of catheter removal, the routine postoperative care by the same personnel was given without any advice on patient mobilization. Data on patient demographics, surgery details, post-operative medication, rst upright mobilization, the length of hospital stay, and patient satisfaction were analyzed. Results: Fifty-two cases and one control for each case comprised the groups. No difference was detected in maternal characteristics or surgical parameters. The regression analysis showed that the length of the catheter therapy was signi cantly associated with the time of patient mobilization. The need for additional opioid medication in the groups was equal. No difference was detected in the length of hospital stay or patient satisfaction index. Conclusion: The duration of catheter therapy signi cantly impacts the timing of postoperative mobilization. It is crucial to understand this relationship and support optimal recovery by avoiding the unwarranted prolongation of catheter therapy after cesarean. What does this study add to the clinical work? The duration of urinary catheter therapy has a major impact on postoperative mobilization. Unnecessary use of catheter signi cantly impairs the postoperative recovery and should be avoided

Acta obstetricia et gynecologica Scandinavica, Mar 12, 2024

Research Square (Research Square), Jun 26, 2023

Background Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In ... more Background Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be di cult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the signi cance of different antenatal and delivery related risk factors for peripartum asphyxia, associated HIE and the need for therapeutic hypothermia. Methods We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. Study cases were identi ed from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated. Results Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia. Conclusions Smoking, induction of labour and obstetric emergencies, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.

Objective: To calculate the incidence and assess risk factors leading to permanent brachial plexu... more Objective: To calculate the incidence and assess risk factors leading to permanent brachial plexus birth injury (BPBI) in Southern Finland Design: Retrospective population-based study Setting: Helsinki University Women’s Hospital and Helsinki University New Children’s Hospital, Finland Sample: All children born from 2006 to 2022 in Southern Finland with a permanent BPBI and their mothers Methods: Birth information of all mothers and their children born from 2006 to 2022 in Southern Finland were gathered from the national database and compared to prospectively collected data from mothers and their children with a permanent BPBI delivered within the same period. Permanent injury was defined as limited active or passive range of motion or decreased strength in the affected limb detected at one year of age. The severity of the injury was assessed using the 3-month Toronto test score. Main outcome measures: Permanent brachial plexus birth injury Results: Altogether, 298 428 children were...

Archives of Gynecology and Obstetrics, Apr 3, 2023

Purpose Shoulder dystocia is an obstetric emergency with severe complications. Our objective was ... more Purpose Shoulder dystocia is an obstetric emergency with severe complications. Our objective was to evaluate the major pitfalls in the diagnostics of shoulder dystocia, diagnostic descriptions documented in medical records, use of obstetric maneuvers, and their correlations to Erb's and Klumpke's palsy and the use of ICD-10 code 066.0. Methods A retrospective, register-based case-control study included all deliveries (n = 181 352) in Hospital District of Helsinki and Uusimaa (HUS) area in 2006-2015. Potential shoulder dystocia cases (n = 1708) were identified from the Finnish Medical Birth Register and the Hospital Discharge Register using ICD-10 codes O66.0, P13.4, P14.0, and P14.1. After thorough assessment of all medical records, 537 shoulder dystocia cases were confirmed. Control group consisted of 566 women without any of these ICD-10 codes. Results The pitfalls in the diagnostic included suboptimal following of guidelines for making the diagnosis of shoulder dystocia, subjective interpretation of diagnostic criteria, and inexact or inadequate documentation in medical records. The diagnostic descriptions in medical record were highly inconsistent. The use of obstetric maneuvers was suboptimal among shoulder dystocia cases (57.5%). Overall, the use of obstetric maneuvers increased during the study period (from 25.7 to 97.0%, p < 0.001), which was associated with decreasing rate of Erb's palsy and increasing use of ICD-10 code O66.0. Conclusion There are diagnostic pitfalls, which could be addressed by education regarding shoulder dystocia guidelines, by improved use obstetric maneuvers, and more precise documentation. The increased use of obstetric maneuvers was associated with lower rates of Erb's palsy and improved coding of shoulder dystocia.

Obstetrical & Gynecological Survey

(ed from BJOG 2023;130:70–77) The incidence of brachial plexus birth injury (BPBI) varies from 0.... more (ed from BJOG 2023;130:70–77) The incidence of brachial plexus birth injury (BPBI) varies from 0.4 to 3.8 per 1000 vaginal births. It is a complication caused by traction to the cervical and thoracic nerve roots that can lead to decreased strength, complete paralysis, or limited range of motion in the affected limb in the first year of life.

Archives of Gynecology and Obstetrics

Purpose Overweight and obesity are major risk factors for perinatal morbidity and mortality, and ... more Purpose Overweight and obesity are major risk factors for perinatal morbidity and mortality, and the need for bariatric surgery (BS) among fertile-aged women is increasing. This study evaluates the outcome of post-BS pregnancies and deliveries. Methods All 20–45-year-old patients delivering between 2004 and 2016 in Finland were included. Patients with previous BS were identified from the hospital discharge register, and the medical birth register was queried for data on pregnancies, deliveries, and perinatal outcomes. The data were matched using personal identification codes, and the outcomes of women with previous BS were compared with those of other pregnancies. Results Women with previous BS (n = 314) constituted the bariatric group. When compared with the non-bariatric group (n = 750,019), they were older (p < 0.001), heavier (p < 0.001) and had more previous pregnancies (p < 0.001). The overall incidence of pregnancy-induced hypertension (p = 0.002), gestational diabet...

Syventävä työ ei kirjastoss

Objective: To study the impact of shoulder dystocia (SD) simulation training on the SD management... more Objective: To study the impact of shoulder dystocia (SD) simulation training on the SD management and the incidence of permanent brachial plexus birth injury (BPBI). Design: Retrospective observational study Setting: Helsinki University Women’s Hospital, Finland Sample: Deliveries with SD Methods: Multi-professional, regular and systematic simulation training for obstetric emergencies began in 2015 and SD was one of the main themes. A study was conducted to assess changes in SD management and the incidence of permanent BPBI. The study period was from 2010 to 2019; years 2010–2014 were considered the pre-training period and 2015–2019 the post-training period. Main outcome measures: The primary outcome measure was the incidence of permanent BPBI after the implementation of systematic simulation training. Also changes in the SD management were analysed. Results: During the study period, 113,085 vertex deliveries were recorded. The incidence of major SD risk factors (gestational diabete...

<p>Indications for elective and emergency cesarean sections in all deliveries 1993–2013.</p

<p>Mode of the delivery according to HIV viral load 2000–2013.</p

Epidemiology and Infection, 2018

HIV-positive children are still born in Europe despite low mother-to-child transmission (MTCT) ra... more HIV-positive children are still born in Europe despite low mother-to-child transmission (MTCT) rates. We aimed to clarify the remaining barriers to the prevention of MTCT. By combining the national registers, we identified all women living with HIV delivering at least one child during 1983–2013. Of the 212 women delivering after HIV diagnosis, 46% were diagnosed during the pregnancy. In multivariate analysis, age >30 years (P = 0.001), sexual transmission (P = 0.012), living outside of the metropolitan area (P = 0.001) and Eastern European origin (P = 0.043) were risk factors for missed diagnosis before pregnancy. The proportion of immigrants increased from 18% before 1999 to 75% during 2011–2013 (P < 0.001). They were diagnosed during the pregnancy equally to natives and achieved similar, good treatment results. No MTCT occurred when the mother was diagnosed before the delivery. In addition, 12 women had delivered in 2 years prior their HIV diagnosis, most before implementati...

BJOG: An International Journal of Obstetrics & Gynaecology

PLoS ONE, 2021

Objective To study women’s apprehensions, understanding and experiences of counselling concerning... more Objective To study women’s apprehensions, understanding and experiences of counselling concerning a screen-positive result in screening for fetal chromosomal defects. Methods A questionnaire study including different steps of the prenatal screening process was carried out in Helsinki University Hospital. Women’s experiences concerning counselling immediately after a screen-positive result and during further examinations in the Fetal Medicine Unit (FMU) were analyzed. Results 143 women filled in the questionnaire. Less than half of the women considered the primary counselling after a screen-positive result to be explicit (43.9%) and sufficient (43.1%). In the FMU, 88.3% and 89.8% of women were satisfied with the explicitness and sufficiency of counselling. Most women (75%) experienced worry before further examinations but less than half (45%) had considered their personal values concerning diagnostic tests. Half (50.5%) of women expected the worry to continue even if diagnostic tests...

Obstetrical & Gynecological Survey, 2021

INTRODUCTION Shoulder dystocia has remained an unpredictable and feared emergency in obstetrics. ... more INTRODUCTION Shoulder dystocia has remained an unpredictable and feared emergency in obstetrics. Some risk factors have been identified but nevertheless there is a lack of risk evaluation tools in clinical practice. The aim of this study was to evaluate the incidence and risk factors of shoulder dystocia in the Finnish population and to develop a shoulder dystocia risk score tool. MATERIAL AND METHODS This retrospective, population-based study included all deliveries in Finland between 2004 and 2017 (n = 800 484). The annual numbers of shoulder dystocia diagnoses were gathered from nationwide Finnish Medical Birth Register and Hospital Discharge Register. The incidence of shoulder dystocia was calculated in subgroups according to the mode of delivery, maternal diabetes status, body mass index (BMI), age, parity and gestational age. Based on these numbers, a shoulder dystocia risk score tool was created. RESULTS The overall incidence of shoulder dystocia was 0.18%. It increased signi...

Journal of Plastic, Reconstructive & Aesthetic Surgery