title: Neonatal outcomes after the obstetric near-miss events uterine rupture, abnormally invasive placenta and emergency peripartum hysterectomy - prospective data from the 2009-2011 Finnish NOSS study.
abstract: BACKGROUND
  Neonatal outcomes after the maternal obstetric near-miss complications of uterine rupture, abnormally invasive placenta, and emergency peripartum hysterectomy were assessed.
  
  
  METHODS
  This case-control study was conducted as part of the Nordic Obstetric Surveillance Study (NOSS). Data on 211 newborns from 197 deliveries in which an obstetric near-miss complication was involved, were collected prospectively from April 2009 to August 2011 from all Finnish delivery units via questionnaires. Missing cases were obtained from national health registers and confirmed by the clinics. Control populations consisted of all other children born during the same period of time in the Finnish Medical Birth Register (n = 147 551).
  
  
  RESULTS
  The number of stillbirths in this cohort was high [n = 8, 3.8% vs. 0.3% among controls, odds ratio (OR) 12.5, 95% confidence interval (CI) 6.32-24.9]. In addition, there were two neonatal deaths. The majority of cases (n = 8, 80%) were connected to uterine rupture. The risk of severe birth asphyxia diagnosis was increased compared with controls (n = 17, 8.1% vs. 0.1%, OR 137, 95% CI 82.7-226). A low umbilical artery pH (<7.05) was also observed among these neonates (28.8% vs. 1.0%, OR 28.7, 95% CI 21.5-38.2). Post-term pregnancies were relatively common among the uterine rupture cases. Adverse neonatal outcomes in the AIP and emergency peripartum hysterectomy cases were associated with preterm deliveries.
  
  
  CONCLUSIONS
  The prospective data collected from clinicians, combined with the information gathered from national health registers, provided valuable insights into rare maternal near-miss cases. These complications also predisposed stillbirth and neonatal death. In this study, 75% of fetal losses were associated with uterine rupture.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Maija
authors.identifier: http://orcid.org/0000-0003-0075-8375
authors.initials: M
authors.lastname: Jakobsson
authors.affiliation: Administration, Hyvinkää Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Anna-Maija
authors.identifier: http://orcid.org/0000-0001-9352-0125
authors.initials: AM
authors.lastname: Tapper
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospital, University of Tampere, Tampere, Finland.
authors.forename: Outi
authors.identifier: http://orcid.org/0000-0003-0161-7486
authors.initials: O
authors.lastname: Palomäki
authors.affiliation: Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Kati
authors.identifier: http://orcid.org/0000-0002-3037-1449
authors.initials: K
authors.lastname: Ojala
authors.affiliation: Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku.
authors.forename: Nanneli
authors.identifier: http://orcid.org/0000-0001-6348-6333
authors.initials: N
authors.lastname: Pallasmaa
authors.affiliation: Department of Obstetrics and Gynecology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
authors.forename: Maija-Riitta
authors.identifier: http://orcid.org/0000-0001-5193-619X
authors.initials: MR
authors.lastname: Ordén
authors.affiliation: THL National Institute for Health and Welfare, Helsinki, Finland.|Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Mika
authors.identifier: http://orcid.org/0000-0001-8254-7525
authors.initials: M
authors.lastname: Gissler
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D000067491:Near Miss, Healthcare; D058725:Peripartum Period; D010922:Placenta Diseases / Q000453:epidemiology* / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012042:Registries; D050497:Stillbirth / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014597:Uterine Rupture / Q000453:epidemiology* / Q000601:surgery*
keywords: Abnormally invasive placenta; birth asphyxia; emergency peripartum hysterectomy; near-miss complication; neonatal death; postpartum hemorrhage; stillbirth; uterine rupture