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PUBLIC RELEASE DATE:
3-Sep-2014

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Unplanned births out-of-hospital increases risk of infant mortality

Babies of young mothers, and those in remote areas are at greatest risk

IMAGE: This is Dr. Björn Gunnarsson.

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New research reveals that unplanned births out-of-hospital in Norway are associated with higher infant mortality. The findings published in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, indicate that young women who have given birth at least once before (multiparous) and those living in remote areas are more likely to have unplanned deliveries, which may increase the risk of death in newborns.

In 2013, close to 60,000 babies were born in Norway according to the Statistics Norway. The country now has 51 institutions with birthing centers—down from 158 units in 1972. With more specialized care the perinatal mortality rates decreased from 22 out of 1,000 births (1967-1971) to just 5 in 2010. However, medical evidence reports that with less birth centers the rates of unplanned births in Norway have increased from 4 per 1,000 births in 1979-83 to 7 in 1,000 births over the past few years.

"This trend to centralize obstetrics has improved perinatal mortality rates," explains lead author Dr. Björn Gunnarsson from the Norwegian Air Ambulance Foundation in Drøbak, Norway. "One downside to specialized care in central locations is an increase in unplanned births and its adverse outcomes, which is the focus of our study."

For this cross-sectional study, researchers used data from the Medical Birth Registry of Norway from 1999 to 2013. This registry includes data for deliveries outside the hospital, which are required to be submitted by the physician or midwife present during or after the birth. The team compared the 4,899 unplanned births with all other births (reference group) that occurred during the study period.

Findings indicate that 7 per 1,000 deliveries are unplanned births that take place out of hospitals in Norway since 1999. Young multiparous women living in remote areas are most likely to have unplanned deliveries. In fact, young multiparous women giving birth have a 20 times greater risk of unplanned birth compared to older women who have never given birth (nullipara).

Further analysis shows that during the study period, the unplanned birth group had higher perinatal mortality rate compared to the reference group at 11 versus 5 per 1,000 births, respectively. The annual infant mortality rate did not change significantly from year to year during the time period, but did decline an average of 3% each year for the reference group. Babies with extremely low birthweight (500-999 grams; 1-2 pounds) in the unplanned birth group had a three times higher mortality risk compared to babies in the same birthweight category in the reference group.

Dr. Gunnarsson concludes, "Our findings suggest that unplanned births are linked to greater risk of perinatal mortality, which may be caused by limited access to proper medical care for vulnerable newborns. Further study of additional morbidities and potential interventions that reduce unplanned births is needed."

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This study is published in Acta Obstetricia et Gynecologica Scandinavica. Media wishing to receive a PDF of this article may contact sciencenewsroom@wiley.com

Full citation: "Characteristics and Outcome of Unplanned Births Out-Of-Institutions in Norway From 1999 To 2013: A Cross-Sectional Study." Björn Gunnarsson, Alexander K. Smárason, Eirik Skogvoll and Sigurd Fasting. Acta Obstetricia et Gynecologica Scandinavica; Published online: September 3, 2014 (DOI: 10.1111/aogs.12450).

URL Upon Publication: http://doi.wiley.com/10.1111/aogs.12450

Author Contact: To arrange an interview with Dr. Gunnarsson, please contact Eline Dalland with Norwegian Air Ambulance Foundation at eline.dalland@norskluftambulanse.no

About the Journal

Acta Obstetricia et Gynecologica Scandinavica is the official scientific journal of the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). It is a clinically oriented journal that covers all aspects of obstetrics, gynecology and reproductive health, including perinatology, gynecologic endocrinology, female urology and gynecologic oncology. The journal is published in English and includes: editors´ messages, editorials, Acta commentaries, Acta reviews and original articles under the main categories of investigation, pregnancy, birth, fertility, infection, gynecology, gynecologic urology, oncology and surgery. The journal is published by Wiley on behalf of the NFOG. For more information, please visit http://wileyonlinelibrary.com/journal/aogs.

About Wiley

Wiley is a global provider of content-enabled solutions that improve outcomes in research, education, and professional practice. Our core businesses produce scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners.

Founded in 1807, John Wiley & Sons, Inc. (NYSE: JWa, JWb), has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's website can be accessed at http://www.wiley.com.



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