Validation of the Finnish Care register for Health Care diagnoses for preeclampsia, gestational diabetes and preterm delivery.

BACKGROUND: Centrally collected Finnish national health register data on adverse pregnancy outcomes are available for research, but the validity of the data is largely unknown. Our aim was to compare the diagnoses of preeclampsia (PE), gestational diabetes (GDM), and preterm delivery from hospital records with the registry based diagnoses from the Finnish Care Register for Health Care (FCR). Data on gestational age at delivery from the Medical Birth Registry (MBR) was also studied. METHODS: The Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) Study cohort was used as a data source. Each diagnosis was ascertained from electronic hospital records. The validity of diagnoses obtained by record linkage of FCR and MBR was assessed against the classification previously confirmed independently by a research nurse and a study physician. RESULTS: Sensitivity of PE diagnoses in FCR was 80.3 % (95 % CI 78.3 % to 82.2 %) andspecificity 95.3 % (95 % CI 93.9 % to 96.4 %). Sensitivity for GDM was 64.1 % (95 % CI: 58.7 % - 69.3 %) and specificity 98.5 % (95 % CI: 97.9 % - 98.9 %), whereas sensitivity and specificity for preterm delivery were 32.4 % (95 % CI: 29.0 % - 36.0 %) and 99.7 % (95 % CI: 99.3 % - 99.9 %). Sensitivity of preterm delivery in the MBR was 99.1 % and specificity 99.9 %. CONCLUSIONS: FCR registry diagnoses for PE have satisfactory sensitivity and high specificity. Diagnoses for GDM and preterm delivery have lower sensitivity limiting their use in studies, and data from MBR should be preferred when studying preterm deliveries.

Traumatic experience with vacuum extraction--influence of personal preparation, physiology, and treatment during labor.

OBJECTIVE: To assess pre-labor attitudes and post-labor experiences of the use of vacuum extraction during delivery. To seek associations between traumatic labor experience and personal preparation, physiology of labor and treatment during labor. METHODS: A total of 205 women filled in a questionnaire within five days of vacuum extraction delivery. The questionnaire was designed to distinguish the group of women having experienced their labor as traumatic from those not having such an experience. The association between explanatory variables grouped as background factors, physiological factors of labor and treatment-related factors in relation to traumatic experience status was studied by bivariate analysis by the chi-square test or Student's t-test. Logistic regression analysis was carried out to examine simultaneous effects of factors. In the first phase, each of the previously chosen groups was analyzed separately, and in the second, all risk factors thus emerging as significant were entered into the final model. RESULTS: Forty-two women (20%) regarded their childbirth experience as traumatic. Of the background factors, insufficient pre-labor training and a pre-labor desire for extra strong pain relief during the coming labor were significantly more common in the traumatic birth group. Of the physiological factors of labor, unsatisfactory pain relief and a difficult third stage of labor were associated with a traumatic birth experience. The treatment-related factors showed mutual correlation and were strongly associated with birth experience. After logistic regression analysis only four independent risk factors emerged as significant: insufficient support immediately after delivery, the experience of being poorly listened to during labor, insufficient doctor's support during the first stage of labor, and pre-labor training classes considered insufficient. CONCLUSIONS: Treatment-related factors were the most powerful predictors of an adverse birth experience after vacuum extraction delivery, exceeding those related to labor physiology. Thus, the role of treatment and care before, during and after vacuum extraction is emphasized.