BACKGROUND AND OBJECTIVES:The long-term prognosis after maternal ischemic stroke (IS) remains understudied. The objectives were to examine if mortality and long-term morbidity are more frequent in women with prior maternal IS compared with women without a pregnancy-related stroke and to assess recovery in maternal IS patients based on functional outcomes and vocational status. METHODS:In this retrospective nationwide cohort study, maternal IS patients in Finland during years 1987-2016 were identified from national healthcare registers and verified from patient records. Three pregnant controls without a pregnancy-related stroke were selected for each case and matched by delivery year, age, parity, and geographical area. Deaths were acquired from the Causes-Of-Death Register until 2022. Morbidities (cardiovascular diseases and depression) were collected from Hospital Discharge Register and vocational status from Statistics Finland until 2016 for those who survived ≥1 year after stroke. Functional outcomes by modified Rankin scale (mRS) were estimated from patient records. RESULTS:There were 97 women with maternal IS, of whom 92 survived ≥1 year after stroke, and 265 matched controls (median age 30.6 years at index delivery in both groups). The median follow-up time was 17.4 years for mortality and 11.6 years for morbidity and vocational status. The overall mortality was higher in maternal IS patients than controls (8.3% vs 1.8%, age-adjusted odds ratio [aOR] 4.96, 95% CI 1.58-15.60) but did not differ significantly after the first year. There were 5 (5.6%) recurrent strokes in maternal IS patients. Patients had more frequently major cardiovascular events (6.7% vs 0%, p < 0.001), cardiac diseases (aOR 8.57, 95% CI 2.22-33.08), and depression (aOR 3.92, 95% CI 1.86-8.24) than controls. Of the patients who survived until the end of follow-up, 92.1% had good functional outcomes (mRS 0-2). Still, employment was rarer (aOR 0.55, 95% CI 0.32-0.94) and retirement (aOR 4.55, 95% CI 2.03-10.17) more common in maternal IS patients than controls. DISCUSSION:Maternal IS patients had a significant cardiovascular burden and were retired more often than controls at the end of follow-up, although most patients had good functional outcomes. Optimizing long-term prognosis in these young patients necessitates comprehensive management of vascular risk factors and targeted rehabilitation strategies to address residual neurologic deficits.

BACKGROUND:Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are related neurovascular conditions, with pregnancy as a shared risk factor. In this study, we aimed to describe shared and distinctive risk factors and outcomes in patients with pregnancy-associated PRES and/or RCVS. METHODS:In this retrospective, nationwide, population-based cohort study, the national healthcare registers were utilized to identify women with PRES and/or RCVS during pregnancy or puerperium during 1987-2016. Subsequent pregnancies, vascular events, and deaths until 2022 were identified. Medical records were reviewed to classify cerebrovascular events and collect clinical details. RESULTS:In total, 27 patients had pregnancy-associated PRES and/or RCVS (18 PRES; 5 PRES + RCVS; 4 RCVS) during 1987-2016, resulting in an incidence of 1.52 per 100,000 (95% Cl 1.02-2.18) deliveries. All patients with PRES ± RCVS had preeclampsia with severe features during late pregnancy or early puerperium. In contrast, isolated RCVS showed a weaker association to preeclampsia and occurred in late puerperium, with a median puerperal day of 26 (IQR 11-45). Altogether, 40.7% of all patients had a stroke, 90.9% of which were hemorrhagic. Preeclampsia was diagnosed in 90.9% of stroke patients. Maternal mortality was 3.7%, whereas perinatal mortality was 7.4%. At 3 months, 92.3% had a good recovery (mRS 0-2). During follow-up, stroke recurrence was 3.7% and 33.3% had subsequent uneventful, full-term pregnancies. CONCLUSIONS:Pregnancy-associated PRES and RCVS are potentially life-threatening, rare conditions that can result in hemorrhagic stroke. PRES ± RCVS is strongly associated with preeclampsia with severe features, whereas puerperal RCVS seems to be a separate, later-occurring condition.

Abstract Background and aims Stroke is the leading cause of maternal death in preeclampsia. Still, factors contributing to stroke risk in preeclamptic patients are poorly documented. Our aims were to investigate stroke risk factors in preeclamptic patients. Methods This retrospective case-control study included 55 preeclamptic patients with stroke, identified from the Stroke in Pregnancy and Puerperium in Finland cohort during 1987-2016, using national healthcare registers. The control group comprised 1,675 preeclamptic patients without stroke from the Finnish Genetics of Preeclampsia Consortium cohort. Controls were recruited prospectively from hospitals during 2008-2011 and retrospectively from medical records during 1990-2008. Medical records were reviewed to verify diagnoses and collect clinical data. Results Significant risk factors for stroke among preeclamptic patients included advanced maternal age (OR 1.07, 95% Cl 1.02-1.13), multiparity (2.30, 1.30-4.09), recurrent preeclampsia (2.18, 1.17-4.07), severe preeclampsia (100.0% vs 70.5%, p<0.001), and deep venous thrombosis/pulmonary embolism (12.77, 3.07-53.12). Cases had higher median peak systolic blood pressure (183 vs 165 mmHg; OR 1.036, 1.022–1.050), lactate dehydrogenase (446 vs 253 U/L; OR 1.001, 1.001–1.002), and alanine aminotransferase levels (35 vs 25 U/L; OR 1.002, 1.001–1.003) than controls. Preeclampsia occurred earlier in pregnancy in cases, although 23.6% had postpartum preeclampsia. Risk factors and clinical characteristics differed by stroke subtype. Conclusions Early occurrence of preeclampsia with severe features increases the risk of stroke, especially in older multiparous patients with recurrent preeclampsia or prior prothrombotic conditions. Sufficient screening of blood pressure and laboratory biomarkers enables early management and might decrease the stroke risk in preeclamptic patients. Conflict of interest The authors have nothing to disclose. Figure 1 - belongs to Results

BACKGROUND:Maternal ischemic stroke (IS) might affect the course of subsequent pregnancies. We aimed to study stroke recurrence, other complications, and the implementation of secondary prevention in subsequent pregnancies of women with a prior maternal IS. METHODS:Women diagnosed with IS during pregnancy or puerperium in Finland during the years 1987 to 2016, and the data of subsequent pregnancies were collected from the Medical Birth Register and Hospital Discharge Register. Diagnoses were verified from medical records. Three matched controls without a maternal stroke were identified for each case. RESULTS:Data on subsequent pregnancies were available for 90 patients with maternal IS after excluding patients who died within 1 year. Patients with maternal IS less frequently had at least 1 subsequent pregnancy (38.9% versus 51.7%; age-adjusted odds ratio, 0.55 [95% CI, 0.32-0.93]), and more frequently, multiple induced abortions (adjusted odds ratio, 6.24 [95% CI, 1.12-34.88]) than controls. Three women had a recurrent maternal IS or transient ischemic attack (8.6%). Patients with maternal IS more commonly had diabetes during pregnancy (29.1% versus 13.6%; adjusted odds ratio, 2.77 [95% CI, 1.17-6.59]) and hypertensive disorders of pregnancy than controls (12.7% versus 4.5%; adjusted odds ratio, 3.57 [95% CI, 1.02-12.51]). In the first subsequent pregnancy, perinatal deaths were more common in patients with maternal IS compared with controls (5.9% versus 0%; P=0.042). Most women used antithrombotic medication (87.9%) in the first subsequent pregnancy, but this declined in later pregnancies. The use of other secondary preventive medications was uncommon both before and during pregnancy. CONCLUSIONS:Although most pregnancies proceed without complications, the subsequent pregnancies of women with a prior maternal IS are high-risk pregnancies that require careful planning and surveillance. They are frequently complicated with diabetes and hypertensive disorders of pregnancy, and the recurrence of IS or transient ischemic attack is notable.

The safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy for an ischemic stroke (IS) during pregnancy and puerperium are poorly studied. We evaluated the complications and outcome of recanalization therapy in maternal ISs. A nationwide cohort of maternal ISs in Finland during 1987–2016 was collected by linking national healthcare registers: Medical Birth Register, Hospital Discharge Register, and Cause-Of-Death Register. The diagnoses were verified retrospectively from patient records. IVT-treated patients were compared to controls, who were young females with non-pregnancy-related IS from the Helsinki Stroke Thrombolysis Registry. Totally, 12 of 97 (12.4

( BJOG . 2023;130(11):1421–1429. doi: 10.1111/1471-0528.17503) The incidence of pregnancy-associated stroke (PAS) is rare, estimated at 30 per 100,000 live births and potentially life threatening for mother and child. In recent years, the incidence of PAS is rising, thought to be a result of advancing maternal age and more frequent comorbidities. Although serious, patients may recover from PAS and even become pregnant again. There is a lack of published research on the risks of stroke recurrence during pregnancy and the early postpartum period in this population. This study aimed to further understand the risks to support family planning and decision making in women with history of PAS.

BACKGROUND AND OBJECTIVES:Maternal stroke is a rare event with an increasing incidence. Data on the long-term prognosis after a maternal stroke are limited. We aimed to examine long-term mortality, recovery, vocational status and morbidity after a maternal stroke in a population-based setting including a comparison with matched, stroke-free controls. METHODS:In this register-based study with hospital chart validation, we included all women with a maternal stroke in Finland in 1987-2016 who survived the first year after the event. The recovery of the cases was assessed from the hospital charts by modified Rankin scale (mRS). Three controls matched by delivery year, age, and parity were selected for each case. All deaths until 2022 were identified from the Register for Causes of Death. Data on vocational status were obtained from Statistics Finland and morbidity from the Hospital Discharge Register and patient charts until year 2016. RESULTS:The study included 235 women with a maternal stroke and 694 matched controls. The median follow-up time was 17.5 years (interquartile range [IQR] 9.6-25.4) for mortality and 11.8 years (IQR 3.8-19.8) for vocational status and subsequent morbidity. Mortality among cases was 5.5% and among controls, 2.4% (age-adjusted odds ratio [OR] 2.3, 95% [CI] 1.1-4.9). At the end of the follow-up, 90.3% of the cases were independent in daily activities (mRS ≤2). In 2016, fewer women with a maternal stroke were working compared with controls (65.9% vs 79.1%, OR 0.5, 95% CI 0.4-0.7) and were more often receiving a pension (18.2% vs 4.9%, OR 4.4, 95% CI 2.7-7.3). Cerebrovascular events (age-adjusted OR 8.6 95% CI 4.4-17.1), cardiac diseases (age-adjusted OR 3.3, 95% CI 1.4-7.7), and major cardiovascular events were more common among cases during the follow-up (age-adjusted OR 7.6 95% CI 3.1-18.7). DISCUSSION:Despite having higher overall mortality and higher cardiovascular morbidity, the majority of the maternal stroke survivors recovered well. As expected, the vocational status of cases was inferior to that of controls, but most women were working at the end of the follow-up. Our study provides important information on the prognosis and sequalae after a maternal stroke to help in patient counseling and to improve secondary prevention.

Intracerebral hemorrhage during pregnancy or puerperium (pICH) is one of the leading causes of maternal death worldwide. However, limited epidemiological data exist on the etiology and outcomes of pICH, which is required to guide prevention and treatment.

Background: Pregnancy-related subarachnoid hemorrhage (pSAH) is rare, but it causes high mortality and morbidity. Nevertheless, data on pSAH are limited. The objectives here were to examine the incidence trends, causes, risk factors, and outcomes of pSAH in a nationwide population-based cohort study in Finland covering 30 years. Methods: We performed a retrospective population-based cohort study and nested case-control study in Finland for the period 1987–2016 (Stroke in Pregnancy and Puerperium in Finland). The Medical Birth Register was linked to the Hospital Discharge Register to identify women with incident stroke during pregnancy or puerperium. A subcohort of women with SAH is included in this analysis. The temporal connection of SAH to pregnancy and clinical details were verified from patient records. Results: The unadjusted incidence of pSAH was 3.21 (95% CI, 2.46–4.13) per 100 000 deliveries. No significant increase occurred in the incidence throughout the study period. However, the age of the mother had a significant increasing effect on the incidence. In total, 77% of patients suffered an aneurysmal pSAH, resulting in death in 16.3% of women and with only 68.2% achieving good recovery (modified Rankin Scale score 0–2) at 3 months. Patients with nonaneurysmal pSAH recovered well. The significant risk factors for pSAH were smoking (odds ratio, 3.27 [1.56–6.86]), prepregnancy hypertension (odds ratio, 12.72 [1.39–116.46]), and pre-eclampsia/eclampsia (odds ratio, 3.88 [1.00–15.05]). Conclusions: The incidence of pSAH has not changed substantially over time in Finland. The majority of pSAH cases were aneurysmal and women with aneurysm had considerable mortality and morbidity. Counseling of pregnant women about smoking cessation and monitoring of blood pressure and symptoms of pre-eclampsia are important interventions to prevent pSAH.

Introduction: Ischemic stroke (IS) is an uncommon, but potentially life-changing, complication of pregnancy. The aim of this study was to analyze the etiology and risk factors of pregnancy-associated IS. Patients and methods: We collected a population-based retrospective cohort of patients diagnosed with IS during pregnancy or puerperium in Finland from 1987 to 2016. These women were identified by linking the Medical Birth Register (MBR) with the Hospital Discharge Register. Three matched controls were selected from MBR for each case. The diagnosis and temporal relationship of IS to pregnancy, and clinical details were verified from patient records. Results: A total of 97 women (median age 30.7 years) were identified as having pregnancy-associated IS. The most common etiologies based on TOAST classification were cardioembolism in 13 (13.4%), other determined in 27 (27.8%) and undetermined in 55 (56.7%) patients. Fifteen patients (15.5%) had embolic strokes of undetermined sources. The most important risk factors were pre-eclampsia, eclampsia, gestational hypertension, and migraine. IS patients had more frequently traditional and pregnancy-related stroke risk factors than the controls (OR 2.38, 95% CI 1.48–3.84) and the risk of IS multiplied with the number of risk factors (4–5 risk factors: OR 14.21, 95% CI 1.12–180.48). Discussion and conclusion: Rare causes and cardioembolism were frequent etiologies for pregnancy-associated IS, but in half of the women, the etiology remained undetermined. The risk of IS increased with the number of risk factors. Surveillance and counseling of pregnant women, especially with multiple risk factors, is crucial for the prevention of pregnancy-associated IS.

Objective To examine the outcomes of the subsequent pregnancies from women with a previous pregnancy-associated stroke (PAS) in comparison to matched controls.Design Population-based retrospective cohort study.Setting and population All women with a PAS in Finland 1987-2016 (n = 235) and controls (n = 694).Methods We identified all subsequent deliveries and induced and spontaneous abortions for women with a previous PAS and their matched controls from the Medical Birth Register and the Hospital Discharge Register until 2016. The number, course and outcomes of the subsequent pregnancies were compared. Patient records were studied for PAS recurrence.Main outcome measures PAS recurrence and pregnancy complications.Results Women with a previous PAS had fewer subsequent deliveries: 73 (31.1%) women had 122 deliveries in all, whereas 303 (47.3%) of the controls had 442 deliveries (age-adjusted odds ratio [OR] 0.54, 95% CI 0.38-0.76). Hypertensive disorders of pregnancy (HDP) (17.2% versus 5.7%, age-adjusted OR 4.0, 95% CI 1.7-9.3), especially chronic hypertension (age-adjusted OR 5.9, 95% CI 1.5-24.7), and any diabetes during pregnancy (24.6% versus 14.5%, age-adjusted OR 2.0, 95% CI 1.1-3.8) were more common in cases. Regarding HDP, the difference between groups was explained by underlying factors such as index pregnancy HDP (multivariable OR 2.4, 95% CI 0.8-6.7). PAS recurred in four cases (5.5%).Conclusions Subsequent pregnancies of women with a history of PAS are more often complicated with hypertensive disorders of pregnancy and any diabetes during pregnancy. PAS recurrence risk is considerable.

Abstract Objectives We compared delivery characteristics and outcome of women with stillbirth to those with live birth. Methods This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003–2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age. Results Labor induction was more common (86.0 vs. 22.0%, p<0.001, gestational age adjusted odds ratio [aOR] 35.25, 95% confidence interval [CI] 12.37–100.45) and cesarean sections less frequent (9.3 vs. 28.7%, p<0.001, aOR 0.21, 95% CI 0.10–0.47) among women with stillbirth. Duration of labor was significantly shorter among the cases (first stage 240.0 min [115.0–365.0 min] vs. 412.5 min [251.0–574.0 min], p<0.001; second stage 8.0 min [0.0–16.0 min] vs. 15.0 min [4.0–26.0 min], p<0.001). Placental abruption was more common in pregnancies with stillbirth (15.0 vs. 0.9%, p<0.001, aOR 8.52, 95% CI 2.51–28.94) and blood transfusion was needed more often (10.7 vs. 4.4%, p=0.002, aOR 6.5, 95% CI 2.10–20.13). The rates of serious maternal complications were low. Conclusions Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.

Objectives This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth. Methods This was a questionnaire survey conducted at Helsinki University Hospital, Helsinki, Finland during 2016-2020. Separate questionnaires were sent to mothers and partners who had experienced an antepartum singleton stillbirth at or after 22 gestational weeks during 2016-2019. The questionnaire covered five major topics: stillbirth diagnosis, delivery, information on postmortem examinations, aftercare at the ward, and follow-up appointment. Results One hundred nineteen letters were sent and 57 (47.9%) of the mothers and 46 (38.7%) of their partners responded. Both mothers and their partners felt well supported during delivery. They were also satisfied with the time holding their newborn. Partners reported even higher satisfaction in this aspect with a significant within-dyad difference (p=0.049). Parents were generally pleased with the support at the ward. However, both groups were less satisfied with social worker counseling (mothers 53.7%, partners 61.0%). The majority felt that the follow-up visit was helpful. Nonetheless, a remarkable proportion felt that the follow-up visit increased their anxiousness (25.9%, 14.0%, p=0.018). Partners rated their mood higher than mothers (p=0.001). Open feedback revealed that the support received after discharge from hospital was often insufficient. Conclusions Our study showed that the parents who experience stillbirth in our institution receive mostly adequate care and support during their hospital stay. However, there is room for further training of healthcare professionals and other professionals contributing in stillbirth aftercare.

In this paper, the terahertz (THz) absorption spectra of a nematic liquid crystal (NLC) cell are estimated via THz time-domain spectroscopy (TDS) using a mode-locked Yb-doped fiber laser as the pump source. The THz-TDS system is implemented by using a dipole antenna as an emitter and a bow tie antenna as a receiver. A THz emission bandwidth exceeding 2.2 THz is achieved corresponding to a free spacing of 220 mm and a signal-to-noise ratio exceeding 30 dB. Subsequently, this system was utilized to measure and analyze the THz absorption spectrum of an E7 NLC cell by applying an electric field. The conclusions experimentally confirmed that the absorption of the specific THz frequency of the cell is inversely proportional to the intensity of the electric field applied to the NLC cell.

Objective To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS. Methods We performed a retrospective population-based cohort study and nested case-control study in Finland from 1987 to 2016. The Medical Birth Register (MBR) was linked to the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period in 5-year age groups and pregnancy/postpartum period was calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors. Results After chart review, 29.6% (257 of 868) of cases were PAS. The incidence of PAS was 14.5 (95% confidence interval [CI] 12.8–16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987 to 1991 to 2012 to 2016 (p < 0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from 20 to 24 years to >40 years of age (p < 0.0001). During the early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable-adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95% CI 1.2–2.7), migraine (OR 16.3, 95% CI 5.3–49.8), and hypertensive disorders of pregnancy (OR 4.0, 95% CI 2.5–6.3) were the most important risk factors for PAS. Conclusion PAS incidence is increasing, stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium. Classification of Evidence This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine, and hypertensive disorders of pregnancy are associated with an increased risk of PAS.

Background: Postpartum hemorrhage (PPH) may cause post-traumatic psychological sequelae. Interventional radiology procedures (IRP) have been established in the management of PPH when conventional management fails. IRP is also used prophylactically in women who are at high risk for PPH in pregnancies with abnormally invasive placentation. We sought to determine if there is an association between PPH, IRP, and psychological sequelae. Objectives: Seventy-three women who underwent IRP due to PPH or were at high risk for PPH. Method: A structured questionnaire was sent to all women. Results: Overall 49 women returned the questionnaire. Two-thirds of the women developed psychological sequelae and one-third reported a lack of professional support. Nine women had symptoms of post-traumatic stress disorder. Psychological sequelae were not associated with a volume of bleeding, whether or not hysterectomy was performed, or whether the IRP was performed as an emergency procedure or prophylactically. However, women who had elective IRP and no hysterectomy performed had significantly less fear of death compared to the rest of the study population. Conclusions: We observed a high rate of psychological sequelae associated with IRP. Lack of proper professional support may have contributed to the development of post-traumatic psychological sequelae suggesting a need for debriefing in such women.

OBJECTIVE:To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS. METHODS:We performed a retrospective population-based cohort study and nested case-control study in Finland from 1987 to 2016. The Medical Birth Register (MBR) was linked to the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period in 5-year age groups and pregnancy/postpartum period was calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors. RESULTS:After chart review, 29.6% (257 of 868) of cases were PAS. The incidence of PAS was 14.5 (95% confidence interval [CI] 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987 to 1991 to 2012 to 2016 (p < 0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from 20 to 24 years to >40 years of age (p < 0.0001). During the early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable-adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95% CI 1.2-2.7), migraine (OR 16.3, 95% CI 5.3-49.8), and hypertensive disorders of pregnancy (OR 4.0, 95% CI 2.5-6.3) were the most important risk factors for PAS. CONCLUSION:PAS incidence is increasing, stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium. CLASSIFICATION OF EVIDENCE:This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine, and hypertensive disorders of pregnancy are associated with an increased risk of PAS.

Background: Stillbirth often remains unexplained, mostly due to a lack of any postmortem examination or one that is incomplete and misinterpreted. Methods: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland, and comprised 214 antepartum singleton stillbirths from 2003 to 2015. Maternal and fetal characteristics and the results of the systematic postmortem examination protocol were collected from medical records. Causes of death were divided into 10 specific categories. Re-evaluation of the postmortem examination results followed. Results: Based on our systematic protocol, the cause of death was originally defined and reported as such to parents in 133 (62.1%) cases. Re-evaluation of the postmortem examination results revealed the cause of death in an additional 43 (20.1%) cases, with only 23 (10.7%) cases remaining truly unexplained. The most common cause of stillbirth was placental insufficiency in 56 (26.2%) cases. A higher proportion of stillbirths that occurred at >= 39 gestational weeks remained unexplained compared to those that occurred earlier (24.1% vs. 8.6%) (P=0.02). Conclusion: A standardized postmortem examination and a re-evaluation of the results reduced the rate of unexplained stillbirth. Better knowledge of causes of death may have a major impact on the follow-up and outcome of subsequent pregnancies. Also, closer examination and better interpretation of postmortem findings is time-consuming but well worth the effort in order to provide better counseling for the grieving parents.

Objectives: This study aimed to assess pregnancy and delivery outcomes in women with a history of stillbirth in a large tertiary referral hospital. Methods: This was a retrospective study from Helsinki University Hospital, Finland. The cohort comprised 214 antepartum singleton stillbirths in the period 2003-2015 (case group). Of these, 154 delivered by the end of 2017. Adverse pregnancy outcomes were compared to those in singleton pregnancies of parous women in Finland from the Finnish Medical Birth Register (reference group). Results: The rates of adverse pregnancy outcomes were higher among case women for preeclampsia (3.3 vs. 0.9%, P = 0.002), preterm birth (8.5 vs. 3.9%, P = 0.004), small-for-gestational-age (SGA) children (7.8 vs. 2.2%, P < 0.001) and stillbirth (2.7 vs. 0.3%, P < 0.001). There were four preterm recurrent stillbirths. Induction of labor was more common among case women than parous women in the reference group (49.4 vs. 18.3%, P < 0.001). Duration of pregnancy was shorter among case women (38.29 +/- 3.20 vs. 39.27 +/- 2.52, P < 0.001), and mean birth weight was lower among newborns of the case women (3274 +/- 770 vs. 3491 +/- 674 g, P < 0.001). Conclusion: Although the rates for adverse pregnancy outcomes were higher compared to the parous background population, the overall probability of a favorable outcome was high. The risk of recurrent premature stillbirth in our cohort was higher than that for parous women in general during the study period. No recurrent term stillbirths occurred, however.