Perinatal statistics – Parturients, delivers and newborns

Quality description

Relevance of statistical data

The Medical Birth Register was established in 1987. It contains data on all mothers who have given birth in Finland and on all newborn infants up to the age of seven days. The purpose of the register is to collect statistical data for the research, development and provision of maternity care, obstetrics services and the care of newborn infants. Complementary information is available from THL's Hospital Discharge Register. 

The Statistical Reports aim to provide information to health care professionals, administrators, planning officials and researchers working in the area of reproductive health. They need statistical up-to-date and detailed data on deliveries and newborns.

The report text describes the concepts used in the Register.

The collection of data is based on the Act on the National Institute for Health and Welfare (668/2008).

Description of methods 

The Medical Birth Register includes data on all live births, and on stillbirths of foetuses with a birth weight of at least 500 g or with a gestational age of at least 22+0 weeks. Information about each infant born is sent to THL either as a database acquisition or with a specific electronic form. With regard to deliveries taking place at home, the form is to be completed by the midwife or the physician who has assisted in the delivery.

Additionally, more detailed information has been gathered on small premature infants since 2005. Small premature infants refer to live births with a weight at birth of less than 1501 g or with a gestational age at birth of less than 32+0 weeks. 2005-2007 infants whose birth weight was exactly 1500 g were not included in the register on small premature infants.

Deaths related to childbirth and maternal deaths are based on the causes of death information from Statistics Finland. For the years 2009–2018, the Medical Birth Register is linked with the causes of death information and the statistics are included in the perinatal statistics for the first time. Deaths related to birth and maternal deaths related to birth are reported per 100 000 childbirths according to the year of birth. Maternal deaths are calculated according to the year of death and reported per 100 000 live births. 

Correctness and accuracy of data

The data are correct in so far as they have been reported correctly. The data submitted to THL by hospitals are checked, and any data that are missing or inferred to be incorrect are confirmed by contacting the treating hospitals, and then corrected in the database.

Some birth data are missing in the Medical Birth Register. The register is therefore supplemented with data compiled by the Digital and Population Data Services Agency on live births and with data compiled by Statistics Finland on stillbirths and deaths during the first week of life. After these additions, the statistics are estimated to have coverage of 100 per cent.

In 1990, 1996, 2004 and 2017, the data content of the register was changed in order to improve its reliability and to bring the form more in line with current care practices. Previous data collection forms and instructions are archived in paper and electronical format.

The patient information system Apotti was introduced in all maternity hospitals in the Helsinki and Uusimaa Hospital District (HUS) in February 2021. Related data recording and retrieval problems continued in 2022 and have caused some quality discrepancies in the data from HUS area.

Whenever possible, child’s place of birth is recorded in the register.  However, for some children the place of birth cannot be established. Especially with children born outside of the hospital, it sometimes is unclear if the birthplace was planned (planned home birth) or not (unplanned home birth or birth en route to the hospital). In 2022, there were 31 such cases in the data. For 12 children no information about the birthplace was discovered.

Timeliness and promptness of published data

The Statistical Report Perinatal statistics: parturients, deliveries and newborns (previously Births and Newborns) is produced by THL annually. The aim is to publish preliminary data in June–July and the Statistical Report itself in September–October. The preliminary data only include statistical data in the form of a time series table. The final data for 2021 was not released until December due to Apotti data delivery problems.

THL publishes in its website both the statistical report and the database reports of pregnant women, childbirth and newborns. Database reports, i.e., filtered cubes and data cubes, enable users to search information and choose the appropriate sections in the register data. Filtered cubes are ready-made compilations of key data on a subject area. Data cubes enable more versatile data analyses. Data cubes and filtered cubes can be used to view the data by region, by the size of hospital and by hospital, as well as annual data since 2007. 

The statistics contained in the Statistical Reports are based on data concerning deliveries during the preceding calendar year. However, in order to reduce random variation, some of the tables have been compiled across two-year periods. Hospitals submit their data to the Medical Birth register at the latest by the end of March of the year following the child’s year of birth. The statistics are completed at the latest by the autumn following the calendar year, after data on causes of death compiled by the Digital and Population Data Services Agency and Statistics Finland have been combined.

Availability and transparency/clarity of data

The Statistical Reports are sent electronically to all maternity hospitals and published on THL’s website. 

Data in the Medical Birth Register are also submitted to international statistical organisations (OECD, NOMESCO, WHO, Eurostat, UN and perinatal statistics in the Nordic countries).

Findata is authorised to disclose data in the Medical Birth register to researchers for scientific research purposes.

Comparability of statistical data

The reforms made to the Medical Birth Register in 1990, 1996, 2004 and 2017 were aimed at improving its reliability and to bring the form more in line with current care practices. New variables in the 2004 data collection were mother's weight and height before pregnancy; mother's medical conditions during pregnancy as ICD-10 codes; duration of delivery; mother's medical conditions during delivery as ICD-10 codes; and head circumference at birth. In 2017, new variables added to the register included regular intake of folic acid before the 12th week of gestation, foetal anomaly screening and further examinations, screening results, infection screening in early pregnancy, group B streptococcus infection screening, IV-PCA, type of twinning, nutrition given to child at or before the age of 7 days at the time of discharge, and provision of additional milk. Some of the pre-existing variables were also changed and specified to make the form better correspond with current care practices.

The annual statistical data presented in the statistical reports are comparable from 1987 onwards. However, in connection with the form updates, some hospitals will be unable to immediately provide all changed or added data in accordance with the new data content, and there is a transitional period of a few years related to the form updates before the new variables can be comprehensively reported on, for instance. For example, the data on parturient weight is not yet comparable for years 2004 and 2005, as the variable was newly included in the register in 2004. 

The patient information system Apotti was introduced in all maternity hospitals in the Helsinki and Uusimaa Hospital District (HUS) in February 2021. Related data recording and retrieval problems continued in 2022 and have caused that all variables from HUS area are not comparable with previous years and there are known quality deviations in the submitted material.

Data on parturients' weight and height before pregnancy have been collected since 2004. More comprehensive data are available as of 2006. Missing BMI data accounted for 2.0 per cent in 2022.

Information on smoking during pregnancy is based on data provided by the parturients themselves concerning smoking. The percentage is calculated based on the number of parturients who have responded to the question on smoking. Missing data accounted for 5.4 per cent in 2022.

The preliminary data do not include the data obtained by combining the Digital and Popu-lation Data Services Agency’s register data on live births and Statistics Finland’s register data on causes of death. However, there are no major differences in data between the preliminary data and the final figures published in the Report. The preliminary data on parturients, deliveries and births consist of nationwide absolute figures and percentages only.

The live birth figures as well as the infant mortality rates as reported by Statistics Finland and THL's Medical Birth Register differ to some extent due to differences in the method of calculation. Statistics Finland gathers data on all children born whose mother has a per-manent domicile in Finland at the time of the child’s birth whatever the place of delivery, while the Medical Birth Register includes data on all children born in Finland. Further-more, Statistics Finland calculates infant mortality rate on the basis of year of death while THL's Medical Birth Register uses the year of birth. The Statistics Finland figures are offi-cial.

Clarity and consistency

The definitions and concepts related to pregnancy and neonatality are based on the Classification of Diseases ICD-10 and Suomalainen tautien kirjaamisen ohjekirja (available in Finnish).

The statistical reports also use established international concepts and classifications (such BMI, mode of delivery, and perineal lacerations, of which third- and fourth-degree lacerations are considered as serious).

Special issues concerning the 2022 statistics

The patient information system Apotti was introduced in all maternity hospitals (Women’s hospital, Lohja Hospital, Hyvinkää Hospital and Jorvi Hospital) in the Helsinki and Uusimaa Hospital District (HUS) in February 2021. Related data recording and retrieval problems continued in 2022 and have caused that all variables from HUS area are not comparable with previous years and there are known quality deviations in the submitted material. For this reason, e.g. indicators on gestational diabetes have been removed from appendix table 1.

In the 2022 data there were 12 infants whose place of birth could not be verified.

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