ABSTRACT
In Finland a nationwide free prenatal care system was mandated by law in 1944. At
present, 99.9% of Finland's pregnant women use it. The primary aim is to provide advice
and care to all women in local centers and to identify pregnant women exhibiting risk
factors and refer them to specialized prenatal units located in 21 central hospital
districts. This screening has succeeded well since the late 1970s, as judged by the
low frequency of stillborn and low birthweight children born outside central hospitals.
The rate of preterm birth has decreased by 1% during the latter half of the 1970s
and is now 5.8%. This decrease occurred concomitantly with an overall decrease of
55% in the use of betami-metic drugs, which suggests that the use of betamimetic agents
has had minor or no significant impact on the reduction of the incidence of prematurity.
In order to improve the identification of mothers at high risk for preterm delivery,
a mathematical model was constructed that included 13 risk factors. This model successfully
identified a class made up of 22% of all women in whom 65% of preterm deliveries occurred,
but 35% of mothers delivering prematurely still remained unidentified. Efficient screening
of genital tract infections, relieving mothers of heavy work, and developing new oxytocin
analogues may further reduce prematurity in the future.
