OBJECTIVE: To assess changes in caesarean section (CS) rates in Europe from 2015 to 2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends. DESIGN: Observational study utilising routine birth registry data. SETTING: A total of 28 European countries. POPULATION: Births at ≥22 weeks of gestation in 2015 and 2019. METHODS: Using a federated model, individual-level data from routine sources in each country were formatted to a common data model and transformed into anonymised, aggregated data. MAIN OUTCOME MEASURES: By country: overall CS rate. For TGCS groups (by country): CS rate, relative size, relative and absolute contribution to overall CS rate. RESULTS: Among the 28 European countries, both the CS rates (2015, 16.0%-55.9%; 2019, 16.0%-52.2%) and the trends varied (from -3.7% to +4.7%, with decreased rates in nine countries, maintained rates in seven countries (≤ ± 0.2) and with increasing rates in 12 countries). Using the TGCS (for 17 countries), in most countries labour induction increased (groups 2a and 4a), whereas multiple pregnancies (group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease across all TGCS groups, whereas in countries with increasing rates, CS tended to increase in most groups. In countries with the greatest increase in CS rates (>1%), the absolute contributions of groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a (induction of labour), 2b and 4b (prelabour CS) and 10 (preterm cephalic singletons) to the overall CS rate tended to increase. CONCLUSIONS: The TGCS shows varying CS trends and rates among countries of Europe. Comparisons between European countries, particularly those with differing trends, could provide insight into strategies to reduce CS without clinical indication.

• MeSH
• císařský řez * MeSH
• lidé MeSH
• novorozenec MeSH
• parita MeSH
• porodní děj * MeSH
• těhotenství mnohočetné MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• poporodní období MeSH
• porodní děj MeSH
• porodnice MeSH
• průzkumy a dotazníky MeSH
• spokojenost pacientů MeSH

• Konspekt
• Gynekologie. Porodnictví
• NLK Publikační typ
• závěrečné práce

• Klíčová slova
• vertikální porodní polohy, porodnický gauč,
• MeSH
• komplikace porodu prevence a kontrola   MeSH
• lidé MeSH
• místo porodu MeSH
• porodní děj dějiny   fyziologie   MeSH
• postura těla fyziologie   MeSH
• přirozený porod * dějiny   trendy   MeSH
• vedení porodu trendy   MeSH
• zdravotnické prostředky MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• novinové články MeSH
• rozhovory MeSH

During the first wave of the COVID-19 pandemic in the spring of 2020, the government of the Czech Republic issued a nationwide ban on visitors to maternity wards. We studied whether the absence of a close person during labor due to this ban impacted perinatal indicators. This study was performed using an administrative observational questionnaire focused on absolute frequencies of events sent to maternity facilities across the Czech Republic. Completed answers were received from 33 facilities covering 4805 births during the study period in 2019 and 4514 births in 2020. The differences in individual parameters were tested using Pearson's chi-squared homogeneity test. There were no significant differences between the two periods in spontaneous pre-term births (p = 0.522) or in the number of cesarean sections (p = 0.536). No significant changes were seen in either local or systemic analgesia. Data showed a significantly shorter (p = 0.026) first stage of labor in 2020 compared to 2019, while there was no significant difference (p = 0.673) in the second stage of labor. There was no statistically significant difference found for newborn perinatal adaptation. There were also no significant differences in intrapartum maternal injuries. Overall, we found no significant differences in basic perinatal indicators during the first wave of COVID-19 in 2020 compared to 2019. Although the absence of a close person may cause stress for the laboring women, it does not impair objective clinical outcomes.

• MeSH
• COVID-19 * epidemiologie   MeSH
• lidé MeSH
• novorozenec MeSH
• pandemie MeSH
• porod v termínu MeSH
• porodní děj * MeSH
• těhotenství MeSH
• vedení porodu MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

• MeSH
• indukovaný porod MeSH
• lidé MeSH
• porodní děj * MeSH
• těhotenství MeSH
• uterotonika * MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• úvodníky MeSH

Východisko: Príspevok sa zaoberá analýzou, ako ro- dičkám pomohla pôrodná asistentka informáciami a odporúčaniami v rozhodovaní sa o odchode do pô- rodnice. Výsledky štúdií ukazujú, že ženy prijaté v la- tentnej fáze pôrodu, oproti ženám prijatým v aktívnej fáze pôrodu, podstúpili cisársky rez častejšie. Súbor a metódy: Sledovaný súbor tvorilo 305 respon- dentiek, ktoré rodili v rokoch 2015 – 2020 v Slovenskej republike v pôrodnici. Anonymným dotazníkom sme zisťovali ich skúsenosti v súvislosti s latentnou fázou pôrodu. Vyselektovali sme skupinu 155 respondentiek. Výsledky: Zistili sme že, pôrodné asistentky poskytli rodičkám spolu 430 odporúčaní, t.j priemerne 2,77 na jednu ženu. Zväčša išlo o odporúčanie: využitie teplej vody v horúcej sprche (97), pohyb a pohyb na fit lop- te (96), klyzma (78), odpočinok (74), sladké nápoje a drobné jedlo na získanie energie (20). 49,51 % res- pondentiek uviedlo, že pôrodná asistentka v ambu- lancii gynekológa primárnej zdravotnej starostlivosti sa nezaujímala. 63 z týchto žien boli prvorodičky. Záver: Pôrodná asistentka pracujúca v ambulancii primárnej zdravotnej starostlivosti by si mala vytvoriť priestor na edukáciu tehotnej ženy a poskytnúť jej správne informácie o začiatku a priebehu pôrodu, ale- bo jej odporučiť absolvovať psychofyzickú prípravu na pôrod.

Background: The article deals with the decision of a woman-mother and her departure to the maternity hospital after the beginning of childbirth. The results of the studies show that women admitted in the latent phase, compared to women admitted in the active pha- se, underwent cesarean section more often. File and methods: The sample consisted of 305 res- pondents who gave birth in the maternity hospital in the Slovak Republic in 2015-2020. We used an ano- nymous questionnaire to find out their experience with the help of midwives in connection with the latent phase of childbirth. We selected a group of 155 res- pondents. Results: We found that midwives recommended a total of 430 recommendations to mothers, i.e., an average of 2.77 per woman. These were mostly recommenda- tions: use of hot water in a hot shower (97), move- ment and movement on a fit ball (96), enema (78), rest (74), sweet drinks and small food to gain energy (20). 49.51% of respondents stated that the midwife in the outpatient clinic of a gynecologist of primary health care was not interested. 63 of these women were first-borns. Conclusion: A midwife working in a primary care clinic should have a place to educate a pregnant wo- man and provide her with the right information abo- ut the beginning and course of childbirth, or recom- mend that she undergo psychophysical preparation for childbirth.

• Klíčová slova
• latentní fáze první doby porodní,
• MeSH
• porodní asistentky MeSH
• průzkumy a dotazníky MeSH
• první doba porodní MeSH
• vedení porodu MeSH

OBJECTIVE: To evaluate whether a synthetic osmotic cervical dilator is noninferior to oral misoprostol for cervical ripening. METHODS: In an open-label, noninferiority randomized trial, pregnant women undergoing induction of labor at 37 weeks of gestation or more with Bishop scores less than 6 were randomized to either mechanical cervical dilation or oral misoprostol. Participants in the mechanical dilation group underwent insertion of synthetic osmotic cervical dilator rods, and those in the misoprostol group received up to six doses of 25 micrograms orally every 2 hours. After 12 hours of ripening, oxytocin was initiated, with artificial rupture of membranes. Management of labor was at the physician's discretion. The primary outcome was the proportion of women achieving vaginal delivery within 36 hours of initiation of study intervention. Secondary outcomes included increase in Bishop score, mode of delivery, induction-to-delivery interval, total length of hospital stay, and patient satisfaction. On the basis of a noninferiority margin of 10%, an expected primary outcome frequency of 65% for misoprostol and 71% for mechanical methods, and 85% power, a sample size of 306 participants was needed. RESULTS: From November 2018 through January 2021, 307 women were randomized, with 151 evaluable participants in the synthetic osmotic cervical dilator group and 152 in the misoprostol group (there were four early withdrawals). The proportion of women achieving vaginal delivery within 36 hours was higher with mechanical cervical dilation compared with misoprostol (61.6% vs 59.2%), with an absolute difference of 2.4% (95% CI -9% to 13%), indicating noninferiority for the prespecified margin. No differences were noted in the mode of delivery. Tachysystole was more frequent in the misoprostol group (70 [46.4%] vs 35 [23.3%]; P=.01). Participants in the synthetic osmotic cervical dilator group reported better sleep, less unpleasant abdominal sensations, and lower pain scores (P<.05). CONCLUSION: Synthetic osmotic cervical dilator is noninferior to oral misoprostol for cervical ripening. Advantages of synthetic osmotic cervical dilator include a better safety profile and patient satisfaction, less tachysystole, lower pain scores, and U.S. Food and Drug Administration approval. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03670836. FUNDING SOURCE: Medicem Technology s.r.o., Czech Republic.

• MeSH
• aplikace intravaginální MeSH
• bolest MeSH
• dilatace MeSH
• dystokie * MeSH
• indukovaný porod metody   MeSH
• lidé MeSH
• misoprostol * MeSH
• těhotenství MeSH
• uterotonika * MeSH
• zrání děložního hrdla MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

• MeSH
• hexoprenalin aplikace a dávkování   terapeutické užití   MeSH
• komplikace porodu MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• obrat plodu * metody   škodlivé účinky   MeSH
• poloha plodu koncem pánevním terapie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

• MeSH
• duly * výchova   MeSH
• lidé MeSH
• perinatální péče metody   MeSH
• porod fyziologie   psychologie   MeSH
• porodní asistentky výchova   MeSH
• první doba porodní MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

• MeSH
• HELLP syndrom diagnóza   terapie   MeSH
• hypertenze komplikace   MeSH
• komplikace diabetu MeSH
• komplikace porodu * diagnóza   prevence a kontrola   terapie   MeSH
• lidé MeSH
• placenta praevia diagnostické zobrazování   terapie   MeSH
• poloha plodu koncem pánevním MeSH
• porod MeSH
• předčasné odlučování placenty diagnóza   etiologie   MeSH
• předčasný odtok plodové vody diagnóza   MeSH
• předčasný porod diagnóza   etiologie   prevence a kontrola   MeSH
• preeklampsie diagnóza   etiologie   terapie   MeSH
• přenášené těhotenství diagnóza   MeSH
• těhotenství mnohočetné MeSH
• tromboembolie komplikace   MeSH
• ultrasonografie prenatální metody   MeSH
• vaginální porod po císařském řezu škodlivé účinky   MeSH
• vedení porodu metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH