INTRODUCTION: The main goal of placenta accreta spectrum (PAS) screening is to enable delivery in an expert center in the presence of an experienced team at an appropriate time. Our study aimed to identify independent risk factors for emergency deliveries within the IS-PAS 2.0 database cohort and establish a multivariate predictive model. MATERIAL AND METHODS: A retrospective analysis of prospectively collected PAS cases from the IS-PAS database between January 2020 and June 2022 by 23 international expert centers was performed. All PAS cases (singleton and multiple pregnancies) managed according to local protocols were included. Individuals with emergent delivery were identified and compared to those with scheduled delivery. A multivariate analysis was conducted to identify the possible risk factors for emergency delivery and was used to establish a predictive model. Maternal outcomes were compared. RESULTS: Overall, 315 women were included in the study. Of these, 182 participants (89 with emergent and 93 with scheduled delivery) were included in the final analysis after exclusion of those with unsuspected PAS antenatally or who lacked information about the urgency of delivery. Gestational age at delivery was higher in the scheduled group (34.7 vs. 32.9, p < 0.001). Antenatal bleeding (OR 2.9, p = 0.02) and a placenta located over a uterine scar (OR 0.38, p = 0.001) were the independent predictive factors for emergent delivery (AUC 0.68). Ultrasound (US) markers: loss of clear zone (p = 0.001), placental lacunae (p = 0.01), placental bulge (p = 0.02), and presence of bridging vessels (p = 0.02) were more frequently documented in the scheduled group. None of these markers improved the predictive values of the model. Higher PAS grades were identified in the scheduled group (p = 0.01). There were no significant differences in maternal outcomes. CONCLUSIONS: Antenatal bleeding and the placental location away from the uterine scar remained the most significant predictors for emergent delivery among patients with PAS, even when combining more predictive risk factors, including US markers. Based on these results, patients who bleed antenatally may benefit from transfer to an expert center, as we found no differences in maternal outcomes between groups delivered in expert centers. Earlier-scheduled delivery is not supported due to the low predictive value of our model.
- MeSH
- císařský řez * statistika a číselné údaje MeSH
- dospělí MeSH
- lidé MeSH
- náhlé příhody MeSH
- placenta accreta * diagnóza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- vedení porodu * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Over the past two decades, caesarean section rates have been steadily increasing with rates are now approaching 55% in some European countries. While caesarean section remains one of the most critical obstetric interventions, often lifesaving for both mother and newborn, it also carries significant risks for maternal and neonatal health. The growing reliance on caesarean birth is further linked to a marked decline in instrumental births, thereby limiting opportunities for future obstetric trainees to acquire essential clinical skills. This invited review offers evidence-based recommendations aimed at safely reducing the incidence of caesarean sections, without compromising the quality of care provided during childbirth.
- MeSH
- císařský řez * statistika a číselné údaje trendy MeSH
- lidé MeSH
- porodnictví MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
International comparisons highlight differences in healthcare practices, raising questions about the application of evidence-based care when wide variations exist between countries with similar populations and income levels. Caesarean section (CS) rates show significant variation, with national and regional averages differing widely. As a common surgical procedure, this variation affects a large number of people and may have major consequences for maternal and newborn health. Comparable health indicators are essential to analyse CS rates and understand the reasons for this variability. A review of data on CS rates in Europe in international databases, such as those maintained by Eurostat, OECD and WHO, confirmed wide variation in CS rates in Europe, from 16% to over 50%, but showed very limited data available to understand these differences. In contrast, many European countries collect a wide array of data in national health information systems which can be used to investigate variations in CS, including on the timing and indication of the CS, and key population and health system characteristics that affect risks of CS. Based on the published literature, work in the Euro-Peristat network and within the EBCOG advisory board, we propose a list of data items that should be available at the national and international levels to allow comprehensive international surveillance and evaluation of CS practices.
- MeSH
- císařský řez * statistika a číselné údaje MeSH
- lidé MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
Information is presented from hospital visiting reports with focus on Caesarean section and vaginal instrumental delivery rates from training units in European countries during the period 1999-2023. In a considerable number of countries training units were audited more than once, allowing assessment of trends in both obstetric interventions. There is a notable rise in Caesarean section rate in a number of European countries, with the highest rates in Poland (55.1%), Turkey (54.8%) and Greece (48.6%). Conversely Caesarean sections were low in France (19.3%) associated with a higher rate of instrumental vaginal delivery rates. Some countries like Germany and Poland have high variability in their rates, indicating fluctuations or regional differences over the years. Vaginal instrumental delivery rates varied across countries having very low rates (Turkey with 1.0% and Poland with 1.2%) and others having relatively high rates (like Switzerland, France and Belgium). Germany and Belgium showed a balanced use of both Caesarean sections and vaginal instrumental deliveries but with considerable variability in both practices. Countries in Central Europe display marked differences in Caesarean section rate: Hungary 37.8%; Slovakia 34.5%, Czech Republic 27.5% and Slovenia 20.7%. Apart from Poland (1.2%), differences in vaginal instrumental delivery rate between these countries are relatively small with Hungary 2.7%, Slovakia 2.8%, Czech Republic 2.9% and Slovenia 2.9%. Low instrumental delivery rates have major effect on the quality of training for the trainees in their formative years. Having a limited experience in this area of clinical practice would influence their future clinical obstetric practice.
- MeSH
- císařský řez * statistika a číselné údaje výchova MeSH
- gynekologie výchova MeSH
- lidé MeSH
- porodnictví * výchova MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
V posledných desaťročiach sme zaznamenali výrazný nárast počtu cisárskych rezov. Hoci je pôrod cisárskym rezom život zachraňujúci, je spojený so zvýšeným rizikom nepriaznivých zdravotných následkov u novorodencov, vrátane respiračných a atopických ochorení, obezity, cukrovky a závažných autoimunitných ochorení. Presné mechanizmy, ktoré sú základom týchto spojitostí zostávajú nepochopené; epigenetické modifikácie sa však ukázali ako pravdepodobný molekulárny základ spájajúci perinatálne faktory s budúcou náchylnosťou na ochorenie. Tento prehľad spája súčasnú literatúru a odhaľuje, že spôsob pôrodu môže ovplyvniť epigenetické markery u novorodencov, predovšetkým prostredníctvom zmien globálnej metylácie DNA a génovo špecifických metylačných vzorcov.
Recent decades have seen a notable increase in cesarean section rates. Although lifesaving, cesarean delivery is associated with an elevated risk of adverse health outcomes in newborns, including respiratory diseases, atopic disorders, obesity, diabetes, and severe autoimmune conditions. The exact mechanisms underlying these associations remain elusive; however, epigenetic modifications have emerged as a plausible molecular basis linking perinatal factors with future disease susceptibility. This review summarizes current literature, revealing that the delivery method may influence epigenetic markers in neonates, primarily through alterations in global DNA methylation and gene-specific methylation patterns.
Cieľ: Cieľom tejto práce je analýza faktorov, ktoré môžu ovplyvniť spôsob vedenia pôrodu u žien s viacplodovou graviditou. Súbor a metodika: Retrospektívna analýza vybraných parametrov u žien s viacplodovou graviditou, ktoré porodili na II. Gynekologicko-pôrodníckej klinike Lekárskej fakulty Univerzity Karlovy (LF UK) a Univerzitnej Nemoncice (UN) Bratislava v rokoch 2010–2022. Výsledky: Za obdobie 2010–2022 na II. Gynekologicko-pôrodníckej klinike LF UK a UN Bratislava bolo 1,13 % pôrodov viacplodovej gravidity. Po spracovaní štatistických údajov sa štatisticky významne javila primiparita ako riziko akútneho cisárskeho rezu, multipary mali vyššiu pravdepodobnosť porodiť vaginálne. Od roku 2017 mal na klinike počet cisárskych rezov klesajúci trend. Ženy s akútnym cisárskym rezom mali priemerne nižšie pH oboch plodov oproti vaginálnemu pôrodu, avšak výskyt asfyktických plodov nebol štatisticky významne rozdielny. Nezistili sme žiadny rizikový faktor zvyšujúci pravdepodobnosť akútneho cisárskeho rezu na plod B u gemín. Záver: Viacplodová gravidita má vyššiu morbiditu nielen pre ženu ale aj pre plody. Výskyt viacplodovej gravidity je ovplyvnený asistovanou reprodukciou. Spôsob vedenia pôrodu závisí na rôznych faktoroch ako chorionicita, poloha plodov a anamnéza predošlého cisárskeho rezu.
Objective: This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Materials and methods: Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010–2022. Results: Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Conclusion: Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.
- MeSH
- císařský řez statistika a číselné údaje MeSH
- dospělí MeSH
- lidé MeSH
- naléhání plodu MeSH
- rizikové faktory MeSH
- těhotenství mnohočetné * statistika a číselné údaje MeSH
- těhotenství s dvojčaty statistika a číselné údaje MeSH
- těhotenství MeSH
- vedení porodu metody statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
OBJECTIVE: Pregnancy at advanced maternal age has become more common over the last decades. Therefore, the study aimed to describe the characteristics and maternal and perinatal outcomes of women giving birth at advanced maternal age and very advanced age. METHODS: We conducted a retrospective cohort study of 2,300 singleton births that occurred in 2020-2021 at the Department of Gynaecology and Obstetrics of the Louis Pasteur University Hospital in Košice. The control (age 20-34 years), advanced maternal age (35-39 years), and very advanced maternal age (≥ 40 years) groups included 1,851, 382, and 67 women, respectively. Exclusion criteria were multiple pregnancies, maternal age less than 20 years, smoking and alcohol use, foetal malformation and intrauterine foetal death, and birth weight of 500 grams or less. Data on mothers and newborn infants have been reported from the birth book and the reports on mothers at childbirth. The data were analysed using IBM SPSS Statistics 23.0. RESULTS: Our results confirmed statistically significant differences regarding the rate of preterm birth (p = 0.004), very preterm birth (p = 0.010), caesarean delivery rate (p < 0.001), very low birth weight (p = 0.027), extremely low birth weight (p = 0.001), and Apgar score at 5 minutes < 7 (p = 0.020) between newborns in the compared maternal age groups. CONCLUSION: Advanced maternal age is a prognostic factor for poor pregnancy outcomes. Women of advanced maternal age are at higher risk of adverse obstetric and perinatal outcomes.
- MeSH
- Apgar skóre MeSH
- císařský řez statistika a číselné údaje MeSH
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- předčasný porod epidemiologie MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- věk matky * MeSH
- výsledek těhotenství * epidemiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- analýza dat MeSH
- císařský řez * dějiny metody statistika a číselné údaje MeSH
- dějiny 20. století MeSH
- lidé MeSH
- porod MeSH
- reprodukční chování statistika a číselné údaje MeSH
- těhotné ženy MeSH
- Check Tag
- dějiny 20. století MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors. OBJECTIVE: To explore the incidence rate of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019. STUDY ELIGIBILITY CRITERIA: A study was included if LA was assessed by an imaging modality after the first vaginal birth or caesarean section. Case series and reports were not included. DATA COLLECTION AND ANALYSIS: RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages were used for type and timing of imaging analyses. RESULTS: We included 37 primary non-randomised studies from 17 countries and involving 5594 women. Incidence rates of LA were 1, 15, 21, 38.5 and 52% following caesarean, spontaneous, vacuum, spatula and forceps births, respectively, with no differences by imaging modality. Odds ratio of LA following spontaneous birth versus caesarean section was 10.69. The odds ratios for LA following vacuum and forceps compared with spontaneous birth were 1.66 and 6.32, respectively. LA was more likely to occur unilaterally than bilaterally following spontaneous (P < 0.0001) and vacuum-assisted (P = 0.0103) births but not forceps. Incidence was higher if assessment was performed in the first 4 weeks postpartum. CONCLUSIONS: LA incidence rates following caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively. Ultrasound and magnetic resonance imaging were comparable tools for LA diagnosis. TWEETABLE ABSTRACT: Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
- MeSH
- císařský řez škodlivé účinky statistika a číselné údaje MeSH
- incidence MeSH
- lidé MeSH
- onemocnění dna pánevního epidemiologie etiologie MeSH
- těhotenství MeSH
- vakuová extrakce porodnická škodlivé účinky statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
