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.
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
- Cesarean Section statistics & numerical data MeSH
- Adult MeSH
- Humans MeSH
- Labor Presentation MeSH
- Risk Factors MeSH
- Pregnancy, Multiple * statistics & numerical data MeSH
- Pregnancy, Twin statistics & numerical data MeSH
- Pregnancy MeSH
- Delivery, Obstetric methods statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female 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 Score MeSH
- Cesarean Section statistics & numerical data MeSH
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Infant, Newborn MeSH
- Premature Birth epidemiology MeSH
- Retrospective Studies MeSH
- Pregnancy MeSH
- Maternal Age * MeSH
- Pregnancy Outcome * epidemiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article 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
- Cesarean Section adverse effects statistics & numerical data MeSH
- Incidence MeSH
- Humans MeSH
- Pelvic Floor Disorders epidemiology etiology MeSH
- Pregnancy MeSH
- Vacuum Extraction, Obstetrical adverse effects statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Systematic Review MeSH
OBJECTIVE: Cesarean section (CS) rates are rising rapidly around the world but no conclusive evidence has been obtained about the possible short- and long-term effects of CS on child behavior. We evaluated prospectively the association between CS and infant temperament across the first 9 postpartum months, controlling for indications for CS and investigating parity and infant sex as moderators. METHODS: The sample consisted of mothers and their healthy infants. Infant temperament was measured using the Infant Characteristics Questionnaire completed by the mothers at 6 weeks (n = 452) and 9 months (n = 258) postpartum. Mode of birth was classified into spontaneous vaginal birth (n = 347 for 6 weeks sample; 197 for 9 months sample), CS planned for medical reasons (n = 55; 28) and emergency CS (n = 50; 33). RESULTS: Multiple regression analysis revealed no main effects of birth mode, but showed a significant interaction between birth mode and parity indicating that emergency CS in firstborn infants was associated with more difficult temperament at 6 weeks. There were no significant associations between indications for CS and infant temperament, although breech presentation predicted difficult temperament at 9 months. CONCLUSION: We largely failed to support the association between CS and infant temperament. Although our results suggest that emergency CS may be associated with temperament in firstborns, further research is needed to replicate this finding, preferably using observational measures to assess child temperament.
- MeSH
- Cesarean Section statistics & numerical data MeSH
- Infant MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Mothers psychology MeSH
- Parity MeSH
- Breech Presentation epidemiology MeSH
- Postpartum Period MeSH
- Prospective Studies MeSH
- Regression Analysis MeSH
- Pregnancy MeSH
- Temperament * MeSH
- Child Development MeSH
- Check Tag
- Infant MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVE: To evaluate the determinants of vaginal delivery and safety in women undergoing cervical ripening with a synthetic osmotic dilator (Dilapan-S) prior to induction of labor. METHODS: We conducted a secondary analysis of an international multicenter prospective observational study of Dilapan-S for cervical ripening in pregnancies greater than 32 weeks. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system. The association between Bishop score and vaginal delivery was further evaluated with a multivariate receiver-operating characteristic (ROC) curve analysis. A Wilcoxon rank test and multivariable logistic regression were used for statistical analysis (significance: P < .05). RESULTS: Between May 2015 and July 2016, 444 pregnant women were included. Three hundred ten (70 %) delivered vaginally. Compared to patients who underwent cesarean delivery, those who delivered vaginally were more likely to have a history of prior vaginal delivery. Vaginal delivery rates were significantly correlated with Bishop scores of pre and post Dilapan-S and difference. After adjusting for age, BMI, number of dilators, cervical ripening time, and gestational age, both prior vaginal delivery and post-Dilapan-S Bishop scores were strong predictors of vaginal delivery (estimate coefficient: 0.1275 ± 0.03 P = .0002; 0.049 ± 0.01 P = .0001; respectively). Aggregate ROC accounting for these variables further supported these findings (AUC = 0.734). The lower confidence interval limit of vaginal delivery rates was above 50 % when post-Dilapan-S Bishop scores were ≥ 5. Cox regression analyses demonstrated that the duration of labor was significant shorter in women that had vaginal delivery. CONCLUSION: Bishop scores after cervical ripening with Dilapan-S are good predictors of vaginal delivery. Bishop scores < 5 post Dilapan-S may warrant further cervical ripening. Further level 1 trials are needed to compare osmotic dilators to other ripening methods.
- MeSH
- Time Factors MeSH
- Cesarean Section statistics & numerical data MeSH
- Adult MeSH
- Gestational Age MeSH
- Labor, Induced methods MeSH
- Humans MeSH
- Young Adult MeSH
- Polymers therapeutic use MeSH
- Proportional Hazards Models MeSH
- Pregnancy MeSH
- Delivery, Obstetric statistics & numerical data MeSH
- Cervical Ripening * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- MeSH
- Anesthesiology MeSH
- Cesarean Section statistics & numerical data trends MeSH
- Adult MeSH
- Humans MeSH
- Anesthesia, Obstetrical statistics & numerical data trends MeSH
- Surveys and Questionnaires MeSH
- Pregnancy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- Slovakia MeSH
OBJECTIVES: To describe the incidence, onset, predictors and outcome of ventricular tachyarrhythmia (VTA) in pregnant women with heart disease. BACKGROUND: VTA during pregnancy will cause maternal morbidity and even mortality and will have impact on fetal outcome. Insufficient data exist on the incidence and outcome of VTA in pregnancy. METHODS AND RESULTS: From January 2007 up to October 2013, 99 hospitals in 39 countries enrolled 2966 pregnancies in women with structural heart disease. Forty-two women (1.4%) developed clinically relevant VTA during pregnancy, which occurred mainly in the third trimester (48%). NYHA class >1 before pregnancy was an independent predictor for VTA. Heart failure during pregnancy was more common in women with VTA than in women without VTA (24% vs. 12%, p=0.03) and maternal mortality was respectively 2.4% and 0.3% (p=0.15). More women with VTA delivered by Cesarean section than women without VTA (68% vs. 47%, p=0.01). Neonatal death, preterm birth (<37weeks), low birthweight (<2500g) and Apgar score <7 occurred more often in women with VTA (4.8% vs. 0.3%, p=0.01; 36% vs. 16%, p=0.001; 33% vs. 15%, p=0.001 and 25% vs. 7.3%, p=0.001, respectively). CONCLUSIONS: VTA occurred in 1.4% of pregnant women with cardiovascular disease, mainly in the third trimester, and was associated with heart failure during pregnancy. NYHA class before pregnancy was predictive. VTA during pregnancy had clear impact on fetal outcome.
- MeSH
- Cesarean Section statistics & numerical data MeSH
- Adult MeSH
- Risk Assessment MeSH
- Pregnancy Complications, Cardiovascular * diagnosis mortality MeSH
- Tachycardia, Ventricular * diagnosis etiology mortality MeSH
- Humans MeSH
- International Cooperation MeSH
- Infant, Newborn MeSH
- Premature Birth epidemiology etiology MeSH
- Registries statistics & numerical data MeSH
- Risk Factors MeSH
- Heart Failure * complications diagnosis epidemiology MeSH
- Severity of Illness Index MeSH
- Pregnancy MeSH
- Pregnancy Trimester, Third MeSH
- Pregnancy Outcome epidemiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe epidemiology MeSH
Cíl práce: Porovnat perinatální výsledky u žen, které byly indikovány k elektivnímu císařskému řezu, s ženami, u kterých byl proveden akutní císařský řez v průběhu porodu. Typ studie: Retrospektivní kohortová studie. Název a sídlo pracoviště: Státní Nemocnice Azevedo Lima (HEAL), Niteroi, Brazilie. Metodika: Srovnávali jsme u elektivních císařských řezů, akutních císařských řezů a vaginálních porodů neonatální data (příjem na jednotku intenzivní neonatologické péče). Dále se využilo hlášení o narození dítěte a dat získaných v průběhu prvních tří měsíců po porodu. Vybrány byly děti narozené v dokončeném třicátém osmém týdnu gravidity. K porovnání skupin se využily χ2 test a Studentův t-test. Výsledky: Srovnána byla data u pacientek, které porodily vaginálně, s daty u pacientek, u kterých byl indikován elektivní císařský řez. U 219 normálních porodů jsme pozorovali 1,8 % hospitalizací na jednotce intenzivní neonatologické péče a 2,3 % hospitalizací u 88 provedených elektivních císařských řezů. U dětí narozených akutním císařským řezem během porodu (108 císařských řezů) bylo procento přijetí na jednotku intenzivní neonatologické péče 8,3 %, oproti výše zmíněným 1,8 % z 219 vaginálních porodů. Závěr: Nejhorších perinatálních výsledků bylo dosaženo v případě, kdy bylo nutné provést akutní císařský řez. KLÍČOVÁ SLOVA: perinatální výsledky, císařský řez, vaginální porod, akutní, termínová gravidita
Objective: To compare the perinatal outcomes of women undergoing an elective cesarean section (CS) with those who had an emergency CS during the labor. Design: Retrospective cohort study. Setting: Hospital Estadual Azevedo Lima (HEAL), Niteroi, Brazil. Methods: We analysed elective CS, emergent CS and vaginal delivery as dependent variables and neonatal data (admission in intensive care unit) as independent variables. Using the Statement of Live Birth during a three-month period, all patients who had their children after 38 complete weeks of pregnancy were selected. χ2 test and Student t-tests were applied to compare the groups. Results: When patients who had vaginal delivery were compared with those who had an elective CS, we observed 219 normal deliveries with 1.8% of hospitalizations in neonatal intensive care units (NICU), and 88 patients of elective CS with 2.3% of admissions in closed units (p = 0.401). We had a sample of 108 newborns delivered by CS during the labor with 8.3% rate of hospitalization in NICU versus 1.8% of 219 newborns delivered vaginally (p = 0.005). Conclusion: The worst perinatal outcomes occurred when emergency CS were performed. KEYWORDS: perinatal outcomes, cesarean section, vaginal delivery, emergency, term pregnancy
- MeSH
- Cesarean Section * statistics & numerical data utilization MeSH
- Adult MeSH
- Cohort Studies MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Perinatal Care * MeSH
- Parturition MeSH
- Natural Childbirth MeSH
- Retrospective Studies MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Female MeSH
- Geographicals
- Brazil MeSH
