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
- 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
Cieľ štúdie: Analýza frekvencie cisárskeho rezu, vaginálneho inštrumentálneho pôrodu a závažnej perineálnej morbidity v Slovenskej republike v rokoch 2007–2018. Metodika: Analýza prospektívne zbieraných dát o cisárskych rezoch, forcepse, vákuumextrakcii v období rokov 2007–2018 a o ruptúrach hrádze 3. a 4. stupňa a epiziotómiách v období rokov 2008–2018 z pôrodníc v Slovenskej republike. Výsledky: Frekvencia cisárskeho rezu stúpla z 24,1 % v roku 2007 na 30,8 % v roku 2013 a do roku 2018 klesla na 29,6 %. Frekvencia vákuumextrakcie stúpla od roku 2007 do roku 2018 z 1,3 % na 2,0 %. Frekvencia forcepsu klesla od roku 2007 do roku 2018 z 0,56 % na 0,43 %. V rokoch 2008–2018 frekvencia ruptúr hrádze 3. a 4. stupňa stúpla z 0,4 % na 0,8 % a frekvencia epiziotómií klesla zo 74,7 % na 47,7 %. Záver: Frekvencia cisárskeho rezu v Slovenskej republike bola najvyššia v roku 2013 (30,8 %), ale v nasledujúcich rokoch pozvoľna klesala. Frekvencia vákuumextrakcie stúpla a forcepsu klesla. Frekvencia epiziotómií mala klesajúci a ruptúr hrádze 3. a 4. stupňa stúpajúci trend.
Objective: Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007–2018. Methods: The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007–2018, and episiotomies and severe perineal morbidity data in the years 2008–2018 from obstetrics hospitals in the Slovak Republic. Results: Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008–2018 from 0.56% to 0.43%. In the years 2008–2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008–2018 from 74.7% to 47.7%. Conclusion: The highest caesarean section rate in the Slovak Republic – 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.
- MeSH
- císařský řez * statistika a číselné údaje MeSH
- epiziotomie statistika a číselné údaje MeSH
- lidé MeSH
- perineum zranění MeSH
- porodnické kleště MeSH
- prospektivní studie MeSH
- ruptura MeSH
- vakuová extrakce porodnická statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Slovenská republika 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
- císařský řez statistika a číselné údaje MeSH
- kojenec MeSH
- lidé MeSH
- longitudinální studie MeSH
- matky psychologie MeSH
- parita MeSH
- poloha plodu koncem pánevním epidemiologie MeSH
- poporodní období MeSH
- prospektivní studie MeSH
- regresní analýza MeSH
- těhotenství MeSH
- temperament * MeSH
- vývoj dítěte MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem 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
- časové faktory MeSH
- císařský řez statistika a číselné údaje MeSH
- dospělí MeSH
- gestační stáří MeSH
- indukovaný porod metody MeSH
- lidé MeSH
- mladý dospělý MeSH
- polymery terapeutické užití MeSH
- proporcionální rizikové modely MeSH
- těhotenství MeSH
- vedení porodu statistika a číselné údaje MeSH
- zrání děložního hrdla * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- MeSH
- anesteziologie MeSH
- císařský řez statistika a číselné údaje trendy MeSH
- dospělí MeSH
- lidé MeSH
- porodnická anestezie statistika a číselné údaje trendy MeSH
- průzkumy a dotazníky MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
