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
- dilatace přístrojové vybavení MeSH
- lidé MeSH
- pánevní dno * zranění MeSH
- parita MeSH
- pilotní projekty MeSH
- randomizované kontrolované studie jako téma MeSH
- těhotenství MeSH
- vedení porodu * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- dopisy MeSH
- komentáře MeSH
BACKGROUND: Quality of life and survival in Cystic Fibrosis (CF) have improved dramatically, making family planning a feasible option. Maternal and perinatal outcomes in women with CF (wwCF) are similar to those seen in the general population. However, the effect of undergoing multiple pregnancies is unknown. METHODS: A multinational-multicenter retrospective cohort study. Data was obtained from 18 centers worldwide, anonymously, on wwCF 18-45 years old, including disease severity and outcome, as well as obstetric and newborn complications. Data were analyzed, within each individual patient to compare the outcomes of an initial pregnancy (1st or 2nd) with a multigravid pregnancy (≥3) as well as secondary analysis of grouped data to identify risk factors for disease progression or adverse neonatal outcomes. Three time periods were assessed - before, during, and after pregnancy. RESULTS: The study population included 141 wwCF of whom 41 (29%) had ≥3 pregnancies, "multiparous". Data were collected on 246 pregnancies, between 1973 and 2020, 69 (28%) were multiparous. A greater decline in ppFEV1 was seen in multiparous women, primarily in pancreatic insufficient (PI) wwCF and those with two severe (class I-III) mutations. Multigravid pregnancies were shorter, especially in wwCF over 30 years old, who had high rates of prematurity and newborn complications. There was no effect on pulmonary exacerbations or disease-related complications. CONCLUSIONS: Multiple pregnancies in wwCF are associated with accelerated respiratory deterioration and higher rates of preterm births. Therefore, strict follow-up by a multidisciplinary CF and obstetric team is needed in women who desire to carry multiple pregnancies.
- MeSH
- cystická fibróza * komplikace MeSH
- dospělí MeSH
- komplikace těhotenství epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- parita MeSH
- předčasný porod epidemiologie MeSH
- progrese nemoci MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- stupeň závažnosti nemoci MeSH
- těhotenství mnohočetné MeSH
- těhotenství MeSH
- výsledek těhotenství * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
INTRODUCTION AND HYPOTHESIS: The main risk factor for pelvic floor disorders is vaginal delivery, which may cause levator ani muscle (LAM) injury and denervation. LAM includes pubovisceral muscle (PVM, pubococcygeus), puborectalis muscle (PRM), and iliococcygeus muscle. We hypothesize that primiparous women with low pelvic floor muscle contraction have a reduced PVM cross-sectional area (CSA) compared to nulliparous women. METHODS (SAMPLE SIZE AND STATISTICAL APPROACHES): This single-centre prospective observational study compared healthy nulliparous (n = 40) to primiparous (n = 40) women after vaginal delivery without LAM avulsion and Oxford score ≤ 3. Demographics, questionnaires (ICIQ-UI-SF, OAB-Q-SF, PISQ-12), POP-Q, Oxford score, ultrasound measurements (minimal anteroposterior and lateral diameters, hiatal area, PRM thickness, levator-urethra gap) and magnetic resonance imaging (MRI)-PVM CSA were evaluated. Normality was tested, and an appropriate test was used to compare the groups. Power calculation suggested 40 participants per group. RESULTS: The primiparous group was older, had a higher BMI, and their hiatal area on ultrasound at contraction was larger compared to the nulliparous group. The CSA of the left-sided PVM (1.15 ± 0.50 cm2) was larger compared to the right side (1.03 ± 0.50 cm2), p = 0.02 in nulliparous women. The PVM CSA of primiparous women with low Oxford score was reduced compared to nulliparous (0.87 ± 0.30 versus 1.09 ± 0.50 cm2, p = 0.006). The intra-rater reliability for PVM CSA had an ICC of 0.90 and inter-rater ICC of 0.77. CONCLUSIONS: Primiparous women after vaginal delivery with low pelvic floor contraction force had reduced PVM CSA on MRI images compared to nulliparous women.
- MeSH
- dospělí MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- onemocnění dna pánevního diagnostické zobrazování etiologie MeSH
- pánevní dno * diagnostické zobrazování MeSH
- parita * MeSH
- prospektivní studie MeSH
- svalová kontrakce fyziologie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- vedení porodu MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Absolutní uterinní faktor infertility je podmíněn vrozenou nebo získanou absencí dělohy či přítomností nefunkční dělohy u žen, které se chtějí stát biologickými matkami. Osobní reprodukční zkušenost může dnes ženám bez dělohy poskytnout transplantace dělohy v kombinaci s metodami asistované reprodukce. V raném období výzkumu byla v zájmu minimalizace rizika předčasného porodu a dalších komplikací souvisejících s těhotenstvím doporučena k transplantaci pouze děloha od dárkyně s anamnézou jednoho až tří dokončených těhotenství. Ke snížení rizika předčasného porodu by se u příjemkyň dělohy mělo trvat spíše na jednočetném těhotenství než na darování dělohy od ženy s alespoň jedním porodem v anamnéze. Mírné zúžení v místě anastomózy vaginální manžety děložního štěpu a neovaginy příjemkyně jsme předpokládali, ale rozsah první vaginální stenózy časně po transplantaci dělohy byl přesto nepříjemným překvapením. Gynekolog by měl pro prevenci potransplantační vaginální striktury zhodnotit tvar a rozměry děložního čípku dárkyně, porovnat je s rozměry neovaginy a poševní klenby příjemkyně a provést anastomózu děložního hrdla k neovagině tak, aby byl zajištěn volný přístup k děložnímu hrdlu pro provedení cervikální biopsie kvůli kontrole rejekce štěpu a pro hladké zavedení katétru pro transfer embrya do děložní dutiny.
Absolute uterine factor infertility is conditioned by the congenital or acquired absence of the uterus or the presence of a nonfunctioning uterus in women who wish to become biological mothers. Uterine transplantation along with assisted reproductive techniques can provide this option for women without a uterus. In the early research period, to minimize the risk of preterm birth and other pregnancy-related complications, the uterus of a donor with a history of one to three successfully completed pregnancies was recommended for transplantation. We believe that insisting on a singleton pregnancy is necessary to reduce the risk of premature birth in uterus recipients, rather than insisting on donating a uterus from a woman with a history of at least one birth. Mild post-transplant narrowing of the vaginal-neovaginal anastomosis was expected; however, the first severe vaginal stricture revealed soon after transplantation was an unpleasant surprise. To prevent post-transplant vaginal stricture, gynecologic surgeons should evaluate the shape and size of the donor’s cervix, compare it with the size of the recipient’s neovagina and vaginal vault, and perform a vaginal-neovaginal anastomosis to ensure free access for post-transplant cervical biopsies to reveal signs of subclinical rejection and smooth insertion of the embryo transfer catheter into the uterine cavity.
- MeSH
- lidé MeSH
- parita MeSH
- předčasný porod * etiologie MeSH
- přenos embrya metody MeSH
- reprodukční techniky MeSH
- rizikové faktory MeSH
- stenóza etiologie prevence a kontrola MeSH
- uterus * abnormality transplantace MeSH
- vagina chirurgie patologie MeSH
- výběr dárců metody MeSH
- ženská infertilita chirurgie etiologie MeSH
- Check Tag
- lidé MeSH
- MeSH
- dospělí MeSH
- gynekologické vyšetření MeSH
- inkontinence moči MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- pánevní dno * fyziologie patofyziologie MeSH
- parita MeSH
- plošný screening MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- rehabilitace MeSH
- svalová síla fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví 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
BACKGROUND: Nulliparous uterine grafts have never been used in uterus transplantation (UTx), possibly due to presumed infertility. Our objective was to verify the feasibility of nulliparous uterine graft transplantation. METHODS: The Czech Uterus Transplant Trial (registered under ClinicalTrials.gov, identifier NCT03277430) is a 2-arm trial comparing the efficacy of deceased donor (DD) versus live-donor uterus transplant (10 patients in both arms). A 25-year-old patient suffering from inborn absolute uterine factor infertility underwent a DD uterus transplant. The donor was a 20-year-old nulliparous brain-dead donor. RESULTS: The transplant procedure was uneventful. The posttransplant period was complicated by (1) recurrent episodes of acute cellular rejection, (2) neutropenia necessitating the administration of granulocyte colony-stimulating factor, (3) vaginal anastomotic stenosis treated with the insertion of a self-expanding stent, (4) the concurrence of Clostridium difficile colitis and acute appendicitis, and (5) temporary renal function impairment of a combined cause. Two years after the UTx, after the fourth embryo transfer, the patient became pregnant. Apart from gestational diabetes mellitus, the pregnancy was uneventful. Due to preterm contractions, delivery was achieved via caesarean section at gestational age 34 + 6 years. The postoperative course was uneventful for both the mother and the newborn. CONCLUSIONS: Herein, we report the first live birth after a DD UTx in Europe. This report provides a proof of concept that nulliparous uteri may present a suitable source of uterine grafts for UTx. Stenting may serve as a feasible treatment method for vaginal anastomotic stenosis.
- MeSH
- asistovaná reprodukce MeSH
- dárci tkání * MeSH
- doba do početí MeSH
- dospělí MeSH
- ductus Mülleri abnormality MeSH
- fertilita * MeSH
- lidé MeSH
- mladý dospělý MeSH
- narození živého dítěte MeSH
- parita * MeSH
- pooperační komplikace etiologie terapie MeSH
- poruchy sexuálního vývoje s karyotypem 46, XX komplikace MeSH
- stenty MeSH
- těhotenství MeSH
- uterus transplantace MeSH
- vrozené vady MeSH
- výběr dárců MeSH
- výsledek terapie MeSH
- ženská infertilita diagnóza etiologie patofyziologie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
OBJECTIVES: Pelvic floor muscles (PFMs) weakening and urinary incontinence (UI) represent health issues that have a negative impact on daily life. This study compares the immediate efficiency of high-intensity focused electromagnetic (HIFEM) therapy and electrostimulation for the treatment of weakened PFMs, accompanied by the UI. METHODS: Ninety-five parous women were considered for the study. Symptomatic patients received either HIFEM or electrostimulation treatment. Treated patients completed 10 therapies scheduled 2 to 3 times per week (HIFEM) or every other day (electrostimulation). Patients underwent examination by 3-dimensional transperienal ultrasound at the baseline and posttreatments. Levator-urethra gap, anteroposterior diameter, laterolateral diameter of levator hiatus, and hiatal area were measured. In addition, Pelvic Floor Disability Index 20 questionnaire and subjective evaluation of patient's intimate health were assessed. RESULTS: Enrolled patients were divided into group I (n = 50, HIFEM), group II (n = 25, electrostimulation), and group III (n = 20, control) according the indication and treatment modality. Three-dimensional ultrasounds showed positive changes in dynamics of the pelvic floor posttreatment (decreased anteroposterior diameter, laterolateral diameter, and hiatal area). However, the significant (P < 0.05) changes of pelvic floor integrity were observed only in group I. In addition, group I achieved greater level of improvement in Pelvic Floor Disability Index 20 questionnaire compared with group II (52% and 18% respectively; P < 0.001). Substantially fewer patients in group I reported urine leakage after treatments. CONCLUSIONS: Posttreatment results suggest that HIFEM technology is suitable for treatment of PFMs weakening and showed to be more effective when compared with electrostimulation in short-term. Therefore, we recommend HIFEM as treatment option for weakened PFMs and UI.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- elektrostimulační terapie * MeSH
- inkontinence moči terapie MeSH
- lidé MeSH
- magnetoterapie * metody MeSH
- onemocnění dna pánevního terapie MeSH
- parita MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
