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Summary Background Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women's, Children's and Adolescents’ Health (2016–30) and the Every Newborn Action Plan (led by UNICEF and WHO) call for an end to preventable stillbirths. A first step to prevent stillbirths is obtaining standardised measurement of stillbirth rates across countries. We estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time. Methods For a systematic assessment, we created a dataset of 2833 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration and health information systems, household-based surveys, and population-based studies. After data quality assessment and exclusions, we used 1531 datapoints to estimate country-specific stillbirth rates for 195 countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model, according to a definition of stillbirth of at least 28 weeks’ gestational age. Our model combined covariates with a temporal smoothing process such that estimates were informed by data for country-periods with high quality data, while being based on covariates for country-periods with little or no data on stillbirth rates. Bias and additional uncertainty associated with observations based on alternative stillbirth definitions and source types, and observations that were subject to non-sampling errors, were included in the model. We compared the estimated stillbirth rates and trends to previously reported mortality estimates in children younger than 5 years. Findings Globally in 2019, an estimated 2·0 million babies (90% uncertainty interval [UI] 1·9–2·2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13·9 stillbirths (90% UI 13·5–15·4) per 1000 total births. Stillbirth rates in 2019 varied widely across regions, from 22·8 stillbirths (19·8–27·7) per 1000 total births in west and central Africa to 2·9 (2·7–3·0) in western Europe. After west and central Africa, eastern and southern Africa and south Asia had the second and third highest stillbirth rates in 2019. The global annual rate of reduction in stillbirth rate was estimated at 2·3% (90% UI 1·7–2·7) from 2000 to 2019, which was lower than the 2·9% (2·5–3·2) annual rate of reduction in neonatal mortality rate (for neonates aged <28 days) and the 4·3% (3·8–4·7) annual rate of reduction in mortality rate among children aged 1–59 months during the same period. Based on the lower bound of the 90% UIs, 114 countries had an estimated decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50·0%, 28 having a decrease of 25·0–49·9%, 50 having a decrease of 10·0–24·9%, and 32 having a decrease of less than 10·0%. For the remaining 81 countries, we found no decrease in stillbirth rate since 2000. Of these countries...

BACKGROUND-Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.

In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.).

C esarean delivery rates in industrialized countries continue to rise. 1,2 The rates vary widely by country, health care facility and delivering physician, partly because of differing perceptions by health care providers as well as by pregnant women of its benefits and risks. [3][4][5][6][7] The relative safety of cesarean delivery and its perceived advantages relative to vaginal delivery have resulted in a change in the perceived risk-benefit ratio, which has accelerated acceptance. 1,[4][5][6][7][8][9][10][11][12] Indeed, a belief has become widespread that the risks of cesarean delivery for healthy women are so low as to make it a reasonable elective option for childbirth. 1,4,[12][13][14][15][16][17][18][19] Historically, most cesarean deliveries took place because of or in association with obstetrical complications or medical illness. However, rates of elective primary cesarean deliveries with no clear medical or obstetrical indication are rising dramatically. 1,5,6,[15][16][17][18][19][20] There is, therefore, a pressing need to assess the risks of maternal complications and death associated with elective cesarean delivery carried out in healthy women. Allen and colleagues 18 recently used the Nova Scotia Atlee Perinatal Database to compare outcomes of women whose cesarean deliveries were performed at term without labour and those with planned vaginal deliveries, but the relatively small sample size, the rarity of severe morbidity and absence of maternal deaths resulted in an incomplete picture. The main purpose of our study was to compare the risks of low-risk, elective cesarean delivery with those of planned vaginal delivery among healthy women at term. MethodsThe Canadian Institute for Health Information (CIHI) began collecting information on all admissions to Canada's acutecare hospitals in the early 1980s. CIHI's Discharge Abstract Database has been widely used for perinatal surveillance and research. 3,21,22 Data on all deliveries that took place from April 1, 1991 through March 31, 2005 were gathered for study except those occurring in the provinces of Quebec and Manitoba: complete information on these provinces was not contained in the database. The total number of in-hospital deliv-

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Objectives To examine variations in the registration of extremely low birthweight and early gestation births and to assess their effect on perinatal and infant mortality rankings of industrialised countries.

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