Objective To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention.Design Retrospective analysis of aggregated routine data.Setting Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project.Population Births in participating countries in 2010.Methods Countries provided aggregated data about overall rates of obstetric intervention and about caesarean section rates for specified subgroups.Main outcome measures Mode of delivery.Results Rates of caesarean section ranged from 14.8% to 52.2% of all births and rates of instrumental vaginal delivery ranged from 0.5% to 16.4%. Overall, there was no association between rates of instrumental vaginal delivery and rates of caesarean section, but similarities were observed between some countries that are geographically close and may share common traditions of practice. Associations were observed between caesarean section rates for women with breech and vertex births and with singleton and multiple births but patterns of association for women who had and had not had previous caesarean sections were more complex.Conclusions The persisting wide variations in caesarean section and instrumental vaginal delivery rates point to a lack of consensus about practice and raise questions for further investigation. Further research is needed to explore the impact of differences in clinical guidelines, healthcare systems and their financing and parents' and professionals' attitudes to care at delivery.

High pre-pregnancy BMI carries an especially high risk for the development of preeclampsia and its complications in twin gestation.

Objective To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention.Design Retrospective analysis of aggregated routine data.Setting Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project.Population Births in participating countries in 2010.Methods Countries provided aggregated data about overall rates of obstetric intervention and about caesarean section rates for specified subgroups.Main outcome measures Mode of delivery.Results Rates of caesarean section ranged from 14.8% to 52.2% of all births and rates of instrumental vaginal delivery ranged from 0.5% to 16.4%. Overall, there was no association between rates of instrumental vaginal delivery and rates of caesarean section, but similarities were observed between some countries that are geographically close and may share common traditions of practice. Associations were observed between caesarean section rates for women with breech and vertex births and with singleton and multiple births but patterns of association for women who had and had not had previous caesarean sections were more complex.Conclusions The persisting wide variations in caesarean section and instrumental vaginal delivery rates point to a lack of consensus about practice and raise questions for further investigation. Further research is needed to explore the impact of differences in clinical guidelines, healthcare systems and their financing and parents' and professionals' attitudes to care at delivery.

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After exclusion of potential confounders and controlling for chorionicity, parity, and gestational age, our data do not support the presence of a "masculinization" effect on birth weight.