Wide Differences in Mode of Delivery Within Europe: Risk-stratified Analyses of Aggregated Routine Data from the Euro-Peristat Study

MacFarlane, A; Blondel, Béatrice; Mohangoo, Ashna D.; Cuttini, Marina; Nijhuis, J.G.; Novak, Živa; Ólafsdóttir, Helga Sól; Zeitlin, Jennifer

doi:10.1097/01.aoa.0000512011.96214.d3

Cited by 8 publications

(15 citation statements)

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“…This finding is in accordance with other studies [9,[21][22][23]. The proportion of caesarean deliveries is noticeably higher in Georgia (43.5% in 2016) [33] compared to the mean in European countries (25.2% in 2010) [42]. Considering this high rate, the negative association with early postpartum exclusive breastfeeding is of particular interest.…”

Section: Discussionsupporting

confidence: 91%

“…In the initial population, 30.8% of all births were emergency caesarean deliveries and 14.3% were elective caesarean deliveries (data not shown). In comparison, the median proportion of emergency caesarean deliveries was 12.9% and for elective caesarean deliveries 10.7% in an aggregated study of European countries [42]. Had reliable data been available, separating the caesarean deliveries into elective and emergency would be important, as it would allow the adjustment for related variables like in vitro fertilization, maternal intrapartum complications, and birthweight.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Factors associated with exclusive breastfeeding at hospital discharge: a study using data from the Georgian Birth Registry

2020

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Background The World Health Organization recommends exclusive breastfeeding for six months, defined as no other solids or liquids besides breast milk and essential vitamins or medicines. Data about exclusive breastfeeding are limited in Georgia, and the information that exist are provided by national surveys, that present inconsistent numbers. Georgia has recently established a national birth registry, which includes information about early postpartum breastfeeding. The objective of this study was to identify factors associated with exclusive breastfeeding of term newborns at hospital discharge in Georgia, using national registry data. Methods All live, singleton, term births registered in the Georgian Birth Registry in November and December 2017 were included, with a final study sample of 7134 newborns. Newborns exclusively breastfed at hospital discharge were compared with those who were not, and potential factors were assessed with logistic regression analysis. Hospital discharge normally occurred between 2 and 5 days postpartum. Results The study identified several factors associated with nonexclusive breastfeeding of term newborns at hospital discharge in Georgia: maternal higher education compared to secondary education or less (Adjusted Odds Ratio [AOR] 0.75; 95% CI 0.59, 0.97), caesarean delivery compared to vaginal or assisted vaginal delivery (AOR 0.47; 95% CI 0.37, 0.60), birthweight < 2500 g compared to 3000–3499 g (AOR 0.51; 95% CI 0.27, 0.97), and admission to neonatal intensive care unit after delivery (AOR 0.02; 95% CI 0.02, 0.03). None of the following factors were associated with exclusive breastfeeding at discharge: mother’s age, marital status, Body Mass Index (BMI), parity, in vitro fertilization, maternal intrapartum complications and the sex of the newborn. Conclusions To the authors’ knowledge, this is the first time determinants of exclusive breastfeeding at hospital discharge have been studied in Georgia. Several factors associated with nonexclusive breastfeeding at discharge were identified, most noteworthy were caesarean delivery and admission to neonatal intensive care unit. These findings are of importance to the Georgian health authorities and maternal/child non-governmental organizations.

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Section: Discussionsupporting

confidence: 91%

Section: Strengths and Limitationsmentioning

confidence: 99%

Factors associated with exclusive breastfeeding at hospital discharge: a study using data from the Georgian Birth Registry

2020

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“…Global elective CS rates vary considerably between different regions and countries. Routine data from the Euro-Peristat study show that the rate of elective CS ranges between 0.5% (Romania) and 38.8% (Cyprus) of total births [6]. Other countries with high elective CS rates include Italy (24.9%), Luxembourg (17.9%), and Malta (16.4%) [6].…”

Section: Introductionmentioning

confidence: 99%

Timing of term elective cesarean section and adverse neonatal outcomes: A multi-center retrospective cohort study

et al. 2021

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Background Rate of cesarean section (CS), including elective CS has globally increased. Studies have found that term elective CS before 39 weeks of gestation is associated with increased risk of adverse respiratory outcomes. Objective To determine the rate of elective CS and examine the association between timing of elective term CS and adverse neonatal outcomes in a large population of Lebanese women. Methods A Multi-Center Study was conducted using data from the National Collaborative Perinatal Neonatal Network database. Simple and multivariable logistic regression models were used to examine the association between timing of term elective CS and adverse neonatal outcomes. Some of the neonatal adverse outcomes we examined included respiratory distress syndrome, admission to the NICU, and a composite of respiratory outcomes. Results A total of 28,997 low risk mothers who delivered through primary and repeat elective CS were included in the study. Uncomplicated elective planned term CS constituted 25% of all CS deliveries in Lebanon. Primary and repeat CS at 37 weeks of gestation increased the odds of most of the studied adverse neonatal outcomes. There were few associations between CS and adverse neonatal outcomes at 38 weeks of gestation. Conclusions Term primary and repeat cesarean delivery prior to 39 weeks of gestation is associated with respiratory and other adverse neonatal outcomes. Delaying birth 1–2 weeks till 39 weeks of gestation can prevent 64–77% of adverse respiratory outcomes.

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“…Mode of delivery is one of Euro-Peristat's core indicators and is compiled separately by risk sub-groups based on parity, plurality, fetal presentation, previous caesarean section and gestational age. 14 Caesarean birth rates are calculated as a proportion of all stillbirths and live births, following the convention of international organisations, such as WHO and the Organisation for Economic Cooperation and Development. For the data collection exercise based on 2015 births, data about the TGCS were compiled using a pretested, standardised data collection table.…”

Section: Methodsmentioning

confidence: 99%

“…Prelabour caesarean sections are those occurring before the onset of labour, but as some countries use a classification based on whether caesarean sections are elective or emergency, Euro-Peristat combines prelabour with elective caesarean sections and caesarean sections during labour with emergency caesarean sections. 14 All data were cross-checked for potential discrepancies with data on total numbers of births, total number of caesarean sections, multiple births, preterm births, parity compiled for other indicators and errors were corrected by the data providers. The final data tables were verified by each of the country teams.…”

Section: Methodsmentioning

confidence: 99%

Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study

Zeitlin

Durox

Macfarlane

et al. 2021

BJOG

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Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub-groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates.Design Observational study using routine data.Setting Twenty-seven EU member states plus Iceland, Norway, Switzerland and the UK.Population All births at ≥22 weeks of gestational age in 2015.Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups.Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups.Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions.Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence-based caesarean policies.

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Wide Differences in Mode of Delivery Within Europe: Risk-stratified Analyses of Aggregated Routine Data from the Euro-Peristat Study

Cited by 8 publications

References 50 publications

Factors associated with exclusive breastfeeding at hospital discharge: a study using data from the Georgian Birth Registry

Factors associated with exclusive breastfeeding at hospital discharge: a study using data from the Georgian Birth Registry

Timing of term elective cesarean section and adverse neonatal outcomes: A multi-center retrospective cohort study

Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study

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