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Amyx M, Philibert M, Farr A, Donati S, Smárason AK, Tica V, Velebil P, Alexander S, Durox M, Elorriaga MF, Heller G, Kyprianou T, Mierzejewska E, Verdenik I, Zīle-Velika I, Zeitlin J. Trends in caesarean section rates in Europe from 2015 to 2019 using Robson's Ten Group Classification System: A Euro-Peristat study. BJOG 2024; 131:444-454. [PMID: 37779035 DOI: 10.1111/1471-0528.17670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023]
Abstract
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.
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Affiliation(s)
- Melissa Amyx
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
| | - Marianne Philibert
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Italian Ministry of Health (ISS), Rome, Italy
| | - Alexander K Smárason
- Institution of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Vlad Tica
- Faculty of Medicine, East European Institute for Reproductive Health, Academy of Romanian Scientists, University 'Ovidius' Constanţa, Constanța, Romania
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
- 3rd Medical School of Charles University, Prague, Czech Republic
| | - Sophie Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mélanie Durox
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
| | | | - Günther Heller
- Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany
| | | | - Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Ivan Verdenik
- Department of Obstetrics and Gynaecology, University Medical Centre, Ljubljana, Slovenia
| | - Irisa Zīle-Velika
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Jennifer Zeitlin
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
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Atobrah-Apraku K, Newman GT, Opuni-Frimpong Y, Seffah JD, Adu-Bonsaffoh K. Lived experiences of women during induction of labour at a tertiary hospital in Ghana: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002290. [PMID: 38359028 PMCID: PMC10868737 DOI: 10.1371/journal.pgph.0002290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
Induction of labour (IOL) has become a major and vital maternal health intervention to facilitate childbirth and minimize the rising caesarean section rates globally. However, there is limited information to facilitate appropriate client counselling, birth preparedness and informed decision making although the procedure has inherent tendency for adverse maternal/perinatal outcomes. Given the need for optimal client education and shared decision making in maternal health, this study explored women's knowledge and their lived experiences of IOL. This qualitative study used in-depth interviews, conducted at the largest teaching hospital in Ghana. Purposive sampling was used to recruit the study participants. Data analysis was performed based on thematic content using inductive framework synthesis. We included 17 women who had undergone IOL, delivered and discharged. Most participants(52.9%) were ≥30 years old, married(88.2%), and 41.1% had no previous childbirth experience. The main indications of IOL were postdate(47%), pre-eclampsia(29%) and gestational diabetes mellitus(11.8%). Data synthesis resulted in three broad themes: women's knowledge on IOL, women's experiences of care and women's difficult experiences including coping mechanisms. We determined mixed responses concerning the themes explored: adequate versus inadequate knowledge; positive versus negative experiences of care and satisfaction. Nearly all women mentioned vaginal examination as their most difficult experience due to severe pain, extreme discomfort, and being psychologically traumatic. The main coping strategy the women developed to navigate the traumatic vaginal examination was by "psyching" themselves. Our study indicates women encounter significant negative and positive experiences during IOL and childbirth in Ghana with vaginal examination cited as the most painful experience. Appropriate antenatal counselling, women empowerment and pre-labour education on childbirth processes and expectations are recommended to enhance birth preparedness and complication awareness. Health system improvement and regular refreshers courses for health workers are urgently required to promote positive women's experiences of care during labour induction and childbirth.
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Affiliation(s)
| | - Grace T. Newman
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Yaw Opuni-Frimpong
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Joseph D. Seffah
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
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Matshitsa L, Mercy-Nkuba N, Hofmeyr GJ. Extended balloon labour induction: A single arm proof of concept trial. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100226. [PMID: 37649714 PMCID: PMC10462842 DOI: 10.1016/j.eurox.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
Background Mechanical labour induction with a transcervical balloon is as effective as pharmacological methods, with fewer adverse effects. Its use has been limited to labour induction with an unfavourable cervix able to retain the balloon. We have developed an innovative approach using 2-3 balloons side-by-side to extend the benefits of mechanical labour induction/augmentation with a favourable cervix without having to resort to amniotomy or uterotonics. Objectives To assess the effectiveness of side-by-side balloons for extended labour induction/augmentation. Methods We conducted a single arm proof of concept trial at Princess Marina Hospital (PMH) in Gaborone, Botswana. Participants were assessed as unsuitable for single balloon labour induction based on a modified Bishop cervical score of 7 or more. Three Foley catheters taped symmetrically side by side were passed through the cervix and inflated with 60mls each. Traction was applied with a weight of 250mls water suspended over the bed-end. The use of uterotonics, time from induction to birth, mode of birth, Apgar scores and adverse maternal and neonatal outcomes were recorded. Participants' satisfaction with the method of labour induction was assessed using a descriptive scale. Results We enrolled 20 participants of whom two were nulliparous. Indications for labour induction were mainly late term (70%) and hypertensive disorders of pregnancy (25%). The mean cervical score was 7.2. Overall, 17 (85%) of the participants achieved a vaginal birth, of whom 5 required oxytocin for labour augmentation. Four of these had requested removal of the balloons, one due to discomfort and three felt the process was taking too long. Three participants underwent caesarean birth. The mean time from initiation of labour induction to vaginal birth was 16 h (standard deviation (SD) 8.4) and 20 h for caesarean birth (SD 10.5). There were no 5-minute Apgar scores below 7 nor neonatal admissions. One baby required brief resuscitation. There were no adverse maternal outcomes. Conclusion This proof-of-concept study suggests that use of side-by-side balloons in participants with favourable cervix is effective in achieving vaginal birth in most participants without uterotonics or amniotomy. There were no adverse outcomes, though the study was too small to exclude the possibility of rare adverse outcomes. This offers a novel option for labour induction/augmentation, particularly where uterotonics or amniotomy are best avoided such as prior caesarean birth, vertical infection transmission risk and in settings with limited capacity for fetal surveillance. The results clearly justify larger randomized trials to evaluate this novel approach with greater precision. On the basis of the current study we are developing a purpose-designed balloon for extended balloon labour induction.
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Affiliation(s)
- Lorato Matshitsa
- Department of Obstetrics and Gynaecology, University of Botswana, Pvt Bag, 00703 Gaborone, Botswana
| | - Nassali Mercy-Nkuba
- Department of Obstetrics and Gynaecology, University of Botswana, Pvt Bag, 00703 Gaborone, Botswana
| | - G. Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Pvt Bag, 00703 Gaborone, Botswana
- Department of Obstetrics and Gynaecology, University of the Witwatersrand and Walter Sisulu University, East London, South Africa
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Pacyga DC, Talge NM, Gardiner JC, Calafat AM, Schantz SL, Strakovsky RS. Maternal diet quality moderates associations between parabens and birth outcomes. ENVIRONMENTAL RESEARCH 2022; 214:114078. [PMID: 35964672 PMCID: PMC10052883 DOI: 10.1016/j.envres.2022.114078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND/OBJECTIVE Maternal paraben exposure and diet quality are both independently associated with birth outcomes, but whether these interact is unknown. We assessed sex-specific associations of parabens with birth outcomes and differences by maternal diet quality. METHODS Illinois pregnant women (n = 458) provided five first-morning urines collected at 8-40 weeks gestation, which we pooled for quantification of ethylparaben, methylparaben, and propylparaben concentrations. We collected/measured gestational age at delivery, birth weight, body length, and head circumference within 24 h of birth, and calculated sex-specific birth weight-for-gestational-age z-scores and weight/length ratio. Women completed three-month food frequency questionnaires in early and mid-to-late pregnancy, which we used to calculate the Alternative Healthy Eating Index (AHEI)-2010. Linear regression models evaluated sex-specific associations of parabens with birth outcomes, and differences in associations by average pregnancy AHEI-2010. RESULTS In this predominately non-Hispanic white, college-educated sample, maternal urinary paraben concentrations were only modestly inversely associated with head circumference and gestational length. However, methylparaben and propylparaben were inversely associated with birth weight, birth weight z-scores, body length, and weight/length ratio in female, but not male newborns. For example, each 2-fold increase in methylparaben concentrations was associated with -46.61 g (95% CI: -74.70, -18.51) lower birth weight, -0.09 (95% CI: -0.15, -0.03) lower birth weight z-scores, -0.21 cm (95% CI: -0.34, -0.07) shorter body length, and -0.64 g/cm (95% CI: -1.10, -0.19) smaller weight/length ratio in females. These inverse associations were more prominent in females of mothers with poorer diets (AHEI-2010 < median), but attenuated in those with healthier diets (AHEI-2010 ≥ median). In newborn males of mothers with healthier diets, moderate inverse associations emerged for propylparaben with gestational length and head circumference. CONCLUSIONS Maternal diet may moderate associations of parabens with birth size in a sex-specific manner. Additional studies may consider understanding the inflammatory and metabolic mechanisms underlying these findings.
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Affiliation(s)
- Diana C Pacyga
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, USA
| | - Nicole M Talge
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, 48824, USA
| | - Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, 48824, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Susan L Schantz
- The Department of Comparative Biosciences, University of Illinois, Urbana-Champaign, IL, 61802, USA; The Beckman Institute, University of Illinois, Urbana-Champaign, IL, 61801, USA
| | - Rita S Strakovsky
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, USA.
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Bączek G, Rzońca E, Rzońca P, Rychlewicz S, Budner M, Bień A. Retrospective Analysis of the Factors Affecting the Induction of Childbirth in 4350 Women from a Single Center in Warsaw, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159540. [PMID: 35954893 PMCID: PMC9368280 DOI: 10.3390/ijerph19159540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
Labor induction is one of the most common procedures performed during childbirth, on average in 20−30% of all pregnant women. The aim of this paper was to perform a retrospective analysis of the factors influencing the induction of childbirth. The data provide population-based evidence for Poland (Masovian Voivodeship). The electronic patient records of a hospital in Warsaw were used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included an analysis of two groups of patients. The study group consisted of patients with labor induction—4350 cases, and the control group of patients with spontaneous contractions—20,345. The factors influencing the lower frequency of labor induction in the study group were previous cesarean section (OR = 0.73, 95% CI: 0.64−0.84, p < 0.05) and a higher number of deliveries (OR = 0.74, 95% CI: 0.68−0.80, p < 0.05). It is necessary to conduct further research about obstetric procedures used during childbirth, such as induction of childbirth, to reduce the risk of complications and improve the perinatal care of the mother and the neonate.
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Affiliation(s)
- Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-116-92-02
| | - Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Sylwia Rychlewicz
- St. Sophia’s Specialist Hospital, Żelazna Medical Center, 01-004 Warsaw, Poland;
| | - Margareta Budner
- Eastern Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Łęczna, Poland;
- Department of Plastic Surgery, Department of Jaw Orthopaedics, University Dentistry Center, University of Lublin, 20-093 Lublin, Poland
- Clinic of Congenital Craniofacial Deformitis, 20-093 Lublin, Poland
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
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D'Souza R, Ashraf R, Foroutan F. Prediction models for determining the success of labour induction: A systematic review and critical analysis. Best Pract Res Clin Obstet Gynaecol 2021; 79:42-54. [DOI: 10.1016/j.bpobgyn.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/03/2023]
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