Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.12.008
Giovanni Morganelli , Stefania Fieni , Sara dell’Omo , Vito Andrea Capozzi , Maurizio Di Serio , Andrea Dall’Asta , Tullio Ghi
Objective
The aim of this systematic review is to summarize the current evidence on preventive interventions and bundles, including combinations of multiple techniques, aimed at reducing vaginal delivery-related perineal injury.
Methods
A systematic research of literature was independently conducted on different databases (PubMed, MEDLINE, EMBASE) by the authors, using a combination of the identified keywords and index terms as per current PRISMA guidelines. The research was restricted to papers published in English starting by 2000. Similar papers as previously published reviews and metanalysis satisfying the inclusion criteria were used as cross-reference to check for potential further inclusions.
Findings
In total 14 papers have been identified to be included in our review, divided into 2 randomized controlled trials and 12 cohort studies (4 prospective cohort studies, 6 retrospective cohort studies, 1 prospective case-control study and 1 multicenter step-wedge cluster study).
Conclusions
Bundles and interventions, including combinations of techniques and tools aimed at enhancing intrapartum perineal care are effective in reducing adverse perineal outcome after vaginal delivery. Most common features include training programs for labor professionals, pushing instructions and communication, hands-on technique for both reducing speed of delivery and perineal support, and restrictive use of medio-lateral episiotomy.
{"title":"Efficacy of intrapartum bundles and interventions in reducing vaginal delivery-related perineal trauma: a systematic review","authors":"Giovanni Morganelli , Stefania Fieni , Sara dell’Omo , Vito Andrea Capozzi , Maurizio Di Serio , Andrea Dall’Asta , Tullio Ghi","doi":"10.1016/j.ejogrb.2024.12.008","DOIUrl":"10.1016/j.ejogrb.2024.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this systematic review is to summarize the current evidence on preventive interventions and bundles, including combinations of multiple techniques, aimed at reducing vaginal delivery-related perineal injury.</div></div><div><h3>Methods</h3><div>A systematic research of literature was independently conducted on different databases (PubMed, MEDLINE, EMBASE) by the authors, using a combination of the identified keywords and index terms as per current PRISMA guidelines. The research was restricted to papers published in English starting by 2000. Similar papers as previously published reviews and metanalysis satisfying the inclusion criteria were used as cross-reference to check for potential further inclusions.</div></div><div><h3>Findings</h3><div>In total 14 papers have been identified to be included in our review, divided into 2 randomized controlled trials and 12 cohort studies (4 prospective cohort studies, 6 retrospective cohort studies, 1 prospective case-control study and 1 multicenter step-wedge cluster study).</div></div><div><h3>Conclusions</h3><div>Bundles and interventions, including combinations of techniques and tools aimed at enhancing intrapartum perineal care are effective in reducing adverse perineal outcome after vaginal delivery. Most common features include training programs for labor professionals, pushing instructions and communication, hands-on technique for both reducing speed of delivery and perineal support, and restrictive use of medio-lateral episiotomy.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 107-116"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.11.022
Xinyu Chen , Siqing Wu , Xinqing Chen , Linmin Hu , Wenjing Li , Ningning Mi , Peng Xie , Yujun Huang , Kun Yuan , Yajuan Sui , Renjie Li , Kangting Wang , Nan Sun , Yuyang Yao , Zuofeng Xu , Jinqiu Yuan , Yunxiao Zhu
Objective
To develop machine learning prediction models for small for gestational age with baseline characteristics and biochemical tests of various pregnancy stages individually and collectively and compare predictive performance.
Study design
This retrospective study included singleton pregnancies with infants born between May 2018 and March 2023. Small for gestational age was defined as a birth weight below the 10th percentile according to the Intergrowth-21st fetal growth standards. The pregnancy data were categorized into four datasets at different gestational time points (14 and 28 weeks and admission). The LightGBM framework was utilized to assess the variable importance by employing a five-fold cross-validation. RandomizedSearchCV and sequential feature selection were applied to estimate the optimal number of features. Seven machine learning algorithms were used to develop prediction models, with an 8:2 ratio for training and testing. The model performance was evaluated using receiver operating characteristic curve analysis and sensitivity at a false positive rate of 10 %.
Results
We included data of 4,394 women with singleton pregnancies, including 148 (3.4%) small for gestational age infants. Women delivering small for gestational age infants exhibited significantly shorter stature and lower fundal height and abdominal circumference at admission. Maternal height, age, and pre-pregnancy weight consistently ranked among the top 20 features in prediction models with any dataset. The models incorporated variables of admission stage have strong predictive performance with the area under the curves exceeding 0.8. The prediction model developed with variables of admission stage yielded the best performance, achieving an area under the curve of 0.85 and a sensitivity of 73% at the false positive rate of 10%.
Conclusions
By machine learning, various pregnancy stages’ prediction models for small for gestational age showed good predictive performance, and the predictive value of variables at each pregnancy stage was fully explored. The prediction model with the best performance was established with variables of admission stage and emphasized the significance of prenatal physical examinations.
{"title":"Constructing small for gestational age prediction models: A retrospective machine learning study","authors":"Xinyu Chen , Siqing Wu , Xinqing Chen , Linmin Hu , Wenjing Li , Ningning Mi , Peng Xie , Yujun Huang , Kun Yuan , Yajuan Sui , Renjie Li , Kangting Wang , Nan Sun , Yuyang Yao , Zuofeng Xu , Jinqiu Yuan , Yunxiao Zhu","doi":"10.1016/j.ejogrb.2024.11.022","DOIUrl":"10.1016/j.ejogrb.2024.11.022","url":null,"abstract":"<div><h3>Objective</h3><div>To develop machine learning prediction models for small for gestational age with baseline characteristics and biochemical tests of various pregnancy stages individually and collectively and compare predictive performance.</div></div><div><h3>Study design</h3><div>This retrospective study included singleton pregnancies with infants born between May 2018 and March 2023. Small for gestational age was defined as a birth weight below the 10th percentile according to the Intergrowth-21st fetal growth standards. The pregnancy data were categorized into four datasets at different gestational time points (14 and 28 weeks and admission). The LightGBM framework was utilized to assess the variable importance by employing a five-fold cross-validation. RandomizedSearchCV and sequential feature selection were applied to estimate the optimal number of features. Seven machine learning algorithms were used to develop prediction models, with an 8:2 ratio for training and testing. The model performance was evaluated using receiver operating characteristic curve analysis and sensitivity at a false positive rate of 10 %.</div></div><div><h3>Results</h3><div>We included data of 4,394 women with singleton pregnancies, including 148 (3.4%) small for gestational age infants. Women delivering small for gestational age infants exhibited significantly shorter stature and lower fundal height and abdominal circumference at admission. Maternal height, age, and pre-pregnancy weight consistently ranked among the top 20 features in prediction models with any dataset. The models incorporated variables of admission stage have strong predictive performance with the area under the curves exceeding 0.8. The prediction model developed with variables of admission stage yielded the best performance, achieving an area under the curve of 0.85 and a sensitivity of 73% at the false positive rate of 10%.</div></div><div><h3>Conclusions</h3><div>By machine learning, various pregnancy stages’ prediction models for small for gestational age showed good predictive performance, and the predictive value of variables at each pregnancy stage was fully explored. The prediction model with the best performance was established with variables of admission stage and emphasized the significance of prenatal physical examinations.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 48-55"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The optimal duration of second stage of labor has been largely discussed in literature, but there are no uniformly accepted contemporary criteria for defining normal or abnormal length. Available evidence suggests that longer duration of second stage of labor is associated with a lower rate of spontaneous vaginal delivery and increased maternal morbidity. On the neonatal side, it seems that longer second stage doesn’t affect new-born morbidity, in a context of very rare neonatal complications.
Objectives
To investigate the association between the second stage of labor management and maternal and neonatal outcomes.
Study design
This is a retrospective multicenter study involving all consecutive singleton term pregnancies who reached the second stage of labor between January and December 2022 at two third level maternity Hospitals. We compared an interventional management (considering operative vaginal delivery after 30 min of pushing) adopted at Robert Debre Hospital in France, and an expectant management (up to 1–2 h of pushing based on parity) adopted at AOUI Verona in Italy. Propensity score matched 1:1 analysis was implemented. The association between the second stage of labor management and maternal and neonatal outcomes was tested by conditional logistic regression, overall and stratified by parity.
Results
The propensity score matching (1:1) identified 1,168 matched couples of women. The interventional management was associated with a higher use of operative vaginal delivery (OR 2.3, 95 %CI 1.8–2.9) and episiotomy (OR 1.4, 95 % CI1.1–1.8), and a lower risk of severe postpartum hemorrhage (OR 0.1, 95 %CI 0.05–0.3) and cesarean section among nulliparous (OR 0.4, 95 % CI 0.2–0.9). No association with perineal lacerations, neonatal outcomes, and major maternal morbidity was observed.
Conclusions
The interventional management was associated with lower risk of postpartum hemorrhage in all patients and cesarean section among nulliparous women, but higher operative vaginal delivery and episiotomy use, without clinical advantages for the newborn. To support one approach over the other, additional factors should be considered, such as women’s preferences and expectations, obstetricians’ skills, and medicolegal context.
背景：第二产程的最佳持续时间已在文献中进行了大量讨论，但没有统一接受的标准来定义正常或异常的长度。现有证据表明，第二产程持续时间较长与阴道自然分娩率较低和产妇发病率增加有关。在新生儿方面，似乎较长的第二阶段并不影响新生儿发病率，在非常罕见的新生儿并发症的背景下。目的：探讨产程第二阶段管理与母婴结局的关系。研究设计：这是一项回顾性多中心研究，涉及2022年1月至12月期间在两家三级妇产医院连续完成第二产程的单胎足月妊娠。我们比较了法国Robert Debre医院采用的介入治疗（考虑30分钟后阴道分娩）和意大利维罗纳AOUI医院采用的期待治疗（根据胎次推1-2小时）。采用倾向评分匹配1:1分析。第二阶段产程管理与产妇和新生儿结局之间的关联通过条件逻辑回归进行检验，总体和按胎次分层。结果：倾向得分匹配（1:1）确定了1168对匹配的女性。介入治疗与手术阴道分娩（OR 2.3, 95% CI 1.8-2.9）和会阴切开术（OR 1.4, 95% CI1.1-1.8）的较高使用相关，并且在无产妇女中发生严重产后出血（OR 0.1, 95% CI 0.05-0.3）和剖宫产（OR 0.4, 95% CI 0.2-0.9）的风险较低。与会阴撕裂伤、新生儿结局和主要产妇发病率无关联。结论：介入治疗与所有患者产后出血和未产妇女剖宫产的风险均较低相关，但与阴道手术分娩和会阴切开术的发生率较高相关，对新生儿无临床优势。为了支持一种方法而不是另一种方法，应该考虑其他因素，例如妇女的偏好和期望，产科医生的技能和医学法律背景。
{"title":"Maternal and neonatal outcomes after a more interventional versus a more expectant management of the second stage of labor: A retrospective multicenter study","authors":"Marina Sangaletti , Diane Korb , Mariachiara Bosco , Pier Carlo Zorzato , Stefano Uccella , Simone Garzon","doi":"10.1016/j.ejogrb.2024.11.049","DOIUrl":"10.1016/j.ejogrb.2024.11.049","url":null,"abstract":"<div><h3>Background</h3><div>The optimal duration of second stage of labor has been largely discussed in literature, but there are no uniformly accepted contemporary criteria for defining normal or abnormal length. Available evidence suggests that longer duration of second stage of labor is associated with a lower rate of spontaneous vaginal delivery and increased maternal morbidity. On the neonatal side, it seems that longer second stage doesn’t affect new-born morbidity, in a context of very rare neonatal complications.</div></div><div><h3>Objectives</h3><div>To investigate the association between the second stage of labor management and maternal and neonatal outcomes.</div></div><div><h3>Study design</h3><div>This is a retrospective multicenter study involving all consecutive singleton term pregnancies who reached the second stage of labor between January and December 2022 at two third level maternity Hospitals. We compared an interventional management (considering operative vaginal delivery after 30 min of pushing) adopted at Robert Debre Hospital in France, and an expectant management (up to 1–2 h of pushing based on parity) adopted at AOUI Verona in Italy. Propensity score matched 1:1 analysis was implemented. The association between the second stage of labor management and maternal and neonatal outcomes was tested by conditional logistic regression, overall and stratified by parity.</div></div><div><h3>Results</h3><div>The propensity score matching (1:1) identified 1,168 matched couples of women. The interventional management was associated with a higher use of operative vaginal delivery (OR 2.3, 95 %CI 1.8–2.9) and episiotomy (OR 1.4, 95 % CI1.1–1.8), and a lower risk of severe postpartum hemorrhage (OR 0.1, 95 %CI 0.05–0.3) and cesarean section among nulliparous (OR 0.4, 95 % CI 0.2–0.9). No association with perineal lacerations, neonatal outcomes, and major maternal morbidity was observed.</div></div><div><h3>Conclusions</h3><div>The interventional management was associated with lower risk of postpartum hemorrhage in all patients and cesarean section among nulliparous women, but higher operative vaginal delivery and episiotomy use, without clinical advantages for the newborn. To support one approach over the other, additional factors should be considered, such as women’s preferences and expectations, obstetricians’ skills, and medicolegal context.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 75-80"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.12.032
Xulian Tu , Wan Xie , Liping Wu , Xia Liu , Xiaoyan Li , Mingyue Leng
Objectives
The aim of this study was to cross-culturally translate a questionnaire about gynecological and pelvic pain symptoms (ENDOPAIN-4D) patient-reported outcome measurement (PROM) into Chinese and evaluate its reliability and validity.
Methods
The questionnaire was translated according to Brislin’s classic back-translation model. We conducted cultural debugging through cognitive interviews with Chinese-speaking women who had experienced pelvic pain (n = 24). Following the patient-reported outcome and a consensus-building process, the research team developed the Chinese version of the ENDOPAIN-4D. Structure, reliability, and structural validity were subsequently verified in a sample of patients with chronic pelvic pain (n = 552).
Results
The results of the cognitive discussion indicated that some interviewers exhibited ambiguity in their comprehension of 16 items. All items except Item 21, whose critical ratio was 0.847, indicating no statistically significant difference, were included in the questionnaire. However, this study retained Item 21 as an additional item because of the distinctive features of endometriosis and the original author’s suggestion. The overall Cronbach’s α coefficient for the questionnaire was 0.87. The Chinese version of the ENDOPAIN-4D demonstrated a moderate correlation with the corresponding standard validity tools (r = 0.57).
Conclusion
The Chinese version of the ENDOPAIN-4D exhibited satisfactory reliability and validity, rendering it a productive instrument for assessing pelvic discomfort in patients.
{"title":"Chinese translation, cross-cultural adaptation, and psychometric validation of patient-reported outcome measurement- questionnaire about gynecological and pelvic pain symptoms (ENDOPAIN-4D)","authors":"Xulian Tu , Wan Xie , Liping Wu , Xia Liu , Xiaoyan Li , Mingyue Leng","doi":"10.1016/j.ejogrb.2024.12.032","DOIUrl":"10.1016/j.ejogrb.2024.12.032","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to cross-culturally translate a questionnaire about gynecological and pelvic pain symptoms (ENDOPAIN-4D) patient-reported outcome measurement (PROM) into Chinese and evaluate its reliability and validity.</div></div><div><h3>Methods</h3><div>The questionnaire was translated according to Brislin’s classic back-translation model. We conducted cultural debugging through cognitive interviews with Chinese-speaking women who had experienced pelvic pain (n = 24). Following the patient-reported outcome and a consensus-building process, the research team developed the Chinese version of the ENDOPAIN-4D. Structure, reliability, and structural validity were subsequently verified in a sample of patients with chronic pelvic pain (n = 552).</div></div><div><h3>Results</h3><div>The results of the cognitive discussion indicated that some interviewers exhibited ambiguity in their comprehension of 16 items. All items except Item 21, whose critical ratio was 0.847, indicating no statistically significant difference, were included in the questionnaire. However, this study retained Item 21 as an additional item because of the distinctive features of endometriosis and the original author’s suggestion. The overall Cronbach’s α coefficient for the questionnaire was 0.87. The Chinese version of the ENDOPAIN-4D demonstrated a moderate correlation with the corresponding standard validity tools (r = 0.57).</div></div><div><h3>Conclusion</h3><div>The Chinese version of the ENDOPAIN-4D exhibited satisfactory reliability and validity, rendering it a productive instrument for assessing pelvic discomfort in patients.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 265-284"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.12.021
Mauro Francesco Pio Maiorano , Vera Loizzi , Brigida Anna Maiorano , Gennaro Cormio
Background
Poly (ADP-ribose) polymerase inhibitors (PARPis) are effective treatment options for patients with advanced ovarian cancer (OC). A typical adverse event (AE) of these agents is haematological toxicity, which represents the leading cause of treatment modification and discontinuation. This systematic review and meta-analysis aimed to analyse the risk of haematological AEs, including anaemia, neutropenia and thrombocytopenia due to the use of PARPis in patients with OC.
Methods
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. PubMed, EMBASE and Cochrane databases, and international meeting abstracts were searched systematically for clinical trials concerning the use of PARPis in patients with OC. The search deadline was 30 March 2024. The pooled incidence of all grades and grade 3or more (≥G3) anaemia, neutropenia and thrombocytopenia were analysed. Subsequently, risk ratios (RRs) were calculated for all grades and ≥G3 AEs of PARPis compared with non-PARPis from randomized controlled trials.
Results
In total, 12 phase II/III trials with olaparib, niraparib and rucaparib were included in this study. Anaemia was the most common all grade (28.8 %) and ≥G3 (12.1 %) AE. The administration of PARPis increased the risk of developing all grade anaemia [risk ratio (RR) = 2.44], neutropenia (RR = 3.15) and thrombocytopenia (RR = 4.66) significantly compared with non-PARPis. Similarly, a significant increase in the risk of ≥G3 anaemia (RR = 5.73) and thrombocytopenia (RR = 5.44), and a non-significant increase in the risk of neutropenia (RR = 3.41) were detected.
Conclusions
In patients with advanced OC, PARPis increase the risk of haematological toxicity compared with other treatments (high-quality evidence). Clinicians should be aware of this risk and the correct management, as these drugs are highly employed in these patients.
{"title":"Haematological toxicity of PARP inhibitors in advanced ovarian cancer: A systematic review and meta-analysis","authors":"Mauro Francesco Pio Maiorano , Vera Loizzi , Brigida Anna Maiorano , Gennaro Cormio","doi":"10.1016/j.ejogrb.2024.12.021","DOIUrl":"10.1016/j.ejogrb.2024.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Poly (ADP-ribose) polymerase inhibitors (PARPis) are effective treatment options for patients with advanced ovarian cancer (OC). A typical adverse event (AE) of these agents is haematological toxicity, which represents the leading cause of treatment modification and discontinuation. This systematic review and <em>meta</em>-analysis aimed to analyse the risk of haematological AEs, including anaemia, neutropenia and thrombocytopenia due to the use of PARPis in patients with OC.</div></div><div><h3>Methods</h3><div>This systematic review and <em>meta</em>-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. PubMed, EMBASE and Cochrane databases, and international meeting abstracts were searched systematically for clinical trials concerning the use of PARPis in patients with OC. The search deadline was 30 March 2024. The pooled incidence of all grades and grade 3or more (≥G3) anaemia, neutropenia and thrombocytopenia were analysed. Subsequently, risk ratios (RRs) were calculated for all grades and ≥G3 AEs of PARPis compared with non-PARPis from randomized controlled trials.</div></div><div><h3>Results</h3><div>In total, 12 phase II/III trials with olaparib, niraparib and rucaparib were included in this study. Anaemia was the most common all grade (28.8 %) and ≥G3 (12.1 %) AE. The administration of PARPis increased the risk of developing all grade anaemia [risk ratio (RR) = 2.44], neutropenia (RR = 3.15) and thrombocytopenia (RR = 4.66) significantly compared with non-PARPis. Similarly, a significant increase in the risk of ≥G3 anaemia (RR = 5.73) and thrombocytopenia (RR = 5.44), and a non-significant increase in the risk of neutropenia (RR = 3.41) were detected.</div></div><div><h3>Conclusions</h3><div>In patients with advanced OC, PARPis increase the risk of haematological toxicity compared with other treatments (high-quality evidence). Clinicians should be aware of this risk and the correct management, as these drugs are highly employed in these patients.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 232-240"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To develop and internally validate a model predicting successful trial of labour among pregnant women with previous caesarean scar.
Design
Cohort study.
Setting
Tertiary care and teaching hospital.
Participants
All pregnant women with one previous caesarean delivery, presenting with singleton pregnancies in cephalic presentation at a gestation age of 37 weeks or more between 2018 and 2022.
Main outcome measures
A stepwise multivariable logistic regression, followed by bootstrapping, was used to develop and validate the model. Success was defined as vaginal birth after caesarean section (VBAC) without complications for the mother and baby.
Result
Out of 4515 cases of TOLAC, 39.8 % had a successful trial of labour. Maternal age (OR = 0.950, 95 %CI: 0.927–0.974), previous baby weight (OR = 1.000, 95 %CI: 1.000–1.001), indication of previous caesarean section such as breech presentation (OR = 0.453, 95 %CI: 0.315–0.652), failed induction (OR = 0.346, 95 %CI: 0.267–0.447), BISHOP score (OR = 1.725, 95 %Cl: 1.673–1.774) and induction of labour (OR = 0.587, 95 %CI: 0.466–0.741) were the strongest predictors of successful TOLAC. DEVI-CS model showed good discrimination with an area under the curve (AUC) of 0.928(95 %CI: 0.921–0.936) and good agreement between predicted and observed probabilities. Decision curve analysis showed a net benefit between 5 % and 90 % between the predicted thresholds.
Conclusion
The new DEVI-CS prediction model, based on easily captured clinical variables, can quantify the chances of a successful trial of labour after a previous caesarean section. It could aid in shared decision-making regarding the mode of delivery among women with planning the trial of labour after caesarean section.
{"title":"Development and internal validation of a model predicting successful trial of labour among pregnant individuals with previous one caesarean section: A cohort study (DEVI-CS model)","authors":"Bhabani Pegu , Sathiya Priya Subburaj , Latha Chaturvedula , Sonali Sarkar , N. Sreekumaran Nair , Anish Keepanasseril","doi":"10.1016/j.ejogrb.2024.12.029","DOIUrl":"10.1016/j.ejogrb.2024.12.029","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and internally validate a model predicting successful trial of labour among pregnant women with previous caesarean scar.</div></div><div><h3>Design</h3><div>Cohort study.</div></div><div><h3>Setting</h3><div>Tertiary care and teaching hospital.</div></div><div><h3>Participants</h3><div>All pregnant women with one previous caesarean delivery, presenting with singleton pregnancies in cephalic presentation at a gestation age of 37 weeks or more between 2018 and 2022.</div></div><div><h3>Main outcome measures</h3><div>A stepwise multivariable logistic regression, followed by bootstrapping, was used to develop and validate the model. Success was defined as vaginal birth after caesarean section (VBAC) without complications for the mother and baby.</div></div><div><h3>Result</h3><div>Out of 4515 cases of TOLAC, 39.8 % had a successful trial of labour. Maternal age (OR = 0.950, 95 %CI: 0.927–0.974), previous baby weight (OR = 1.000, 95 %CI: 1.000–1.001), indication of previous caesarean section such as breech presentation (OR = 0.453, 95 %CI: 0.315–0.652), failed induction (OR = 0.346, 95 %CI: 0.267–0.447), BISHOP score (OR = 1.725, 95 %Cl: 1.673–1.774) and induction of labour (OR = 0.587, 95 %CI: 0.466–0.741) were the strongest predictors of successful TOLAC. DEVI-CS model showed good discrimination with an area under the curve (AUC) of 0.928(95 %CI: 0.921–0.936) and good agreement between predicted and observed probabilities. Decision curve analysis showed a net benefit between 5 % and 90 % between the predicted thresholds.</div></div><div><h3>Conclusion</h3><div>The new DEVI-CS prediction model, based on easily captured clinical variables, can quantify the chances of a successful trial of labour after a previous caesarean section. It could aid in shared decision-making regarding the mode of delivery among women with planning the trial of labour after caesarean section.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 210-217"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.11.042
Mathilde Collet , Jan Chrusciel , Marc Levert , René Gabriel , Olivier Graesslin , Émilie Raimond , Stéphane Sanchez
Background
Due to the global growth of its prevalence and its impact on patient health, obesity is considered a near-epidemic condition by the World Health Organization (WHO). Its overall prevalence has now reached 17 % in France. The impact of obesity is also a concern for pregnant women, due to the risk of maternal and fetal complications. Obesity increases the risk of cesarean delivery. However, few data are available regarding risk factors for failed attempted vaginal delivery in obese women.
Objective
The purpose of this study was to examine predictors associated with caesarean delivery among class III obese women undergoing labor.
Methods
Retrospective and multicentric cohort study at the Reims University Hospital and Troyes Hospital from 1 January 2018 to 31 December 2023. All women aged 18 years or older, with body mass index of 40 or higher at booking, with a singleton pregnancy and cephalic presentation and a vaginal delivery attempt after 24 weeks were included in the study. Demographic, obstetrical and neonatal factors were compared between women having a successful vaginal delivery and women having a cesarean delivery after a failed vaginal delivery attempt. A multivariable analysis by logistic regression was performed to evaluate the probability of a change to cesarean section.
Results
Overall, 236 obese women attempting vaginal delivery met all inclusion criteria. Among them, 166 (70.3 %) had a successful vaginal delivery, while 70 (29.7 %) had a cesarean section. Women having a cesarean delivery were more likely to be nulliparous (55.7 % vs. 33.1 %, p = 0.001), to have a weight gain of more than 9 kg during the pregnancy (32.9 % vs. 19.9 %, p = 0.028), to have a diagnosis of preeclampsia (12.9 % vs. 3.6 %, p = 0.008) and to have had induced labor (64.3 % vs. 42.2 %, p = 0.002), when compared to women with successful vaginal delivery. In multivariable analysis, pre-eclampsia was a significant risk factor for cesarean delivery (adjusted OR 4.08; 95 % CI 1.09 – 16.88; p = 0.04). In contrast, having a history of at least one successful vaginal delivery was a protective factor (adjusted OR 0.20; 95 % CI 0.08 – 0.44; p < 0.001).
Conclusion
Preeclampsia was associated with cesarean delivery in class III obese women attempting a vaginal delivery, while a history of previous vaginal delivery reduced this risk. Although vaginal delivery remains the recommended route by default in preeclampsia patients, our results suggest that obese patients with preeclampsia, especially if they are nulliparous, should be warned of the high risk of cesarean delivery.
{"title":"Predictors of conversion to cesarean section in a French cohort of 236 class III (body mass index of 40 or more) obese women attempting vaginal delivery: A restrospective multicentric study","authors":"Mathilde Collet , Jan Chrusciel , Marc Levert , René Gabriel , Olivier Graesslin , Émilie Raimond , Stéphane Sanchez","doi":"10.1016/j.ejogrb.2024.11.042","DOIUrl":"10.1016/j.ejogrb.2024.11.042","url":null,"abstract":"<div><h3>Background</h3><div>Due to the global growth of its prevalence and its impact on patient health, obesity is considered a near-epidemic condition by the World Health Organization (WHO). Its overall prevalence has now reached 17 % in France. The impact of obesity is also a concern for pregnant women, due to the risk of maternal and fetal complications. Obesity increases the risk of cesarean delivery. However, few data are available regarding risk factors for failed attempted vaginal delivery in obese women.</div></div><div><h3>Objective</h3><div>The purpose of this study was to examine predictors associated with caesarean delivery among class III obese women undergoing labor.</div></div><div><h3>Methods</h3><div>Retrospective and multicentric cohort study at the Reims University Hospital and Troyes Hospital from 1 January 2018 to 31 December 2023. All women aged 18 years or older, with body mass index of 40 or higher at booking, with a singleton pregnancy and cephalic presentation and a vaginal delivery attempt after 24 weeks were included in the study. Demographic, obstetrical and neonatal factors were compared between women having a successful vaginal delivery and women having a cesarean delivery after a failed vaginal delivery attempt. A multivariable analysis by logistic regression was performed to evaluate the probability of a change to cesarean section.</div></div><div><h3>Results</h3><div>Overall, 236 obese women attempting vaginal delivery met all inclusion criteria. Among them, 166 (70.3 %) had a successful vaginal delivery, while 70 (29.7 %) had a cesarean section. Women having a cesarean delivery were more likely to be nulliparous (55.7 % vs. 33.1 %, p = 0.001), to have a weight gain of more than 9 kg during the pregnancy (32.9 % vs. 19.9 %, p = 0.028), to have a diagnosis of preeclampsia (12.9 % vs. 3.6 %, p = 0.008) and to have had induced labor (64.3 % vs. 42.2 %, p = 0.002), when compared to women with successful vaginal delivery. In multivariable analysis, pre-eclampsia was a significant risk factor for cesarean delivery (adjusted OR 4.08; 95 % CI 1.09 – 16.88; p = 0.04). In contrast, having a history of at least one successful vaginal delivery was a protective factor (adjusted OR 0.20; 95 % CI 0.08 – 0.44; p < 0.001).</div></div><div><h3>Conclusion</h3><div>Preeclampsia was associated with cesarean delivery in class III obese women attempting a vaginal delivery, while a history of previous vaginal delivery reduced this risk. Although vaginal delivery remains the recommended route by default in preeclampsia patients, our results suggest that obese patients with preeclampsia, especially if they are nulliparous, should be warned of the high risk of cesarean delivery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 318-323"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.12.044
Gal Bachar , Naphtali Justman , Naama Farago , Shira Lieberman , Chen Ben David , Ofer Fainaru , Nizar Khatib , Ron Beloosesky , Dana Vitner , Zeev Weiner , Yaniv Zipori
Purpose
Retroverted uterus affects 15–20% of patients. While typically not a cause for concern, some studies suggest a relationship between a retroverted uterus and subfertility. Study objective was to investigate the association between uterine position and spontaneous conception rates, as well as potential risks for adverse pregnancy outcomes in nulliparous patients.
Methods
We analyzed data from a retrospective cohort study of 621 nulliparous patients with confirmed pregnancies who received prenatal care at a large medical center between 2006 and 2022. Ultrasound exams documented their uterine position at the beginning of pregnancy. Women were categorized into two groups according to their uterine position. We compared the groups regarding mode of conception (spontaneous/ IVF), pregnancy complications, and vaginal delivery outcomes.
Results
Compared to patients with anteverted uteri, those with retroverted uteri had a significantly higher rate of conception through IVF (12.3 % vs. 6.8 %, p = 0.022). IVF indications were similar between groups (p = 0.961). Pregnancy complications, including pre-labor rupture of membranes, miscarriages, and preterm delivery < 37 and < 32 weeks’, were similar. Breech presentation at delivery was comparable between cohorts (∼6%, p = 0.576). Among patients attempting vaginal delivery (n = 539), cesarean delivery rates were comparable (18.2 % anteverted vs. 23.1 % retroverted, p = 0.249). No significant differences were observed in other maternal or neonatal outcomes between the groups.
Conclusion
While a retroverted uterus may be associated with a higher likelihood of requiring in vitro fertilization (IVF), it does not appear to significantly impact pregnancy complications or vaginal delivery outcomes. However, the limited sample size and retrospective design of our study necessitate further investigation to confirm these findings.
目的：子宫逆行性影响15-20%的患者。虽然通常不值得担心，但一些研究表明子宫后移与生育能力低下之间存在关系。研究目的是探讨子宫位置与无产患者自然受孕率的关系，以及不良妊娠结局的潜在风险。方法：我们分析了一项回顾性队列研究的数据，该研究纳入了2006年至2022年间在一家大型医疗中心接受产前护理的621例确认怀孕的未生育患者。超声检查记录了她们在怀孕初期的子宫位置。根据子宫位置将女性分为两组。我们比较了两组的受孕方式（自然/体外受精）、妊娠并发症和阴道分娩结果。结果：与子宫前倾患者相比，子宫后倾患者体外受精受孕率显著提高（12.3% vs. 6.8%, p = 0.022）。两组间IVF指征相似（p = 0.961）。妊娠并发症，包括产前胎膜破裂、流产和早产结论：虽然子宫内倾可能与体外受精（IVF）的可能性较高有关，但它似乎对妊娠并发症或阴道分娩结果没有显著影响。然而，本研究样本量有限，且采用回顾性设计，需要进一步调查以证实这些发现。
{"title":"The impact of uterine position on conception modes and perinatal outcomes in nulliparous patients","authors":"Gal Bachar , Naphtali Justman , Naama Farago , Shira Lieberman , Chen Ben David , Ofer Fainaru , Nizar Khatib , Ron Beloosesky , Dana Vitner , Zeev Weiner , Yaniv Zipori","doi":"10.1016/j.ejogrb.2024.12.044","DOIUrl":"10.1016/j.ejogrb.2024.12.044","url":null,"abstract":"<div><h3>Purpose</h3><div>Retroverted uterus affects 15–20% of patients. While typically not a cause for concern, some studies suggest a relationship between a retroverted uterus and subfertility. Study objective was to investigate the association between uterine position and spontaneous conception rates, as well as potential risks for adverse pregnancy outcomes in nulliparous patients.</div></div><div><h3>Methods</h3><div>We analyzed data from a retrospective cohort study of 621 nulliparous patients with confirmed pregnancies who received prenatal care at a large medical center between 2006 and 2022. Ultrasound exams documented their uterine position at the beginning of pregnancy. Women were categorized into two groups according to their uterine position. We compared the groups regarding mode of conception (spontaneous/ IVF), pregnancy complications, and vaginal delivery outcomes.</div></div><div><h3>Results</h3><div>Compared to patients with anteverted uteri, those with retroverted uteri had a significantly higher rate of conception through IVF (12.3 % vs. 6.8 %, p = 0.022). IVF indications were similar between groups (p = 0.961). Pregnancy complications, including pre-labor rupture of membranes, miscarriages, and preterm delivery < 37 and < 32 weeks’, were similar. Breech presentation at delivery was comparable between cohorts (∼6%, p = 0.576). Among patients attempting vaginal delivery (n = 539), cesarean delivery rates were comparable (18.2 % anteverted vs. 23.1 % retroverted, p = 0.249). No significant differences were observed in other maternal or neonatal outcomes between the groups.</div></div><div><h3>Conclusion</h3><div>While a retroverted uterus may be associated with a higher likelihood of requiring in vitro fertilization (IVF), it does not appear to significantly impact pregnancy complications or vaginal delivery outcomes. However, the limited sample size and retrospective design of our study necessitate further investigation to confirm these findings.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 324-328"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.12.028
Samantha Taylor , Basile Tessier Cloutier , Xing Zeng , Gabriel Levin
{"title":"Isolated tumor cells in a sentinel lymph node in a woman with endometrial intraepithelial neoplasia","authors":"Samantha Taylor , Basile Tessier Cloutier , Xing Zeng , Gabriel Levin","doi":"10.1016/j.ejogrb.2024.12.028","DOIUrl":"10.1016/j.ejogrb.2024.12.028","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 431-432"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ejogrb.2024.11.052
Viktoria El Radaf , Letícia Nunes Campos , Charles Savona-Ventura , Tahir Mahmood , Mehreen Zaigham
The aim of this systemic review and meta-analysis was to examine the differences in caesarean section rates across European regions and at a country level by utilizing the Robson classification system. The study has compared caesarean rates across European regions using the Robson classification to identify the drivers of caesarean section use.
This review shows significant variations in caesarean section rates across European regions, ranging from 16.9 % in Northern Europe to 43.6 % in Southern Europe. There was a higher contribution of previous CS (Robson Group 5), ranging from 51.2 to 95.0 % of CS in this group to overall rates, particularly in Southern Europe (95.0 %), raises concerns about the “domino effect” of primary caesareans. This finding emphasises the critical importance of strategies to reduce primary CS rates.
Background
Caesarean section (CS) rates exhibit considerable global variation, reflecting diverse medical practices, cultural attitudes, and healthcare policies. While some regions maintain relatively low rates, others report significantly higher incidences of the procedure. Analysing these differences is crucial for understanding and developing targeted healthcare strategies and ensuring optimal maternal and neonatal outcomes. This review examines differences in CS rates in Europe according to the Robson 10 group classification.
Methods
We identified articles between January 2000 to June 2023 using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library. There was no restriction on patient population, except for birth in a country of the European region. We excluded all studies that were conference proceedings and studies reported in a language other than English and Swedish.
Findings
The search generated a total of 1024 studies, out of which 44 were included, encompassing 6,641,615 births. The majority were from Northern (38 %) and Western Europe (33.5 %). CS rates varied markedly across Europe, ranging from 16.9 % in Northern region to 43.6 % in Southern Europe. The highest contribution to CS rates came from Robson Group 5 (previous CS), with contributions ranging from 51.2 % in Northern to 95.0 % in Southern Europe. The mode of birth for Robson Group 6 (nulliparous, breech) was predominately by CS (88.8 % in Northern to 92.5 % in Central-Eastern Europe).
Interpretation
CS rates continue to vary widely across Europe, with the highest rates in Southern and the lowest in Northern Europe. Previous CS and breech presentation were prominent drivers of CS rates. Region-specific strategies are needed to address these diverse factors to minimise accelerating CS rates across Europe.
本系统回顾和荟萃分析的目的是利用罗布森分类系统检查欧洲地区和国家一级剖宫产率的差异。该研究使用罗布森分类来比较欧洲地区的剖腹产率，以确定剖腹产使用的驱动因素。本综述显示欧洲各地区剖宫产率存在显著差异，从北欧的16.9%到南欧的43.6%不等。先前的CS （Robson第5组）对总体发生率的贡献更高，在该组CS中占51.2%至95.0%，特别是在南欧（95.0%），引起了对原发性剖腹产的“多米诺骨牌效应”的关注。这一发现强调了降低原发性CS发生率的策略至关重要。背景：剖宫产率在全球表现出相当大的差异，反映了不同的医疗实践、文化态度和卫生保健政策。虽然一些地区保持相对较低的比率，但其他地区报告的手术发生率明显较高。分析这些差异对于理解和制定有针对性的保健战略以及确保产妇和新生儿的最佳结局至关重要。本综述根据罗布森10组分类检查了欧洲CS率的差异。方法：使用MEDLINE/PubMed、CINAHL、EMBASE、Global Index Medicus、Web of Science和Cochrane图书馆检索2000年1月至2023年6月的文献。除了出生在欧洲区域的某个国家外，对患者人口没有限制。我们排除了所有会议记录的研究以及用英语和瑞典语以外的语言报道的研究。结果：搜索共产生1024项研究，其中44项被纳入，涉及6,641,615名新生儿。大多数来自北欧（38%）和西欧（33.5%）。欧洲各国的CS比率差别很大，从北欧的16.9%到南欧的43.6%不等。对CS率贡献最大的是罗布森第5组（以前的CS），其贡献从北欧的51.2%到南欧的95.0%不等。罗布森第6组的出生方式（无产，臀位）主要是CS（北欧88.8%，中欧-东欧92.5%）。解释：欧洲各地的CS发病率差异很大，南欧的发病率最高，北欧的发病率最低。先前的CS和后臀表现是CS率的主要驱动因素。需要针对特定区域的战略来解决这些不同的因素，以尽量减少整个欧洲的CS加速率。
{"title":"Robson ten group classification system for Caesarean sections across Europe: A systematic review and meta-analysis","authors":"Viktoria El Radaf , Letícia Nunes Campos , Charles Savona-Ventura , Tahir Mahmood , Mehreen Zaigham","doi":"10.1016/j.ejogrb.2024.11.052","DOIUrl":"10.1016/j.ejogrb.2024.11.052","url":null,"abstract":"<div><div>The aim of this systemic review and meta-analysis was to examine the differences in caesarean section rates across European regions and at a country level by utilizing the Robson classification system. The study has compared caesarean rates across European regions using the Robson classification to identify the drivers of caesarean section use.</div><div>This review shows significant variations in caesarean section rates across European regions, ranging from 16.9 % in Northern Europe to 43.6 % in Southern Europe. There was a higher contribution of previous CS (Robson Group 5), ranging from 51.2 to 95.0 % of CS in this group to overall rates, particularly in Southern Europe (95.0 %), raises concerns about the “domino effect” of primary caesareans. This finding emphasises the critical importance of strategies to reduce primary CS rates.</div></div><div><h3>Background</h3><div>Caesarean section (CS) rates exhibit considerable global variation, reflecting diverse medical practices, cultural attitudes, and healthcare policies. While some regions maintain relatively low rates, others report significantly higher incidences of the procedure. Analysing these differences is crucial for understanding and developing targeted healthcare strategies and ensuring optimal maternal and neonatal outcomes. This review examines differences in CS rates in Europe according to the Robson 10 group classification.</div></div><div><h3>Methods</h3><div>We identified articles between January 2000 to June 2023 using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library. There was no restriction on patient population, except for birth in a country of the European region. We excluded all studies that were conference proceedings and studies reported in a language other than English and Swedish.</div></div><div><h3>Findings</h3><div>The search generated a total of 1024 studies, out of which 44 were included, encompassing 6,641,615 births. The majority were from Northern (38 %) and Western Europe (33.5 %). CS rates varied markedly across Europe, ranging from 16.9 % in Northern region to 43.6 % in Southern Europe. The highest contribution to CS rates came from Robson Group 5 (previous CS), with contributions ranging from 51.2 % in Northern to 95.0 % in Southern Europe. The mode of birth for Robson Group 6 (nulliparous, breech) was predominately by CS (88.8 % in Northern to 92.5 % in Central-Eastern Europe).</div></div><div><h3>Interpretation</h3><div>CS rates continue to vary widely across Europe, with the highest rates in Southern and the lowest in Northern Europe. Previous CS and breech presentation were prominent drivers of CS rates. Region-specific strategies are needed to address these diverse factors to minimise accelerating CS rates across Europe.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 178-198"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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