c10:mode of delivery - euro-peristat...c10:mode of delivery euro-persitatmeeting rolduc abbey, the...

C10:MODE OF DELIVERYEuro-Persitat Meeting

Rolduc Abbey, the Netherlands9 April 2018

Henrique Barros

Why indicator is important and its exact definition

• Over the last 20 years, the prevalence of cesarean delivery has increased all over the world; Delivery by cesarean is a recognized risk factor for the mother (placentation disorders, uterine rupture andstillbirth) and the children (short-term lung function impairment, hypoglycemia, reduced breast feeding initiation, altered immune responses, and long-term effects on immune-related conditions, such as asthma, respiratory morbidity, and type 1 diabetes)

• Indicator Definition: percentage distribution of births (live born and stillborn) by method of delivery

Specified by: timing to labor, parity, plurality, fetal presentation, previous caesarean section, gestational age, Robson classification

Number of countries able to provide the indicator

• Method of delivery was available for 33 countries (no global data for the UK - corresponding to three countries) and missing for Greece.

• However, a variable number of countries could not provide information to calculate cesarean frequency by specific characteristics (e.g. no data on c-section by parity for 8 countries)

Quality questions

• The quality of the indicator is expected to be high. However, some questions of comparability need to be addressed:

a) coverage (e.g. in Portugal, detailed data only available for the continental region and for public hospitals)

b) similar denominators (e.g. number of births vs. number of deliveries)

c) information on specific variables lacking

21.6

43.0

26.1

21.4

32.2

19.5

31.3

26.6

20.9

20.2

21.6

35.4

56.9

22.0

21.9

32.7

39.0

32.0

17.4

29.7

27.6

46.9

21.2

31.1

16.4

18.3

23.2

32.4

29.9

16.8

16.6

34.4

9.5

29.2

2.7

6.3

7.1

4.2

15.1

11.2

12.1

1.4

3.5

3.7

2.4

1.9

11.2

4.2

8.4

7.2

18.6

0.5

2.8

2.1

9.2

6.0

14.6

12.2

12.0

7.6

10.2

10.8

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

BelgiumBulgaria

Czech RepublicDenmarkGermany

EstoniaIrelandGreece

SpainFrance

France ENPCroatia

ItalyCyprusLatvia

LithuaniaLuxembourg

HungaryMalta

NetherlandsAustriaPoland

PortugalRomaniaSloveniaSlovakiaFinland

SwedenUK: England and Wales

UK: ScotlandUK: Northern Ireland

IcelandNorway

Switzerland

Percentage of births

Total Caesarean

Vaginal instrumental

Percentage of births by caesarean section (2015)

Percentage of births by caesarean section (2015)

16.4 16.6 16.8 17.418.3

19.520.2 20.9 21.2 21.6 21.6 21.9 22.0

23.2

26.1 26.627.6 28.0

29.7 29.931.1 31.3

32.0 32.2 32.4 32.734.4

35.4

39.0

42.243.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Percentage of births by type of caesarean section (CS)

11.6

17.4

11.2

16.1

6.6

7.1

9.8

11.5

22.7

40.5

9.3

8.4

16.9

19.5

8.7

14.6

11.4

3.6

9.8

17.7

6.4

7.8

11.8

14.8

15.4

6.4

5.8

17.9

10.0

0.0

8.7

10.2

16.1

12.9

13.8

10.5

10.1

12.7

16.4

12.7

13.4

15.8

12.5

8.7

15.0

16.2

43.3

11.5

13.4

10.0

10.5

11.3

17.6

14.5

10.4

10.7

16.5

0.0 10.0 20.0 30.0 40.0 50.0 60.0

BelgiumBulgaria



SpainFrance

France ENPCroatia

ItalyCyprusLatvia

LithuaniaLuxembourg

HungaryMalta



SwedenUnited Kingdom

UK: England and WalesUK: Scotland

UK: Northern IrelandIceland

NorwaySwitzerland


CS before labour/ Elective

CS during labour/ Emergency

Note: In UK: England and Wales, data are for England only.

Percentage of caesarean section by parity

22.7

28.0

22.3

34.5

21.3

33.2

23.2

24.5

35.4

57.1

22.2

22.5

35.1

30.9

19.2

31.2

22.8

32.9

20.8

20.4

23.7

33.2

30.3

15.8

18.7

35.8

20.9

24.4

20.7

30.1

18.2

30.1

18.0

18.7

35.4

56.6

21.9

21.2

30.4

33.2

16.0

28.3

19.7

29.1

13.2

16.7

22.2

31.8

29.6

44.2

15.0

33.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0

BelgiumBulgaria



SpainFrance

France ENPCroatia

ItalyCyprusLatvia

LithuaniaLuxembourg

HungaryMalta






NorwaySwitzerland


Nullipara

Multipara


Percentage of caesarean section by plurality

20.2

25.3

20.0

18.0

29.9

19.6

19.0

20.3

33.6

54.8

20.9

20.8

30.8

29.9

16.6

28.1

26.9

19.6

29.8

15.4

17.1

22.1

31.1

28.6

15.8

15.5

32.5

59.1

80.3

63.0

62.7

66.8

55.2

53.5

60.5

87.2

93.2

58.0

55.9

82.7

98.5

42.1

79.8

64.0

60.7

78.2

49.5

56.7

59.0

74.2

69.5

43.0

45.4

80.8

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

BelgiumBulgaria



SpainFrance

France ENPCroatia

ItalyCyprusLatvia

LithuaniaLuxembourg

HungaryMalta






NorwaySwitzerland


Singletons

Multiples


Percentage of caesarean section by fetal presentation


Percentage of caesarean section (CS) by previous CS

69.7

74.9

66.6

61.7

66.7

59.1

68.5

88.5

95.3

87.7

76.4

78.0

78.1

61.9

68.4

78.7

80.8

44.6

69.3

68.3

83.9

78.4

65.0

52.6

88.2

15.8

20.6

18.7

14.6

15.7

15.3

17.0

26.0

45.7

14.4

15.5

25.4

23.7

8.1

22.1

16.7

22.6

12.9

10.2

20.1

24.9

19.6

11.4

12.6

28.5

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

BelgiumBulgaria



SpainFrance

France ENPCroatia

ItalyCyprusLatvia

LithuaniaLuxembourg

HungaryMalta






NorwaySwitzerland


Previous CS

No previous CS


Percentage of caesarean section by gestational age

42,1

46,6

47,7

43,4

57,1

47,5

42,0

39,5

39,6

61,6

78,4

37,2

37,4

57,8

55,2

32,1

56,3

42,2

64,4

39,4

43,6

32,5

54,7

52,5

42,4

39,5

59,6

30,3

33,6

38,3

27,9

41,6

27,2

25,8

27,7

53,3

68,6

32,0

22,6

44,9

47,9

23,0

46,6

25,3

30,0

20,5

30,9

26,7

36,1

35,3

21,3

25,1

51,8

15,4

21,9

14,8

15,4

26,4

7,3

16,6

16,1

17,9

24,5

39,2

18,5

20,6

23,7

21,6

14,1

20,3

17,8

0,0

13,1

12,6

20,4

28,5

25,9

13,5

12,0

24,5

0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0

BelgiumBulgaria



SpainFrance

France ENPCroatia

ItalyCyprusLatvia

LithuaniaLuxembourg

HungaryMalta






NorwaySwitzerland


Preterm (22+0-36+6)

Near Term (37+0-38+6)

Term (39+0-41+6)


Caesarean section (%) - 2010 and 2015

26.1

21.4

32.2

19.5

31.3

26.6

20.9

35.4

56.9

22.0

21.9

32.7

39.0

32.0

17.4

29.7

42.2

27.6

46.9

21.2

31.1

16.4

18.3

23.2

32.4

29.9

16.8

16.6

34.4

23.1

22.1

31.3

21.2

27.0

26.3

21.0

38.0

52.2

24.4

25.2

30.0

32.3

33.1

17.0

28.8

34.0

36.3

36.9

19.1

29.4

16.8

17.1

24.6

27.8

29.9

14.8

17.1

33.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Czech Republic

Denmark

Germany

Estonia

Ireland

Spain

France

Italy

Cyprus

Latvia

Lithuania

Luxembourg

Hungary

Malta

Netherlands

Austria

Poland

Portugal

Romania

Slovenia

Slovakia

Finland

Sweden

UK: England

UK: Scotland

UK: Northern Ireland

Iceland

Norway

Switzerland


Caesarean in 2015Caesarean in 2010

Summary of findings

• Key messages• Large C-section variation by country, with an apparent regional distribution• 17 countries increased the frequency of C-section• A C-section increases the rate of C-section in a subsequent pregnancy

• Next steps• Double-check.

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