50 research outputs found
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Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries
Background
International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons.
Methods
In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10â000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country.
Findings
Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65â0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80â1·16) although changes varied widely between countries (RRs 0·62â2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment.
Interpretation
Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared
Producing valid statistics when legislation, culture, and medical practices differ for births at or before the threshold of survival: Report of a European workshop
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Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study.
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadObjective: 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 â„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.
Tweetable abstract: Many European countries can provide Robson's Ten-Group Classification to improve caesarean rate comparisons.
Keywords: Caesarean birth; Europe; Robson classification; Ten-Group Classification System; health information systems; perinatal health indicators.InfAct Joint Action
Bridge Health Project, Public Health Programme, Consumers, Health, Agriculture and Food Executive Agency (CHAFEA
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Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births
International audienceNo abstract availabl
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Using Robson's TenâGroup Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the EuroâPeristat study
Objective
Robson's Ten Group Classification System (TGCS) creates clinically relevant subâgroups 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
Twentyâseven EU member states plus Iceland, Norway, Switzerland and the UK.
Population
All births at â„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 evidenceâbased caesarean policies.
Tweetable abstract
Many European countries can provide Robson's TenâGroup Classification to improve caesarean rate comparisons