title: Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study.
abstract: OBJECTIVE
  To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention.
  
  
  METHODS
  Retrospective analysis of aggregated routine data.
  
  
  METHODS
  Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project.
  
  
  METHODS
  Births in participating countries in 2010.
  
  
  METHODS
  Countries provided aggregated data about overall rates of obstetric intervention and about caesarean section rates for specified subgroups.
  
  
  METHODS
  Mode of delivery.
  
  
  RESULTS
  Rates of caesarean section ranged from 14.8% to 52.2% of all births and rates of instrumental vaginal delivery ranged from 0.5% to 16.4%. Overall, there was no association between rates of instrumental vaginal delivery and rates of caesarean section, but similarities were observed between some countries that are geographically close and may share common traditions of practice. Associations were observed between caesarean section rates for women with breech and vertex births and with singleton and multiple births but patterns of association for women who had and had not had previous caesarean sections were more complex.
  
  
  CONCLUSIONS
  The persisting wide variations in caesarean section and instrumental vaginal delivery rates point to a lack of consensus about practice and raise questions for further investigation. Further research is needed to explore the impact of differences in clinical guidelines, healthcare systems and their financing and parents' and professionals' attitudes to care at delivery.
authors.affiliation: Centre for Maternal and Child Health Research, City University London, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Macfarlane
authors.affiliation: INSERM, Obstetrical Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Blondel
authors.affiliation: Department of Child Health, TNO, the Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands.
authors.forename: A D
authors.initials: AD
authors.lastname: Mohangoo
authors.affiliation: Research Unit of Perinatal Epidemiology, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cuttini
authors.affiliation: Department of Obstetrics and Gynaecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Nijhuis
authors.affiliation: Perinatology Unit, University Medical Centre, Llubjana University, Llubjana, Slovenia.
authors.forename: Z
authors.initials: Z
authors.lastname: Novak
authors.affiliation: Department of Obstetrics and Gynaecology, Landspitali University Hospital, Landspitali v/Hringbraut, Iceland.
authors.forename: H S
authors.initials: HS
authors.lastname: Ólafsdóttir
authors.affiliation: INSERM, Obstetrical Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001946:Breech Presentation / Q000453:epidemiology* / Q000628:therapy; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003625:Data Collection; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005062:European Union / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012042:Registries; D012189:Retrospective Studies
keywords: Breech birth; Euro-Peristat; caesarean section; instrumental vaginal delivery; international comparisons; mode of delivery; parity; repeat caesarean section; twins