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Aim: The authors investigated the effect of rising cesarean rates on maternal and perinatal mortality and in neonatal morbidity in Hungary., Methods: The authors searched the validated Hungarian National Health database of neonatal discharge records for ICD-10 codes: P0590 (growth restriction); P2010 (fetal hypoxia in labor); P2090 (intrauterine hypoxia); P2200 (respiratory distress syndrome); P2390 (congenital pneumonia); P2400 (meconium aspiration); P2850 (respiratory insufficiency); P3990 (neonatal infection); P9130 (cerebral irritability) and P9141 (cerebral depression) collected between 2006 and 2015. County-specific number of deliveries, perinatal deaths, and data on the route of delivery from the national database were also collected. Controlling for regional disparities with Human Development Index was also performed. Logistic regression analysis was performed to identify determinants of early neonatal mortality., Results: While cesarean section-rate rose from 28.6% to 38.2% perinatal mortality stayed within the range between 7.8‰ and 6.1‰. Early (0-6 days) neonatal mortality (NMR) of the whole country in 2006 was 2.8‰ and showed a significant decrease over the years to reach 1.7‰ in 2015. The rate of most neonatal morbidities decreased significantly. Controlled regression analysis proved that cesarean rates negatively influenced neonatal mortality rates., Conclusion: The rise of the cesarean section rate in Hungary between 2006 and 2015 was associated with a detectable reduction of perinatal mortality and morbidity; however, the proportion of improvement in neonatal morbidity is far less than the increment in cesarean rate., (© 2020 Japan Society of Obstetrics and Gynecology.)

Objective: The authors analysed the Caesarean section rate as a function of birth weight among Robson-1 parturients and compared with that among the unselected obstetric population., Study Design: A retrospective analysis of birth weight, maternal height and the route of delivery was carried out in an unselected obstetric population of 26,012 parturients. The authors compared birth weight centile distributions of vaginally, and that of abdominally delivered fetuses between Robson-1 parturients as well as those of the total obstetric population., Results: The 90th birth weight centile of fetuses delivered at 37, 38, 39, 40, 41, and 42 weeks gestation were 3960 g, 3960 g, 4000 g, 3950 g, 4000 g and 3820 g, respectively. Among Robson-1 parturients, 677 fetuses weighed >4000 g, and 448 patients (66%) were delivered vaginally. Maternal height did not influence either the birth-weight-percentiles or the Caesarean-rates substantially. Above the birth weight of 4000 g, the Caesarean-rate among Robson-1 parturient rose similarly to that of the total obstetric population. In the knowledge of the most accurately estimated fetal weight, the odds of Caesarean delivery among Robson-1 parturients was not different from that of the total obstetric population. Among pregnancies with fetuses weighing less than 5000 g, the Caesarean-rate was below 50% in both Robson-1 parturients and the total obstetric population of 10 years., Conclusion: Even the best possible estimation of fetal weight cannot give a valid reason to downplay the intent of vaginal birth based on the fetal size above 3900 g that would be associated with increased odds of Caesarean delivery., (Copyright © 2019 Elsevier B.V. All rights reserved.)