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Objective 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 ≥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., Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.

Perinatal mortality is a major population health indicatorconveying important signals about the state of maternitycare and measures of the current and future health ofmothers and newborns. International comparisons are usedto encourage countries to improve their perinatal healthand health systems. However, extensive evidence highlightsmethodological challenges to ensuring valid and robustcomparisons, as a lack of standardised criteria can lead tobias and inappropriate inferences.One major issue is the wide international variation in the criteria for classification and registration of deaths as a stillbirth or neonatal death at the threshold of survival.Standard practice is to minimise this problem by using a gestational age cut-off of 24 or even 28 weeks for mortality rate calculations. However, this strategy excludes a significant number of stillbirths, at least one in five deaths before 24 weeks of gestation and over one in three deaths before 28 weeks.As the gestational age limit for initiation of neonatal care decreases, exclusion of these stillbirths limits the full evaluation ofcare provision and outcomes at early gestational ages. Fur-ther, it underestimates the burden of loss on parents’ men-tal and physical health.

Einleitung: Ziel der Studie war die Analyse des Einflusses des Geschlechts auf Tumorstadium, der karzinomspezifischen Mortalität sowie der Gesamtmortalität von Karzinomen des oberen Harntraktes in einer populationsbasierten Analyse. Material und Methoden: Das Studienkollektiv umfasste alle[zum vollständigen Text gelangen Sie über die oben angegebene URL], 43. Gemeinsame Tagung der Österreichischen Gesellschaft für Urologie und Andrologie und der Bayerischen Urologenvereinigung

Introduction: Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators. Material and methods: We used aggregate data from national routine statistics available in the Euro-Peristat project. We compared rates of severe (third- and fourth-degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho). Results: In 2010 in all vaginal deliveries, rates of severe tears ranged from 0.1% in Romania to 4.9% in Iceland, and rates of episiotomies from 3.7% in Denmark to 75.0% in Cyprus. A negative correlation between the rates of episiotomies and severe tears was observed in all deliveries (rho = −0.66; p = 0.001), instrumental deliveries (rho = −0.67; p = 0.002) and non-instrumental deliveries (rho = −0.72; p < 0.001). However there was no relation between time trends of these two indicators (rho = 0.43; p = 0.28). Conclusions: The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology

Objective: Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods: We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with randomeffects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results: In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1-9.8) of preterm birth (

Background: While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States.Methods: This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26-31 weeks GA), moderate preterm (32-36 weeks GA), near term (37-38 weeks GA), term (39-41 weeks GA) and post-term (42+ weeks GA) births, using Spearman's rank tests.Results: High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries' overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births.Conclusions: Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.

Background:Fetal and neonatal mortality rates are essential indicators of population health, but variations in recording of births and deaths at the limits of viability compromises international comparisons. The World Health Organization recommends comparing rates after exclusion of births with a birth weight less than 1000 grams, but many analyses of perinatal outcomes are based on gestational age. We compared the effects of using a 1000-gram birth weight or a 28-week gestational age threshold on reported rates of fetal and neonatal mortality in Europe.Methods:Aggregated data from 2004 on births and deaths tabulated by birth weight and gestational age from 29 European countries/regions participating in the Euro-Peristat project were used to compute fetal and neonatal mortality rates using cut-offs of 1000-grams and 28-weeks (2.8 million total births). We measured differences in rates between and within countries using the Wilcoxon signed rank test and 95% confidence intervals, respectively.Principal Findings:For fetal mortality, rates based on gestational age were significantly higher than those based on birth weight (p

[for full text, please go to the a.m. URL], 12. Grazer Konferenz - Qualität der Lehre: Skills and Attitudes

[for full text, please go to the a.m. URL], 13. Grazer Konferenz - Qualität der Lehre: Teaching Medicine – an Interprofessional Agenda

The analysis of two freshmen's cohorts at the Medical University of Vienna consistently yielded four predictors for passing the first summative integrative exam (SIP1) at the end of the first study year: male sex, German mother tongue, good school performance, and high learning capacity. In particular the - against international trends - worse ratio of successful female students needs clarification.In this analysis of their further study progress we are able to show that a considerable number of those female students who did not succeed at first or second examination date and thus did not enter third semester immediately, show up in class schedules with at least one year's delay. While the other three predictors stay effective the large quantity of this group annihilates the initial sex-effect. We conclude that the loss of time results not from a lack of cognitive abilities but from a combination of SIP-specific demands and sex-specific learning behaviour. From our view, the splitting of the SIP into several small chapters could eliminate the disadvantage of female students. Die Untersuchung zweier Jahrgänge an StudienanfängerInnen der Medizinischen Universität Wien ergab übereinstimmend vier Prädiktoren für das Bestehen der ersten summativen integrativen Prüfung (SIP1) am Ende des ersten Studienjahres: männliches Geschlecht, deutsche Muttersprache, gute Schulleistungen, hohe Lernkapazität. Vor allem das schlechtere Abschneiden weiblicher Studierender bedarf angesichts der weltweit gegenläufigen Befunde einer Erklärung. Die vorliegende Untersuchung des weiteren Studienverlaufs zeigt nun, dass ein beträchtlicher Teil jener weiblichen Studierenden, die wegen Nichtbestehens der SIP1 nicht in das dritte Semester zugelassen wurden, mit einem Jahr Verlust wieder im Studium aufscheinen. Der Anteil dieser Gruppe ist so groß, dass der anfängliche Geschlechtseffekt egalisiert wird, während die anderen drei Prädiktoren unverändert bestehen bleiben. Wir kommen zu dem Schluss, dass der Zeitverlust weiblicher Studierender nicht durch den Mangel an kognitiven Fähigkeiten, sondern durch ein Zusammenspiel SIP-spezifischer Erfordernisse und geschlechtsspezifischen Lernverhaltens erklärt werden können. Mehrere Teilprüfungen an Stelle der SIP könnten aus unserer Sicht die Benachteiligung weiblicher Studierender beheben.