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Introducción: La necesidad de racionalizar y optimizar el uso de las cesáreas es un reto internacional en salud pública. Para ello, la OMS recomienda el uso de la clasificación Robson, que permite comparar las tasas de cesárea en función del perfil materno-fetal. El objetivo de este trabajo es evaluar la tasa de cesárea en el Hospital Universitario Materno-Infantil La Paz de Madrid entre 2010 y 2018 por medio de la clasificación Robson. Material y métodos: La población analizada corresponde a los datos de los 41.037 partos registrados en el programa Obstetricia del Hospital Universitario Materno-Infantil La Paz de Madrid de 2010 a 2018. Por medio del programa SPSS, se evalúa el cambio temporal en a) el porcentaje de partos (vaginales y por cesárea) respecto al total de nacimientos, b) la tasa de cesárea respecto a los partos vaginales y c) la contribución relativa a la tasa global de cesárea. Resultados: Las más elevadas contribuciones parciales a la tasa global de cesárea correspondieron a nulíparas con parto inducido, con cesárea previa, nulíparas con parto espontáneo y con gestaciones múltiples. El grupo de las nulíparas con parto inducido fue el único que registró un aumento significativo de su contribución a la tasa total de cesárea (30,4% en 2018). Conclusiones: Los resultados de este trabajo indican que el reto en salud pública es seguir evaluando la relación entre inducción del parto y riesgo de cesárea intraparto, particularmente en mujeres nulíparas, el grupo que registra la más alta tasa relativa de cesárea y en aumento significativo.(AU)

Introduction: The need to rationalise and optimise the use of caesarean sections is an international public health challenge. To this end, the WHO recommends the use of the Robson classification, which allows comparison of caesarean section rates according to the maternal-fetal profile. The aim of this study is to evaluate the rate of caesarean section in the Hospital Universitario Materno-Infantil La Paz in Madrid between 2010 and 2018 using the Robson classification. Material and methods: The population analysed corresponds to data from the 41,037 deliveries registered in the Obstetrics programme of the Hospital Universitario Materno-Infantil La Paz of Madrid from 2010 to 2018. Using SPSS software, the temporal change in (a) the percentage of deliveries (vaginal and caesarean) with respect to total births, (b) the caesarean rate with respect to vaginal deliveries and (c) the relative contribution to the overall caesarean rate is evaluated. Results: The highest partial contributions to the overall caesarean section rate were made by nulliparous women with induced labour, previous caesarean section, nulliparous women with spontaneous labour and multiple gestations. The group of nulliparous with induced labour was the only one with a significant increase in its contribution to the overall caesarean section rate (30.4% in 2018). Conclusions: The results of this work indicate that the challenge in public health is to further assess the relationship between induction of labour and risk of intrapartum caesarean section, particularly in nulliparous women, the group with the highest and significantly increasing relative caesarean section rate.(AU)

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Previous studies have demonstrated a negative, significant impact on birthweight associated with the current economic crisis in Spain, which has also been reported for other European countries. Effects by parity are not known. Our aim is to compare the trends in low birthweight (LBW) by parity in Spain from 1996 to 2016. Using the National Vital Statistics data, joinpoint regression analysis was used to identify the time periods of significant changes in the prevalence of LBW by parity. Adjusted relative risk (RR) of LBW by year of birth was calculated in order to confirm that the time trend differences in LBW by parity were independent of possible confounders. The prevalence of LBW among live births to primiparous increased from 5.12% to 6.87% in 2008 and then stabilised at maximum values, while among live births to multiparous LBW increased from 3.96% to a maximum of 5.20% and then significantly reduced. Trends in adjusted RR of LBW by parity confirm that primiparous and multiparous were affected differently by the economic crisis. Older, nulliparous women may have felt more biosocial pressure to reproduce during the economic crisis, compared to women who were already mothers. This biosocial pressure may have increased the risks for LBW.

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BACKGROUND: Delayed childbearing is considered a risk factor for maternal-foetal health. As in other higher-income countries, in Spain age at maternity has steadily increased during the last two decades. AIM: To quantify the impact of the delay in the age at maternity on small for gestational age (SGA) categories of <3rd, 3rd-5th and 5th-10th percentiles. METHODS: 2,672,350 singleton live births born to Spanish mothers in 2007-2015 were analysed. Adjusted relative risk was calculated to estimate the adjusted partial population attributable fractions (PAFp) for mothers aged 35-39 and ≥40 years for each category of SGA considering the interaction between age at maternity and parity. FINDINGS: Primipara 35-39 years old mothers have the highest PAFp in the three categories of SGA, with the maximum value for SGA <3rd percentile (2.57%, 95% CI 2.25, 2.88). PAFp for both primipara and multipara ≥40 years old mothers were less than 1%. PAFp for primipara older mothers increased significantly in 2007-2015 for the three categories of SGA, more clearly among those aged 35-39 years. The contribution of multipara mothers of both age groups did not increase significantly during the period. CONCLUSION: Delayed maternity is a significant adjusted risk factor for SGA, contributing to the increase of its prevalence. However, results also suggest a limited clinical impact of delayed maternity on foetal growth. Positive changes in maternal profile associated with the shift in maternal age might contribute to explain the limited impact of mothers aged 35 years and older on negative birth outcome in Spain.

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OBJECTIVE: Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. METHODS: Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. RESULTS: Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). CONCLUSIONS: Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth.

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