Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia. METHODS: Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model.Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95-35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14-34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76-2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16-1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86-2.21, p<0.001).The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend. 

/pdf/has-the-cesarean-epidemic-in-czechia-been-reversed-despite-2ba1l3mx.pdf

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

At the present time, legal actions against physicians in Italy number about 15,000 per year, and hospitals spend over 10 billion (∼US$15.5 billion) to compensate patients injured from therapeutic and diagnostic errors. In a survey summary issued by the Italian Court for the Rights of the Patient, between 1996 and 2000 orthopaedic surgery was the highest-ranked specialty for the number of complaints alleging medical malpractice. Today among European countries, Italy has the highest number of physicians subject to criminal proceedings related to medical malpractice, a fact that is profoundly changing physicians' approach to medical practice. The national health system has paid increasingly higher insurance premiums and is having difficulty finding insurance companies willing to bear the risk of monetary claims alleging medical malpractice. Healthcare costs will likely worsen as Italian physicians increasingly practice defensive medicine, thereby overutilizing resources with the goal of documenting diligence, prudence, and skill as defenses against potential litigation, rather than aimed at any patient benefit. To reduce the practice of defensive medicine and healthcare costs, a possible solution could be the introduction of an extrajudicial litigation resolution, as in other civil law countries, and a reform of the Italian judicial system on matters of medical malpractice litigation.

Medical malpractice: The experience in Italy

/pdf/estudiantes-universitarias-nuligestas-en-edad-fertil-y-su-2mdcleom.pdf

Estudiantes universitarias nuligestas en edad fértil y su postura acerca de posibles vías del parto

Il tema della responsabilita medica e sanitaria e composito, problematico, specialistico, in perenne divenire e controverso tanto che non conosce eguali nella materia della responsabilita.
Il primo intervento legislativo rivolto a collocare e delineare la responsabilita sanitaria e stato prodotto con il D.L. 13 settembre 2012, n. 158, adottato in via d’urgenza, stante la contrazione delle risorse finanziarie destinate al Servizio Sanitario Nazionale, a seguito delle manovre di contenimento della spesa pubblica; la legge di conversione del suddetto decreto (L. 8 novembre 2012 n. 189) e poi intervenuta con successive modifiche rivolte a correggere quegli aspetti che avevano originariamente lasciato ampio spazio alle azioni di responsabilita nei confronti dei medici e delle strutture sanitarie.
La legge n. 189/2012 (c.d. Riforma Balduzzi) ha pero lasciato numerosi dubbi interpretativi e lacune che, a distanza di una manciata di anni, hanno fatto sorgere la necessita di intervenire nuovamente sul delicato settore per regolamentare gli aspetti non ancora normati ed evitare cosi di lasciare margini interpretativi eccessivamente ampi. 
L’iperattivo legislatore ha inteso rivisitare e nuovamente regolamentare il tema della responsabilita sanitaria con la legge n. 24 del 8 marzo 2017, denominata Legge Gelli, pubblicata in Gazzetta Ufficiale n. 64 del 17 marzo, recante "Disposizioni in materia di sicurezza delle cure e della persona assistita, nonche in materia di responsabilita professionale degli esercenti le professioni sanitarie", entrata in vigore in data 1 aprile 2017. 
Il presente lavoro e diviso in tre capitoli.
Con il primo si intende illustrare il panorama normativo e giurisprudenziale dell’ultimo quinquennio con un rapido cenno alle elaborazioni di maggiore interesse; con il secondo capitolo si introduce la novella del 2017, con i primi spunti di riflessione da parte dei giuristi; con il terzo si affronta la tematica del contenzioso civile in riferimento ai rimedi alternativi di risoluzione delle controversie.

L'evoluzione della responsabilità civile e penale del medico

Background: The marked increase in the rates of CS has not only raises the challenges for the medical professional but also became a debatable issues for many gynecologists. In order to explain the increasing rates of CS it is necessary to identify which group of women is more frequently undergoing CS. Objective: The study aimed to evaluate the role the fetal distress and Robson ten group classification play for the indication of caesarean section. Study design: It is a retrospective study conducted at Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital Sialkot, from January 2022 to June 2022. Material and Methods: 5787 women were admitted in tertiary care unit for delivery. Among these 2031 went through caesarean and the remaining delivered normally. Most of the population was included in group 1 and 5, where 501 and 535 individuals were present. Results: The group having the most contribution towards CS was group 5. And the group showing least contribution towards CS was group no.10. Group 5 also showed high contribution towards CS. The evaluation was carried out for 205 patients, the mean age of the patients was 26 years in this study. Most of the patients belonged to gestation week greater than 36 weeks. Conclusion: The group that has low risk had more chances to contribute to the CS rate. The indication for CS was most of the time fetal distress which was seen at the time patients were admitted in hospital. Keywords: Caesarean section and fetal distress.

Robson Ten Group Classification System and Fetal Distress as the Indication for Caesarean Section

Improvements in medical technologies have seen over-medicalization of childbirth. Caesarean section (CS) is a lifesaving procedure proven effective in reducing maternal and perinatal mortality across the globe. However, as with any medical procedure, the CS intrinsically carries some risk to its beneficiaries. In recent years, CS rates have risen alarmingly in high-income countries. Many exceeding the World Health Organisation (WHO) recommendation of a 10 to 15% annual CS rate. While this situation poses an increased risk to women and their children, it also represents an excess human and financial burden on health systems. Therefore, from a health system perspective this study systematically summarizes existing evidence relevant to the factors driving the phenomenon of increasing CS rates using Italy as a case study. Employing the WHO Health System Framework (WHOHSF), this systematic review used the PRISMA guidelines to report findings. PubMed, SCOPUS, MEDLINE, Cochrane Library and Google Scholar databases were searched up until April 1, 2020. Findings were organised through the six dimensions of the WHOHSF framework: service delivery, health workforce, health system information; medical products vaccine and technologies, financing; and leadership and governance. CS rates in Italy are affected by complex interactions among several stakeholder groups and contextual factors such as the hyper-medicalisation of delivery, differences in policy and practice across units and the national context, issues pertaining to the legal and social environment, and women’s attitudes towards pregnancy and childbirth. Mitigating the high rates of CS will require a synergistic multi-stakeholder intervention. Specifically, with processes able to attract the official endorsement of policy makers, encourage concensus between regional authorities and local governments and guide the systematic compliance of delivery units with its clinical guidelines.

/pdf/an-unnecessary-cut-multilevel-health-systems-analysis-of-3pv22dklh8.pdf

“An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review

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“An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review