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A letter to the editor is presented in response to the article "An Overview of Mortality and Sequelae of Preterm Birth From Infancy to Adulthood" by S. Saigal and L. W. Doyle in the January 19, 2008 issue.

Opinion. Surveys the cesarean section rates in the United Kingdom (UK) and other developed countries. Presence of high cesarean section rates in the United States and Canada; Incomplete monitoring of cesarean section rates in the UK; Fear of litigation among obstetricians and other reasons for high cesarean rates; Attempts to reduce cesarean section rates.

Background: International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons.Methods: In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country.Findings: Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65-0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80-1·16) although changes varied widely between countries (RRs 0·62-2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment.Interpretation: Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared.Funding: EU Union under the framework of the Health Programme and the Bridge Health Project. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "Home birth--proceed with caution," in a 2010 issue of "Lancet."

A strong association between deprivation and severe COVID-19 outcomes has been reported among adults. We estimated population-based rates of SARS-CoV-2 testing, laboratory-confirmed infections, and hospital admissions with COVID-19 in children and young people (aged 0–23 years) in Scotland according to sociodemographic risk factors. We used a birth cohort of all children and young people born in Scotland in 1997–2020, consisting of linked vital registration, maternity, hospital admissions, and SARS-CoV-2 PCR testing data. Participants were followed from birth or Jan 1, 2020 (whichever occurred last) until Dec 31, 2020, death, or emigration. Admissions with COVID-19 were defined as participants with a positive SARS-CoV-2 test during or up to 28 days before admission to hospital, or a relevant International Classification of Diseases version 10 code recorded (U07.1/U07.2). We calculated crude rates of tests, laboratory-confirmed infections, and admissions, by age group, sex, and Scottish Index of Multiple Deprivation (SIMD) quintiles with 95% CIs. The cohort included 1 230 290 children and young people living in Scotland during 2020. By Dec 31, 2020, 243 958 (19·8%) were tested for SARS-CoV-2 at least once, and 17 709 (7·3%) had tested positive. Infants (aged <2 years) and 18–23-year-olds were most likely to be tested; there was no clear trend in testing rates by SIMD quintile. 18–23-year-olds, females, and those from the most deprived SIMD quintile were most likely to test positive. 379 participants had an admission with COVID-19, corresponding to a rate of 32·0 per 100 000 person-years (95% CI 28·9–35·4). Females (admission rate 35·4 per 100 000 person-years [95% CI 30·9–40·6]) and infants (143·5 per 100 000 person-years [113·3–181·7]) were most likely to be admitted to hospital. There was a clear gradient in hospital admissions by SIMD, with participants in the most deprived quintile (42·9 per 100 000 person-years [36·1–50·8]) experiencing 1·9 times (95% CI 1·3–2·6) the admission rate compared with those in the least deprived (22·6 per 100 000 person-years [16·9–30·3]). Rates of infection and admissions with COVID-19 were associated with area-level deprivation among children and young people. Infants had a relatively low infection rate but the highest admission rate. Analyses examining risk factors, including ethnic group and long-term conditions are underway, to inform the public health response to SARS-CoV-2 in children. Although children and young people in Scotland had low COVID-19-related admission rates versus adults, a socioeconomic gradient was evident, indicating children living in more deprived areas are at increased risk of short-term, and potential long-term, health and education impacts of COVID-19. UKRI Medical Research Council and the Great Ormond Street Biomedical Research Centre. [ABSTRACT FROM AUTHOR]