Abstract P080: Glucose Homeostasis, Diabetes, and Orthostatic Hypotension in a Community-based Population: The ARIC Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Stephen P Juraschek ◽  
Natalie Daya ◽  
A. Richey Sharrett ◽  
Elizabeth Selvin
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Standing Position ◽  
Continuous Variable ◽  
Undiagnosed Diabetes ◽  
Diabetes Group ◽  
Cross Sectional ◽  
Diabetes Status ◽  
Group 5 ◽  
Group 2

Background: Although orthostatic hypotension (OH) screening is recommended for adults with diabetes, the extent to which blood glucose (BG) levels are associated with OH has not been characterized. Hypothesis: Higher BG levels are associated with having OH, while low levels of BG are not associated with OH. Methods: We examined the cross-sectional association of OH with BG and diabetes status in middle-aged (range 44 to 66 yrs) ARIC participants (1987-1989). OH was defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) within 2 min of standing, when transitioning from the supine to standing position. Using logistic regression, we examined the association of the following 5 categories of BG without diabetes or diabetes and OH: (1) low-normal BG (fasting BG <80 or non-fasting BG <100 mg/dL), (2) high-normal BG (fasting BG of 80-99 or non-fasting BG of 100-139 mg/dL), (3) pre-diabetes (fasting BG of 100-125 or non-fasting BG of 140-199 mg/dL), (4) undiagnosed diabetes (fasting BG ≥126 or non-fasting BG ≥200 mg/dL), or (5) diabetes (self-reported diagnosis or current medication use). We also modeled BG as a continuous variable by diabetes status, using restricted cubic splines to characterize the association between BG level and OH. Results: In 12,636 participants (mean age 54.6 ± 5.7 yrs, 55% women, 26% black), 4.3% had OH at baseline. The mean BG was 108 ± 38 mg/dL; 7% had diabetes (self-reported diagnosis or diabetes medications). After adjustment, adults with low BG (group 1) or diabetes (group 5) were both more likely to have OH compared to the normal BG group (group 2) with ORs of 2.15 (95% CI: 1.26, 3.65) and 2.20 (95% CI: 1.65, 2.92), respectively. Continuous characterization of the relationship between BG and OH was U-shaped for participants with or without diabetes ( Figure, panels A&B ). Conclusions: Low BG in adults without diabetes, diabetes, and high BG in adults with diabetes were associated with OH. This suggests a more prominent role for BG homeostasis in blood pressure stabilization with standing.

scholarly journals Standing Up Slowly Antagonises Initial Blood Pressure Decrease in Older Adults with Orthostatic Hypotension

Gerontology ◽  
2016 ◽  
Vol 63 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Eline S. de Bruïne ◽  
Esmee M. Reijnierse ◽  
Marijke C. Trappenburg ◽  
Jantsje H. Pasma ◽  
Oscar J. de Vries ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Orthostatic Hypotension ◽  
Standing Position ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Pharmacological Intervention ◽  
Cross Sectional ◽  
Normal Transition ◽  
Standing Up

Background: Orthostatic hypotension (OH) is common in older adults and associated with increased morbidity and mortality, loss of independence and high health-care costs. Standing up slowly is a recommended non-pharmacological intervention. However, the effectiveness of this advice has not been well studied. Objectives: The aim of this study was to investigate whether standing up slowly antagonises posture-related blood pressure (BP) decrease in a clinically relevant population of geriatric outpatients. Methods: In this cross-sectional study, 24 community-dwelling older adults referred to a geriatric outpatient clinic and diagnosed with OH were included. BP was measured continuously during 3 consecutive transitions from supine to standing position during normal, slow and fast transition. Results: The relative BP decrease at 0-15 s after slow transition was significantly lower than after normal transition (p = 0.003 for both systolic BP and diastolic BP) and fast transition (p = 0.045 for systolic BP; diastolic BP: non-significant). The relative diastolic BP decrease at 60-180 s after normal transition was significantly lower than after fast transition (p = 0.029). Conclusion: Standing up slowly antagonises BP decrease predominantly during the first 15 s of standing up in a clinically relevant population of geriatric outpatients diagnosed with OH. Results support the non-pharmacological intervention in clinical practice to counteract OH.

scholarly journals Correlation of refractive error with axial length and corneal topography

2016 ◽  
Vol 15 (1) ◽  
pp. 25-33
Author(s):  
Surabhi Ruia ◽  
Poonam Kishore ◽  
Vinita Singh ◽  
Nitin Chaudhary
Keyword(s):  
Negative Correlation ◽  
Refractive Error ◽  
Axial Length ◽  
Corneal Topography ◽  
Radius Of Curvature ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Study Materials ◽  
Group 5 ◽  
Group 2

Purpose: To collect and analyze normative data about corneal topography and axial length in various refractive errors in Indian population.Design: Cross-sectional observational study. Materials and Method: Three hundred eyes (150 patients) of age group 12-35 yrs were arranged in 5 groups according to refractive status; Group 1 (n=44): myopia of SphericalEquivalent (SE) > 6 D; Group 2 (n=67): myopia of SE >0.5 D to 6 D; Group 3 (n=88): nearly emmetropic of SE -0.5 D to +0.5 D; Group 4 (n=59): hypermetropia of SE >0.5 to 6 D; Group 5 (n=42): hypermetropia of SE > 6 D. Axial length(AL), central radius of curvature of cornea (CR), central power of cornea (CK) , Al/CR ratio for each group were documented . Correlation with SE and among each other was studied. Results: Mean AL (in mm) of myopic patients (n=111) was 24.23 ± 1.34, emmetropic (n=88) 22.62 ± 0.94 and hypermetropics (n=101) 20.73 ±0.94. Mean CR (in mm) of myopic patients was 7.55 ± 0.35, emmetropics was 7.70 ±0.32, and hypermetropes was 7.99 ±0.35. Mean CK (in D) of myopics was 44.86±2.59, emmetropes was 43.91±1.76, and hypermetropes was 42.32±1.89. Mean AL/CR ratio of myopics was 3.22 ± 0.29, emmetropics 2.94± 0.07, and hypermetropics 2.60 ± 0.19. AL was negatively correlated with SE(r=-0.91, p<0.0001) and positively with AL/CR(r=0.88, p<0.0001) and CK (r=0.36, p<0.0001). CR was negatively correlated with AL/CR (r=-0.74, p<0.0001) while positively correlated with SE (r=0.62, p<0.0001). CK showed positive correlation with AL/CR (r=0.75, p<0.0001) while negative correlation with SE (r=-0.61, p<0.0001). AL/CR was negatively correlated withSE(r=-0.95, p<0.0001). Conclusion: This study showed a negative correlation between axial length and refractive error and between AL/CR ratio and refractive error with stronger inverse relationship in hypermetropes than myopes. There was a positive correlation of CR with SE with a weaker direct relationship in myopes than hypermetropes. 

Abstract 476: Renal AT2 Receptor Activation Prevents Sodium Retention And Lowers Blood Pressure In Angiotensin II-Dependent Hypertension

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Shetal H Padia ◽  
Nancy L Howell ◽  
Brandon A Kemp ◽  
John J Gildea ◽  
Susanna R Keller ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Angiotensin Ii ◽  
Receptor Activation ◽  
Pressure Probe ◽  
Ang Ii ◽  
Induced Hypertension ◽  
Group 5 ◽  
Group 2 ◽  
Angiotensin Type

A major proposed mechanism for the initiation of hypertension involves a primary increase in renal tubular sodium (Na+) reabsorption. Activation of intrarenal angiotensin type-2 receptors (AT2R) increases Na+ excretion; however, the role of intrarenal angiotensin type-2 receptors (AT2R) in the development of hypertension is unknown. Sprague-Dawley rats (N=36) underwent uninephrectomy and telemetric blood pressure probe implantation. Following a 72h recovery, two osmotic minipumps were inserted in each rat, one for chronic systemic delivery of 5% dextrose in water (D5W) or angiotensin II (Ang II, 200 ng/kg/min), and one for chronic intrarenal delivery of D5W (0.25 μL/h x 7d), highly selective AT2R agonist Compound 21 (C-21; 60 ng/kg/min x 7d), or specific AT2R antagonist PD-1223319 (PD; 10 ng/kg/min x 7d). Five groups of rats were studied: Group 1 (Control; N=10): systemic D5W + intrarenal D5W; Group 2 (Ang II-induced hypertension; N=8): systemic Ang II + intrarenal D5W; Group 3 (N=6): systemic Ang II + intrarenal C-21; Group 4 (N=6): systemic Ang II + 48h lead-in intrarenal C-21; Group 5 (N=6): systemic Ang II + intrarenal PD. Systemic Ang II infusion increased mean systolic blood pressure from 126±5 to 190±3 mm Hg over a 7d period in Group 2 (ANOVA F=73; P<1 X 10-6). Intrarenal administration of AT2R agonist C-21 (Groups 3 and 4) markedly inhibited the pressor effect of systemic Ang II (P<0.0001). Intrarenal AT2R antagonist PD (Group 5) augmented the pressor action of Ang II (P<0.0001). Consecutive 24h urinary Na+ excretion (UNaV) was reduced from 0.95±0.04 to 0.34±0.07 μmol/min (P<0.0001) on day 1 of Ang II infusion; Ang II-induced antinatriuresis was inhibited by intrarenal C-21 (P<0.0001) and augmented by intrarenal PD (P<0.0001) during the entire 7d infusion, demonstrating that one of the mechanisms to prevent Ang II-induced hypertension during intrarenal AT2R activation is the abolition of the initial increase in Na+ reabsorption that triggers the hypertensive cascade in this model. Thus, renal AT2Rs represent a novel therapeutic target for the prevention of hypertension.

scholarly journals Prognostic Value of Masked Uncontrolled Hypertension Defined by Different Ambulatory Blood Pressure Criteria

2020 ◽  
Vol 33 (8) ◽  
pp. 726-733
Author(s):  
Francesca Coccina ◽  
Anna M Pierdomenico ◽  
Chiara Cuccurullo ◽  
Jacopo Pizzicannella ◽  
Rosalinda Madonna ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Uncontrolled Hypertension ◽  
Prognostic Impact ◽  
Prognostic Information ◽  
Group 4 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Abstract BACKGROUND Masked uncontrolled hypertension (MUCH), that is, nonhypertensive clinic but high out-of-office blood pressure (BP) in treated patients is at increased cardiovascular risk than controlled hypertension (CH), that is, nonhypertensive clinic and out-of-office BP. Using ambulatory BP, MUCH can be defined as daytime and/or nighttime and/or 24-hour BP above thresholds. It is unclear whether different definitions of MUCH have similar prognostic information. This study assessed the prognostic value of MUCH defined by different ambulatory BP criteria. METHODS Cardiovascular events were evaluated in 738 treated hypertensive patients with nonhypertensive clinic BP. Among them, participants were classified as having CH or daytime MUCH (BP ≥135/85 mm Hg) regardless of nighttime BP (group 1), nighttime MUCH (BP ≥120/70 mm Hg) regardless of daytime BP (group 2), 24-hour MUCH (BP ≥130/80 mm Hg) regardless of daytime or nighttime BP (group 3), daytime MUCH only (group 4), nighttime MUCH only (group 5), and daytime + nighttime MUCH (group 6). RESULTS We detected 215 (29%), 357 (48.5%), 275 (37%), 42 (5.5%),184 (25%) and 173 (23.5%) patients with MUCH from group 1 to 6, respectively. During the follow-up (10 ± 5 years), 148 events occurred in patients with CH and MUCH. After adjustment for covariates, compared with patients with CH, the adjusted hazard ratio (95% confidence interval) for cardiovascular events was 2.01 (1.45–2.79), 1.53 (1.09–2.15), 1.69 (1.22–2.34), 1.52 (0.80–2.91), 1.15 (0.74–1.80), and 2.29 (1.53–3.42) from group 1 to 6, respectively. CONCLUSIONS The prognostic impact of MUCH defined according to various ambulatory BP definitions may be different.

scholarly journals Waist:height ratio: a superior index in estimating cardiovascular risks in Turkish adults

2013 ◽  
Vol 17 (10) ◽  
pp. 2246-2252 ◽  
Author(s):  
Reci Meseri ◽  
Reyhan Ucku ◽  
Belgin Unal
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Risk Score ◽  
Framingham Risk Score ◽  
Undiagnosed Diabetes ◽  
Anthropometric Measurement ◽  
Cardiovascular Risks ◽  
Framingham Risk ◽  
Chd Risk ◽  
Diabetes Status

AbstractObjectiveTo determine the best anthropometric measurement among waist: height ratio (WHtR), BMI, waist:hip ratio (WHR) and waist circumference (WC) associated with high CHD risk in adults and to define the optimal cut-off point for WHtR.DesignPopulation-based cross-sectional study.SettingBalcova, Izmir, Turkey.SubjectsIndividuals (n 10 878) who participated in the baseline survey of the Heart of Balcova Project. For each participant, 10-year coronary event risk (Framingham risk score) was calculated using data on age, sex, smoking status, blood pressure, serum lipids and diabetes status. Participants who had risk higher than 10 % were defined as ‘medium or high risk’.ResultsAmong the participants, 67·7 % were female, 38·2 % were obese, 24·5 % had high blood pressure, 9·2 % had diabetes, 1·5 % had undiagnosed diabetes (≥126 mg/dl), 22·0 % had high total cholesterol and 45·9 % had low HDL-cholesterol. According to Framingham risk score, 32·7 % of them had a risk score higher than 10 %. Those who had medium or high risk had significantly higher mean BMI, WHtR, WHR and WC compared with those at low risk. According to receiver-operating characteristic curves, WHtR was the best and BMI was the worst indicator of CHD risk for both sexes. For both men and women, 0·55 was the optimal cut-off point for WHtR for CHD risk.ConclusionsBMI should not be used alone for evaluating obesity when estimating cardiometabolic risks. WHtR was found to be a successful measurement for determining cardiovascular risks. A cut-off point of ‘0·5’ can be used for categorizing WHtR in order to target people at high CHD risk for preventive actions.

scholarly journals Analysis of Caesarean Section Rates Using the Robson Ten-group Classification at a Tertiary Care Teaching Hospital in Eastern India: A Cross-sectional Study

2021 ◽  
Author(s):  
Hiralal Konar ◽  
Madhutandra Sarkar ◽  
Sisir Kumar Chowdhury
Keyword(s):  
Caesarean Section ◽  
Tertiary Care ◽  
Relative Size ◽  
Group Classification ◽  
Cross Sectional ◽  
Care Teaching ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Introduction: The Robson ten-group classification identifies the women’s groups that make the greatest contribution to the overall rate of Caesarean Section (CS), and thereby helps to optimise CS rates. It also helps to ensure optimum maternal and perinatal outcomes. Aim: This study was undertaken to examine the rates of CS using the Robson ten-group classification, and also to identify the women’s groups that contribute most to CS rates in a tertiary care teaching and referral hospital in Kolkata, India. Materials and Methods: This cross-sectional observational study was conducted over a period of one year from May 2012 to April 2013. All pregnant women admitted under the supervision of a particular unit of the Department of Obstetrics and Gynaecology and delivered in that hospital during the study period were included. Necessary data collection was done on the following parameters, i.e., previous obstetric history, category of pregnancy, course of labour and delivery, and gestational age. The women were categorised into the ten Robson groups. For each group, the CS rate, relative size of the group, and the percentage contribution made by the group to the overall CS rate were calculated and expressed in percentages. Chi-square test, Z-test and the trial version of Statistical Package for Social Sciences (SPSS) version 20.0 were used to analyse the data. Results: The CS rate in the present study was 43.13% (735 out of 1704 deliveries). Not only the largest group in terms of relative size 649 (38.08%), the Robson group 1 had a CS rate of 41.75% (271/649), as well as the largest absolute number of caesarean deliveries. The group 1 made the largest contribution (271) to the overall CS rate (15.9%). The group 5 was the second largest contributing group 155 (9.09%), followed by group 3 96 (5.63%) and group 2 69 (4.04%). In the present study group 5 showed the CS rate of 95.67%, group 3 with CS rate of 24.48% and group 2 with CS rate of 60.52%. Conclusion: The Robson groups 1, 2, 3 and 5 were found to be the major contributors to the overall CS rate. These groups may be targeted for effective interventions to reduce the CS rate. Active management of labour in a primigravida with spontaneous onset, reduction of primary caesarean delivery, promoting vaginal birth after CS, and careful assessment of cases before induction of labour in nulliparous women, are likely to be few effective strategies.

scholarly journals Changes in retina's vascular and nervous structures in patients with hypertension

2021 ◽  
Author(s):  
Run-ze Zhao ◽  
Melba Márquez Fernández ◽  
Maria Cáceres Toledo ◽  
Teddy Osmin Tamargo Barbeito ◽  
Guo-xun Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cross Sectional Study ◽  
Hypertensive Retinopathy ◽  
Ganglion Cell Complex ◽  
Fiber Layer ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group 2 ◽  
Post Hoc ◽  
Group 1

Abstract Introduction: This study aims to analyze the correlation between hypertension (HTN) and changes in the retina's vascular and nervous structures in patients with hypertension.Method: This was a cross-sectional study, which included a group of 45 subjects who did not suffer from hypertension (HTN) (Group 1), other two groups of 51 patients with controlled (Group 2) and not controlled (Group 3) HTN. Changes in vascular and nervous structures were identified and evaluated by ophthalmoscopy and OCT, respectively. Parametric and non-parametric tests, Post-hoc, Pearson, and Spearman correlation were used, with p<0.05 considered statistically significant.Results: We observed hypertensive retinopathy (HTNR G I and II) in both groups with HTN, with a significant difference (p=0.023). We found a lower average retinal nerve fiber layer (RNFL), the average and minimum ganglion cell complex (GCC) in the patients of groups 2 and 3 than those of group 1. We found a negative and slight correlation between systolic blood pressure (SBP), diastolic blood pressure (DBP), and HTNR with superior GCC thickness in hypertensive patients.Conclusions: hypertension correlated to changes in the retina's vascular and nervous structures, and the nervous structure alterations were not visible by ophthalmoscopy but detected by OCT.

scholarly journals Association Between Bedtime at Night and Systolic Blood Pressure in Adults in NHANES

2021 ◽  
Vol 8 ◽  
Author(s):  
Yingjie Su ◽  
Changluo Li ◽  
Yong Long ◽  
Liudang He ◽  
Ning Ding
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Sleep Time ◽  
Cross Sectional Study ◽  
Continuous Variable ◽  
Gradual Decrease ◽  
Female Group ◽  
Cross Sectional ◽  
Health And Nutrition ◽  
The Relationship

Objectives: This study aimed to explore the association between bedtime at night and systolic blood pressure (SBP) in adults.Methods: We conducted a cross-sectional study composed of 7,642 individuals from the National Health and Nutrition Examination Survey (NHANES). Bedtime was defined as the response to the question: “What time do you usually fall asleep on weekdays or workdays?” SBP was taken using the average of all measured values. Multiple linear regression analyses were done to explore the relationship between bedtime and SBP.Results: The bedtime was changed from categorical variable to continuous variable for data analysis, and a significantly negative association was identified between bedtime and SBP (β, −0.23 [95% CI, −0.43, −0.02]). With the delay of bedtime, the SBP showed a gradual decrease trend, and it was dropped to the lowest at 0:00. After 0:00, the SBP was gradually increased with the delay of sleep time. The stratified analyses showed that in the female group, with the delay of bedtime, the range of SBP was decreased more obviously at 0:00. In the 18–45 year group, bedtime had little effect on SBP. Among ≥45 years old group, this trend was still the same. In the black group, an obvious downward trend was found at 22:00.Conclusion: With the delay of bedtime, the SBP had shown a gradual decrease trend, and it was dropped to the lowest at 0:00. After 0:00, the SBP was gradually increased with the delay of sleep time. Bedtime and SBP showed a U-shaped relationship.

scholarly journals Study of blood pressure in relation with age, sex and BMI in school going children of age group 5-15 years in Amalapuram, Andhra Pradesh, India

2019 ◽  
Vol 6 (3) ◽  
pp. 1068
Author(s):  
Rajesh Kumar Sethi ◽  
Raghava Badabagni ◽  
Padmaja Sridevi Pabbineedi ◽  
Radhika Chennupati
Keyword(s):  
Blood Pressure ◽  
Peer Group ◽  
The Body ◽  
Age Group ◽  
Cross Sectional ◽  
History Of ◽  
Family History Of Hypertension ◽  
Males And Females ◽  
Group 5 ◽  
Relationship Of

Background: The measurement of blood pressure is an important component of routine Pediatric physical examination. Children with higher levels of blood pressure tend to maintain higher blood pressure levels in adulthood in comparison to their peer group. The aims and objectives of this study were to define the normal pattern of blood pressure and prevalence of hypertension in urban school children between the age group of 5-15 years and to evaluate relationship of blood pressure with variables such as age, sex, height, weight and BMI in Amalapuram, Andhra Pradesh.Methods: This was a prospective cross-sectional observational study conducted from July 2016 to December 2018 in Department of Pediatrics, KIMS Amalapuram.Results: The overall prevalence of hypertension in the present study was 3.2%. Of these 16 children 11 were males amounting to 4.41% of total number of males and 5 were females amounting to 1.99% of total number of females. The prevalence of hypertension was more in the males. It was observed that there is not much increase in mean blood pressure up to 130 cms (both in males and females) and increased significantly and gradually in children above 130 cms of height. Blood pressure increases gradually and in a proportionate manner with increase in weight and BMI.Conclusions: Blood pressure is an important vital sign which reflects the integrity of the cardiovascular system, renal, endocrinal system and other systems in the body. Blood pressure of an individual varies with age, sex, height, weight and BMI. It also has a strong correlation with family history of hypertension. Thus, concluded that hypertension has its roots in childhood and early adolescence.

scholarly journals Using the Robson Classification to Explain the Fluctuations in Cesarean Section

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
H. Cammu ◽  
E. Martens ◽  
G. Van Maele
Keyword(s):  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Induced Labor ◽  
Robson Classification ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
The Absolute ◽  
Group 5 ◽  
Group 2

Purpose. As the rate of cesarean sections (CS) continues to rise in Flanders (northern part of Belgium), it is important to understand the reasons behind this evolution and to find ways to achieve appropriate CS rates. For this analysis, we categorized CS changes between 1992 and 2016, applying the Robson 10-Group Classification System (TGCS). We also applied the TGCS to analyze the information of the only clinics where between 2008 and 2016, the absolute CS rate had fallen by more than two percent. Methods. This paper is based on a population-based cross-sectional study. Robson’s TGCS was used to analyze CS rates for the years 1992, 2000, 2008, and 2016, using the Flemish population-based birth register. Results. Between 1992 and 2016, the overall CS rate increased from 11.8% in 1992 to 20.9% in 2016. The major contributors to that increase were (a) single, cephalic nulliparous women, at term in spontaneous labor (Robson group 1); (b) single, cephalic nulliparous women, at term in induced labor or CS before labor (group 2); and (c) multiparous women with single cephalic at term pregnancy with history of CS (group 5). In the subgroup of the seven clinics where the collective CS rate had decreased from 23.2% in 2008 to 19.3% in 2016, the main contributors to this decrease were Robson groups 1 and 2. Conclusions. The CS increase in Flanders between 1992 and 2016 is mainly the result of the absolute CS increase in the childbirth of nulliparous women with a single cephalic baby at term in spontaneous or induced labor and in women with a single cephalic presentation at term and a previous CS. Further research in these aforementioned groups is needed to identify the real reasons for the CS increase.

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