Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study.
ABSTRACT BACKGROUND: Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night). We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births. METHODS: This retrospective cohort study was based on data from the Netherlands Perinatal Registry, a countrywide registry that covers 99% of all hospital births in the Netherlands. Data of 449,714 infants, born at 28 completed weeks or later, in the period 2003 through 2007 were used. Infants with a high a priori risk of morbidity or mortality were excluded. Outcome measures were intrapartum and early neonatal mortality, a low Apgar score (5 minute score of 0--6), and a composite adverse perinatal outcome measure (mortality, low Apgar score, severe birth trauma, admission to a neonatal intensive care unit). RESULTS: Evening and night-time deliveries that involved induction or augmentation of labour, or an emergency caesarean section, were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Weekend deliveries were not associated with an increased risk when compared to weekday deliveries. It was estimated that each year, between 126 and 141 cases with an adverse perinatal outcomes could be attributed to this evening and night effect. Of these, 21 (15 -16%) are intrapartum or early neonatal death. Among the 3100 infants in the study population who experience an adverse outcome each year, death accounted for only 5% (165) of these outcomes. CONCLUSION: This study shows that for infants whose mothers require obstetric interventions during labour and delivery, birth in the evening or at night, are at an increased risk of an adverse perinatal outcomes.
Full-textDOI: · Available from: Maarten Schipper, May 26, 2015
SourceAvailable from: Oliver Karam[Show abstract] [Hide abstract]
ABSTRACT: AimNeonatal resuscitation requires minimal equipment, but the immediate availability of expert staff accounts for the largest proportion of the costs. Despite this, staff requirements and timetables are currently planned without comprehensive epidemiologic data. The aim of this study was to evaluate the staffing required for neonatal resuscitations in the delivery room.Methods We measured attendance for each specific role in a tertiary university-affiliated hospital and for four possible intervention levels: preparation time, basic paediatric care, moderate resuscitation and extended resuscitation.ResultsBetween 2005 and 2012 resuscitation staff attended 11,561 of the 32,799 births: 27.2% for preparation time, 17.7% for basic paediatric care, 6.4% for moderate resuscitation and 3.5% for extended resuscitation. Moderate and extended resuscitations occurred in roughly 10% of births and evenly during 24-hour periods. Basic paediatric care levels were higher during weekday mornings and extended resuscitations were uniformly distributed. However there was a drop in all types of interventions around 7am to 8am, when staff were changing shifts.Conclusions Moderate and extended resuscitations occurred evenly over 24 hours in roughly 10% of births, stressing the importance of having a highly competent neonatal team constantly available. All activities associated with resuscitation were lower during morning shift changes.This article is protected by copyright. All rights reserved.Acta Paediatrica 01/2015; 104(6). DOI:10.1111/apa.12909 · 1.84 Impact Factor
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ABSTRACT: The highest percentages of births occurred during the morning and midday hours. ● Births on Saturday and Sunday were more likely to occur in the late evening and early morning hours than births Monday through Friday. ● Compared with induced vaginal deliveries and noninduced vaginal deliveries, cesarean deliveries were the least likely to occur during the evening and early morning. ● Noninduced vaginal births were more likely than cesarean and induced vaginal births to occur in the early morning. ● Cesarean deliveries with no trial of labor were much more concentrated during the day than were cesarean deliveries with a trial of labor. ● Births delivered in hospitals and all births show similar time-of-day patterns. As the use of medical interventions for childbirth (i.e., induction of labor and cesarean delivery) has increased during the last few decades, an increasing proportion of deliveries occur during regular daytime hours (1,2). Hospital personnel resources and maternal and newborn outcomes can be influenced by the time of day of delivery (3–7). Data on the time of day of the birth became available with the 2003 revision of the birth certificate. This report examines 2013 birth certificate data from the National Vital Statistics System (NVSS) to describe the time of day of birth by method of delivery and place of birth for a 41-state and District of Columbia (DC) reporting area that had adopted the 2003 revised birth certificate by January 2013. This reporting area represents 90% of U.S. births. Keywords: time of day of birth • cesarean • trial of labor
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ABSTRACT: Objective: To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night. Design: Prospective cohort study. Setting: Urban maternity unit in Ireland with off-site consultant staff at night. Population: All nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013. Methods: Delivery outcomes were compared for women who delivered by day (08:00-19:59) or at night (20:00-07:59). Main outcome measures: The main outcomes included postpartum haemorrhage (PPH), anal sphincter tear and neonatal unit admission. Procedural factors included operator grade, sequential use of instruments and caesarean section. Results: Of the 597 women who required an OVD, 296 (50%) delivered at night. Choice of instrument, place of delivery, sequential use of instruments and caesarean section did not differ significantly in relation to time of birth. Mid-grade operators performed less OVDs by day than at night, OR 0.60 (95% CI 0.43 to 0.83), and a consultant supervisor was more frequently present by day, OR 2.26 (95% CI 1.05 to 4.83). Shoulder dystocia occurred more commonly by day, OR 2.57 (95% CI 1.05 to 6.28). The incidence of PPH, anal sphincter tears, neonatal unit admission, fetal acidosis and neonatal trauma was similar by day and at night. The mean decision to delivery intervals were 12.0 and 12.6 min, respectively. Conclusions: There was no evidence of an association between time of OVD and adverse perinatal outcomes despite off-site consultant obstetric support at night.BMJ Open 10/2014; 4(10):e006291. DOI:10.1136/bmjopen-2014-006291 · 2.06 Impact Factor