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Yang M, Ahn SY, Jo HS, Sung SI, Chang YS, Park WS. Mortality and Morbidities according to Time of Birth in Extremely Low Birth Weight Infants. J Korean Med Sci 2021; 36:e86. [PMID: 33821593 PMCID: PMC8021978 DOI: 10.3346/jkms.2021.36.e86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/14/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although the overall quality of high-risk neonatal care has improved recently, there is still concern about a difference in the quality of care when comparing off-hour births and regular-hour births. Moreover, there are no data in Korea regarding the impact of time of birth on mortality and morbidities in preterm infants. METHODS A total of 3,220 infants weighing < 1,000 g and born at 23-34 weeks in 2013-2017 were analyzed based on the Korean Neonatal Network data. Mortality and major morbidities were analyzed using logistic regression according to time of birth during off-hours (nighttime, weekend, and holiday) and regular hours. The institutes were sub-grouped into hospital group I and hospital group II based on the neonatal intensive care unit (NICU) care level defined by the mortality rates of < 50% and ≥ 50%, respectively, in infants born at 23-24 weeks' gestation. RESULTS The number of births during regular hours and off-hours was similar. In the total population and hospital group I, off-hour births were not associated with increased neonatal mortality and morbidities. However, in hospital group II, increased early mortality was found in the off-hour births when compared to regular-hour births. CONCLUSION Efforts to improve the overall quality of NICU are required to lower the early mortality rate in off-hour births. Also, other sensitive indexes for the evaluation of quality of NICU care should be further studied.
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MESH Headings
- After-Hours Care
- Cerebral Intraventricular Hemorrhage/epidemiology
- Cerebral Intraventricular Hemorrhage/mortality
- Databases, Factual
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/mortality
- Female
- Gestational Age
- Humans
- Infant
- Infant Mortality
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Intensive Care Units, Neonatal
- Logistic Models
- Male
- Morbidity
- Odds Ratio
- Quality of Health Care
- Republic of Korea
- Time Factors
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Affiliation(s)
- Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
| | - Heui Seung Jo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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Time of Birth and the Risk of Severe Unexpected Complications in Term Singleton Neonates. Obstet Gynecol 2020; 136:377-385. [PMID: 32649496 DOI: 10.1097/aog.0000000000003922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether there is a relationship between evening, night, and weekend births and severe unexpected neonatal morbidity in low-risk term singleton births. METHODS We conducted a population-based, cross-sectional analysis. Severe unexpected neonatal morbidity as defined by the National Quality Forum specification 0716 was derived from linked birth certificate and hospital discharge summaries for 1,048,957 low-risk singleton term Californian births during 2011 through 2013. The association between the nursing shift (7 am-3 pm vs 3-11 pm and 11 pm -7 am) and weekday compared with weekend birth and the risk of severe unexpected neonatal morbidity was estimated using mixed effects logistic regression models. RESULTS Severe unexpected neonatal morbidity was higher among births during the 3-11 pm evening shift (2.1%) and the 11 pm-7 am night shift (2.1%), compared with those during the 7 am-3 pm day shift (1.8%). The adjusted odds ratios (ORs) were 1.10 (95% CI 1.06-1.13) for the evening shift and 1.15 (1.11-1.19) for the night shift. The adjusted ORs of severe unexpected neonatal morbidity were increased only on Sunday, as compared with other days (adjusted OR 1.08, 95% CI 1.02-1.14). When our analysis was by perinatal region, the increase was seen in four of the nine perinatal regions. CONCLUSION After risk adjustment, the risk of severe unexpected morbidity in the low-risk singleton California birth cohort was significantly increased on Sundays and births during evening and night shifts. These elevations were detected in only four of California's nine perinatal regions. Further analysis at the individual hospital level is warranted.
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The impact of nurses' and physicians' shift change on obstetrical outcomes. Arch Gynecol Obstet 2020; 303:653-658. [PMID: 32886235 DOI: 10.1007/s00404-020-05773-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effect around nurses' shift change and on-call physicians' shift change on obstetrical outcomes. METHODS A retrospective study of women who had an attempt of labor in a single-medical center, January 2006-December 2017. Obstetrical outcomes were compared between the time around nurses' shift change (6:00-8:00, 14:00-16:00, and 22:00-00:00) to the rest of the day, and between the time around on-call physicians' shift change (6:00-8:00, 14:00-16:00) to the rest of the day. RESULTS 32,861 women were included, 7826 deliveries occurred during nurses' shift-change, and 25,035 deliveries occurred during the rest of the day. The groups had similar general and obstetrical characteristics, with no statistical difference in cesarean delivery rate (10% vs. 9.8%, P = 0.45) (Table 1). Nurses' shift change had no measurable effect on obstetrical outcomes, including induction of labor, preterm labor, 5-min-Apgar score and cord pH value, except PPH which was less likely to occur during nurses' shift change period (3.8% vs. 4.4%, P = 0.045) (Table 2). From 32,861 deliveries, 5155 deliveries occurred during on-call physicians' shift-change, and 27,706 deliveries occurred during the rest of the day. Induction\augmentation of labor and epidural analgesia were less likely to happen during on-call physicians' shift change (34.4% vs. 38%, P < 0.0001, 59.6% vs. 61.8%, P = 0.003, respectively) (Table 3). The two groups had similar obstetrical outcomes, without statistical difference in cesarean delivery rate (10% vs. 9.8%, P = 0.63) (Table 4). Table 1 General and obstetric characteristics of women giving birth during the time of nurses shift change versus during the rest of the day Variable Change of nurses shifts (n = 7826) All other hours of the day (n = 25,035) P value Maternal age, y 30.3 ± 5.1 30.2 ± 5.2 0.09 Gestational age at birth (weeks) 39.7 ± 1.09 39.8 ± 1.10 0.55 Nulliparity 2077 (35%) 7067 (37%) 0.01 Induction\augmentation of labor 2905 (37) 9368 (38) 0.62 Epidural analgesia 4746 (61) 15,396 (62) 0.16 Neonatal birth weight, g 3340 ± 422 3330 ± 423 0.06 Data is presented as mean ± S.D or N (%) Table 2 Maternal and neonatal adverse outcomes of women giving birth during the time of nurses shift change versus during the rest of the day Variable (%) Change of nurses shifts (n = 7826) All other hours of the day (n = 25,035) P value Vacuum assisted delivery 615 (7.9) 2002 (8.0) 0.69 Cesarean delivery 788 (10) 2443 (9.8) 0.45 Postpartum hemorrhage 294 (3.8) 1089 (4.4) 0.045 Third- and fourth-degree perineal laceration 106 (1.4) 372 (1.5%) 0.51 5-min Apgar score < 7 39 (0.5) 139 (0.6) 0.65 Umbilical pH < 7.2 170 (23) 580 (23) 0.96 Prolonged second stage 190 (2.5) 559 (2.2) 0.22 Maternal and fetal composite adverse outcome* 1309 (16.7%) 4219 (16.9%) 1.00 Data is presented as N (%) *Maternal and fetal composite adverse outcome was defined as the presence of any of the following: vacuum delivery, CD, prolonged second stage, postpartum hemorrhage, third and fourth degree perineal laceration, 5-min Apgar score < 7 and umbilical cord pH < 7.2 Table 3 General and obstetric characteristics of women giving birth during the time of the on-call physicians shift change versus during the rest of the day Variable Change of physicians shifts (n = 5155) All other hours of the day (n = 27,706) P value Maternal age, years 30.3 ± 5.1 30.2 ± 5.2 0.38 Gestational age at birth (weeks) 39.8 ± 1.09 39.8 ± 1.10 0.95 Nulliparity (%) 1303 (33.4) 7841 (37) < 0.0001 Induction\augmentation of labor (%) 1769 (34.3) 10,504 (38) < 0.0001 Epidural analgesia (%) 3067 (59.6) 17,075 (61.8) 0.003 Neonatal birth weight (gr) 3345 ± 416 3330 ± 424 0.019 Data is presented as mean ± S.D or N (%) Table 4 Maternal and neonatal adverse outcomes of women giving birth during the time of physicians on-call shift change versus during the rest of the day Variable (%) Change of physicians shifts (n = 5155) All other hours of the day (n = 27,706) P value Vacuum assisted delivery 397 (7.7) 2220 (8.0) 0.45 Cesarean delivery 517 (10.0) 2714 (9.8) 0.63 Postpartum hemorrhage 209 (4.1) 1174 (4.3) 0.54 Third- and fourth-degree perineal laceration 67 (1.3) 411 (1.5) 0.31 5-min Apgar score < 7 22 (0.5) 156 (0.6) 0.30 Umbilical pH < 7.2 94 (20.3) 656 (23.3) 0.15 Prolonged second stage 127 (2.5%) 622 (2.3%) 0.36 Maternal and fetal composite adverse outcome* 852 (16.5%) 4676 (16.9%) 1.00 Data is presented as N (%) *Maternal and fetal composite adverse outcome was defined as the presence of any of the following: vacuum delivery, CD, prolonged second stage, postpartum hemorrhage, third and fourth degree perineal laceration, 5-min Apgar score < 7 and umbilical cord pH < 7.2 CONCLUSION: Nurses' shift change and on-call physicians' shift change does not appear to be associated with an increase in adverse maternal or neonatal outcomes.
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Association Between Time of Day and the Decision for an Intrapartum Cesarean Delivery. Obstet Gynecol 2020; 135:535-541. [PMID: 32028489 DOI: 10.1097/aog.0000000000003707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether the decision and indications for performing intrapartum cesarean delivery vary by time of day. METHODS We conducted a secondary analysis of a multicenter observational cohort of 115,502 deliveries (2008-2011), including nulliparous women with term, singleton, nonanomalous live gestations in vertex presentation who were attempting labor. Those who attempted home birth, or underwent cesarean delivery scheduled or decided less than 30 minutes after admission were excluded. Time of day was defined as cesarean delivery decision time among those who delivered by cesarean and delivery time among those who delivered vaginally, categorized by each hour of a 24-hour day. Primary outcomes were decision to perform cesarean delivery and the indications for cesarean delivery (labor dystocia, nonreassuring fetal status, or other indications). Secondary outcomes included whether a dystocia indication adhered to standards promoted to reduce cesarean delivery rates. Bivariate analyses were performed using χ and Kruskal-Wallis tests for categorical and continuous outcomes, respectively, and generalized additive models with smoothing splines explored nonlinear associations without adjustment for other factors. RESULTS Seven thousand nine hundred fifty-six (22.1%) of 36,014 eligible women underwent cesarean delivery. Decision for cesarean delivery (P<.001) decreased from midnight (21.2%) to morning, reaching a nadir at 10:00 (17.9%) and subsequently rising to peak at 21:00 (26.2%). The frequency of cesarean delivery for dystocia also was significantly associated with time of day (P<.001) in a pattern mirroring overall cesarean delivery. Among cesarean deliveries for dystocia (n=5,274), decision for cesarean delivery at less than 5 cm dilation (P<.001), median duration from 5 cm dilation to cesarean delivery decision (P=.003), and median duration from complete dilation to cesarean delivery decision (P=.014) all significantly differed with time of day. The frequency of nonreassuring fetal status and "other" indications were not significantly associated with time of day (P>.05). CONCLUSION Among nulliparous women who were attempting labor at term, the decision to perform cesarean delivery, particularly for dystocia, varied with time of day. Some of these differences correlate with labor management differences, given the changing frequency of latent phase cesarean delivery and median time in active phase.
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Dogra Y, Suri V, Aggarwal N, Dogra RK. Induction of labor with oxytocin in pregnancy with low-risk heart disease: A randomized controlled trial. Turk J Obstet Gynecol 2019; 16:213-218. [PMID: 32231850 PMCID: PMC7090258 DOI: 10.4274/tjod.galenos.2019.59932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/05/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare maternal and perinatal outcomes in pregnant women with underlying heart disease who underwent induction of labor with those who had spontaneous labor. MATERIALS AND METHODS A total of 50 pregnant women with heart disease who were registered in cardio-obstetric clinic were recruited consecutively between 38-41 weeks' gestation. Patients with favorable Bishop scores at 38 weeks were randomized into two groups. Induction of labor with oxytocin was performed in one group, and the second group underwent spontaneous onset of labor. Descriptive analysis in terms of mean, standard deviation, and percentage was performed. Unpaired t-test was applied for comparison of two groups using SPPS statistical software. RESULTS No significant difference in the rate of maternal complications was observed between the two groups. No cardiac complications were reported in pregnant females who underwent induction of labor. Fifty-two percent of patients delivered during workday hours when labor was induced, whereas only 24% of pregnant women delivered during working hours who underwent spontaneous delivery. No maternal or neonatal deaths were reported. CONCLUSION Induction of labor with oxytocin is a relatively safe procedure in women with heart disease, it does not result in any cardiac complications. More patients delivered during daytime when electively induced, which minimized the maternal and fetal risks because obstetric, anesthesiologist, cardiologist, and perinatologist specialists are readily available during the daytime.
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Affiliation(s)
- Yogita Dogra
- All India Institute of Medical Sciences, Clinic of Obstetrics and Gynecology, New Delhi, India
| | - Vanita Suri
- Postgraduate Institute of Medical Training and Research, Clinic of Obstetrics and Gynecology, Chandigarh, India
| | - Neelam Aggarwal
- Postgraduate Institute of Medical Training and Research, Clinic of Obstetrics and Gynecology, Chandigarh, India
| | - Ravi Kant Dogra
- Indira Gandhi Medical College, Department of Anesthesiology, Shimla, India
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Liu LY, Miller ES, Yee LM. Association between time of day and performance, indications, and outcomes of obstetric interventions among nulliparous women delivering at term. J Perinatol 2019; 39:808-813. [PMID: 30911083 DOI: 10.1038/s41372-019-0353-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/04/2019] [Accepted: 02/20/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study is to determine whether there is an association between delivery time and obstetric interventions, as well as maternal and perinatal outcomes. STUDY DESIGN Retrospective cohort study of nulliparous women delivering singleton, vertex, live births at ≥37 weeks gestation at a single center from 2014 to 2015. Nighttime deliveries were designated as those occurring between 18:00 and 05:59 h. The primary outcomes were obstetrical interventions (cesarean delivery, operative vaginal delivery, episiotomy). Secondary outcomes included indications for operative deliveries, as well as maternal and perinatal outcomes. RESULTS Of 7691 women eligible for inclusion, 3707 (48.2%) delivered during the nighttime. Women who experienced nighttime deliveries had no demographic or clinical differences compared with women delivering during the daytime. Women delivering during the nighttime had greater odds of cesarean delivery (OR 1.27, 95% CI 1.14-1.43) and operative vaginal delivery (OR 1.83, 95% CI 1.20-2.78). Women who delivered at night were also more likely to have neonates with a 5 min Apgar score <7 (OR 1.59, 95% CI 1.08-2.32) and umbilical artery pH < 7.0 (OR 1.76, 95% CI 1.18-2.63). There were no differences observed in any of the other outcomes examined. CONCLUSIONS Delivery during the nighttime is associated with alterations in some obstetric interventions and perinatal outcomes.
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Affiliation(s)
- Lilly Y Liu
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Frank-Wolf M, Tovbin J, Wiener Y, Neeman O, Kurzweil Y, Maymon R. Is there a correlation between time of delivery and newborn cord pH? J Matern Fetal Neonatal Med 2016; 30:1637-1640. [DOI: 10.1080/14767058.2016.1220526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Maya Frank-Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel,
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel,
| | - Josef Tovbin
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, and
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yifat Wiener
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, and
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ortal Neeman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, and
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yaffa Kurzweil
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, and
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, and
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Brookfield KF, O’Malley K, El-Sayed YY, Blumenfeld YJ, Butwick AJ. Does Time of Delivery Influence the Risk of Neonatal Morbidity? Am J Perinatol 2016; 33:502-9. [PMID: 26595143 PMCID: PMC4821785 DOI: 10.1055/s-0035-1567891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine whether time of delivery influences the risk of neonatal morbidity among women with singleton pregnancies. STUDY DESIGN Secondary analysis of data from the Maternal Fetal Medicine Units Network Factor V Leiden Mutation study. We categorized time of delivery as day (07:00-16:59), evening (17:00-23:59), and overnight (midnight-06:59). Severe neonatal morbidity was defined by at least one of the following: respiratory distress syndrome, transient tachypnea of the newborn, sepsis, seizures, neonatal intensive care admission, or a 5-minute APGAR ≤3. We calculated frequencies of severe neonatal morbidity by time of delivery. Multivariate analysis was performed to determine whether time of delivery was independently associated with severe neonatal morbidity. RESULTS Among 4,087 women, 1,917 (46.9%) delivered during the day, 1,140 (27.9%) delivered in the evening, and 1,030 (25.2%) delivered overnight. We observed no significant differences in the rates of neonatal morbidity between delivery time periods (day: 12.3%; evening: 12.8%; overnight: 12.6%; p = 0.9). No significant association was observed between time of delivery and neonatal morbidity after adjustment for maternal, obstetric, and peripartum factors. CONCLUSION Our findings suggest that time of delivery is not associated with severe neonatal morbidity.
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Affiliation(s)
- Kathleen F. Brookfield
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Katharine O’Malley
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Yasser Y. El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Yair J. Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Alexander J. Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Knight HE, van der Meulen JH, Gurol-Urganci I, Smith GC, Kiran A, Thornton S, Richmond D, Cameron A, Cromwell DA. Birth "Out-of-Hours": An Evaluation of Obstetric Practice and Outcome According to the Presence of Senior Obstetricians on the Labour Ward. PLoS Med 2016; 13:e1002000. [PMID: 27093698 PMCID: PMC4836717 DOI: 10.1371/journal.pmed.1002000] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Concerns have been raised that a lack of senior obstetricians ("consultants") on the labour ward outside normal hours may lead to worse outcomes among babies born during periods of reduced cover. METHODS AND FINDINGS We carried out a multicentre cohort study using data from 19 obstetric units in the United Kingdom between 1 April 2012 and 31 March 2013 to examine whether rates of obstetric intervention and outcome change "out-of-hours," i.e., when consultants are not providing dedicated, on-site labour ward cover. At the 19 hospitals, obstetric rotas ranged from 51 to 106 h of on-site labour ward cover per week. There were 87,501 singleton live births during the year, and 55.8% occurred out-of-hours. Women who delivered out-of-hours had slightly lower rates of intrapartum caesarean section (CS) (12.7% versus 13.4%, adjusted odds ratio [OR] 0.94; 95% confidence interval [CI] 0.90 to 0.98) and instrumental delivery (15.6% versus 17.0%, adj. OR 0.92; 95% CI 0.89 to 0.96) than women who delivered at times of on-site labour ward cover. There was some evidence that the severe perineal tear rate was reduced in out-of-hours vaginal deliveries (3.3% versus 3.6%, adj. OR 0.92; 95% CI 0.85 to 1.00). There was no evidence of a statistically significant difference between out-of-hours and "in-hours" deliveries in the rate of babies with a low Apgar score at 5 min (1.33% versus 1.25%, adjusted OR 1.07; 95% CI 0.95 to 1.21) or low cord pH (0.94% versus 0.82%; adjusted OR 1.12; 95% CI 0.96 to 1.31). Key study limitations include the potential for bias by indication, the reliance upon an organisational measure of consultant presence, and a non-random sample of maternity units. CONCLUSIONS There was no difference in the rate of maternal and neonatal morbidity according to the presence of consultants on the labour ward, with the possible exception of a reduced rate of severe perineal tears in out-of-hours vaginal deliveries. Fewer women had operative deliveries out-of-hours. Taken together, the available evidence provides some reassurance that the current organisation of maternity care in the UK allows for good planning and risk management. However there is a need for more robust evidence on the quality of care afforded by different models of labour ward staffing.
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Affiliation(s)
- Hannah E. Knight
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Lindsay Stewart Centre for Audit and Clinical Informatics, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- * E-mail:
| | - Jan H. van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ipek Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gordon C. Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom
| | - Amit Kiran
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Steve Thornton
- Department of Obstetrics and Gynaecology, University of Exeter Medical School, Exeter, United Kingdom
| | - David Richmond
- Lindsay Stewart Centre for Audit and Clinical Informatics, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Alan Cameron
- Lindsay Stewart Centre for Audit and Clinical Informatics, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - David A. Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Are there modifiable risk factors that may predict the occurrence of brachial plexus injury? J Perinatol 2015; 35:349-52. [PMID: 25429385 DOI: 10.1038/jp.2014.215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify risk factors, particularly modifiable, associated with brachial plexus injury. STUDY DESIGN A retrospective case-control study conducted at a single hospital between the years 1993 and 2012. All neonates who were diagnosed of brachial plexus injury were included. A control group matched at a ratio of 1:2 was randomly selected. Demographic and obstetric data were obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. All medical files were manually checked and validated. A stepwise logistic regression model was performed to identify independent predictors for brachial plexus injury before delivery among those found significant in the univariate analysis. RESULTS Of all 83 806 deliveries that took place during this period, 144 cases of brachial plexus injury were identified (1.7/1000 deliveries). Overall, 142 cases and 286 controls had available data. Among the study group, 41 (28.9%) had documented shoulder dystocia compared with 1 (0.4%) among the controls (P<0.0001). Logistic regression analysis revealed that maternal age above 35 years (P=0.01; odds ratio (OR) 2.7; 95% confidence interval (CI) 1.3 to 5.7), estimated fetal weight before delivery (P<0.0001; OR 2.5; 95% CI 1.7 to 3.8, for each 500 g increase), vaginal birth after cesarean (P=0.02; OR 3.3; 95% CI 1.2 to 8.8) and vacuum extraction (P=0.02; OR 3.6; 95% CI 1.2 to 10.3) were all found to be independent predictors for developing brachial plexus injury. When stratifying the analysis according to parity, vacuum delivery was found to be an independent risk factor only among primiparous women (OR 6.0; 95% CI 1.7 to 21.6). CONCLUSIONS The findings suggest that very few factors contributing to brachial plexus injury are modifiable. For that reason, it remains an unpredictable and probably an unavoidable event.
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Miller H, Goetzl L, Wing DA, Powers B, Rugarn O. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts. J Matern Fetal Neonatal Med 2015; 29:517-22. [PMID: 25758619 PMCID: PMC4776722 DOI: 10.3109/14767058.2015.1011117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts. METHODS Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment. RESULTS Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively. CONCLUSIONS When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used.
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Affiliation(s)
- Hugh Miller
- a Watching Over Mothers & Babies Foundation , Tucson , AZ , USA
| | - Laura Goetzl
- b Department of Obstetrics, Gynecology and Reproductive Sciences , Temple University , Philadelphia , PA , USA
| | - Deborah A Wing
- c Department of Obstetrics and Gynecology , University of California , Irvine, Orange , CA , USA .,d Miller Children's and Women's Hospital , Long Beach , CA , USA
| | - Barbara Powers
- e Independent Consultant , Phoenixville , PA , USA , and
| | - Olof Rugarn
- f Ferring Pharmaceuticals , Copenhagen , Denmark
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Butler K, Ramphul M, Dunney C, Farren M, McSweeney A, McNamara K, Murphy DJ. A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night. BMJ Open 2014; 4:e006291. [PMID: 25354825 PMCID: PMC4216855 DOI: 10.1136/bmjopen-2014-006291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Katherine Butler
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Meenakshi Ramphul
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Clare Dunney
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Maria Farren
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Aoife McSweeney
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Karen McNamara
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Deirdre J Murphy
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
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Gijsen R, Hukkelhoven CWPM, Schipper CMA, Ogbu UC, de Bruin-Kooistra M, Westert GP. Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study. BMC Pregnancy Childbirth 2012; 12:92. [PMID: 22958736 PMCID: PMC3496693 DOI: 10.1186/1471-2393-12-92] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 08/23/2012] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Ronald Gijsen
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment, PO Box 1, Bilthoven, BA, 3720, The Netherlands.
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