A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night

Abstract

ObjectiveTo evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night.DesignProspective cohort study.SettingUrban maternity unit in Ireland with off-site consultant staff at night.PopulationAll nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013.MethodsDelivery outcomes were compared for women who delivered by day (08:00–19:59) or at night (20:00–07:59).Main outcome measuresThe 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.ResultsOf 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.ConclusionsThere was no evidence of an association between time of OVD and adverse perinatal outcomes despite off-site consultant obstetric support at night.

Do Time of Birth, Unit Volume and Staff Seniority Affect Neonatal Outcome in Deliveries at ≥34+0 Weeks of Gestation?

“…In contrast to reports that found no impact of the level of experience, 4,[38][39][40][41] or to de Graaf et al, 2 who found an inverse correlation of staff seniority and neonatal adverse events, we found more adverse outcomes with increasing seniority of the attending obstetricians in the initial modelling data. More senior staff attending and increased adverse neonatal outcome seems contradictory, when assuming an association of a high level of seniority and education with good obstetric outcome; however, there might be several explanations for the present findings.…”

Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

“…In contrast to reports that found no impact of the level of experience, or to de Graaf et al, who found an inverse correlation of staff seniority and neonatal adverse events, we found more adverse outcomes with increasing seniority of the attending obstetricians in the initial modelling data. More senior staff attending and increased adverse neonatal outcome seems contradictory, when assuming an association of a high level of seniority and education with good obstetric outcome; however, there might be several explanations for the present findings.…”

Is time of birth a predictor of adverse perinatal outcome? A hospital-based cross-sectional study in a low-resource setting, Tanzania

“…Other studies associated intrapartum fetal death [13], and admission to neonatal intensive care unit (NICU) [9], with births occurring during weekends. Conversely, other authors did not find any difference in the risk of poor perinatal outcome during off-hours [16–18]. This evidence of high risk of adverse outcomes during off-hours has led to a general questioning of the quality of care and availability of access to skilled care providers, organization of work and availability of equipment, and supplies during off-hours.…”