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

Reif, P; Pichler, Gerhard; Griesbacher, Antonia; Lehner, G; Schöll, Wolfgang; Lang, Uwe; Hofmann, H; Dirnagl, Ulrich

doi:10.1111/1471-0528.15000

Cited by 20 publications

(13 citation statements)

References 41 publications

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“…These ndings are somewhat similar to those of Reif et al, who apparently found an inverse correlation between staff seniority and neonatal adverse events with more adverse outcomes with increasing seniority; in this work senior staff were more likely to be involved in the management of high -risk births ab initio or in initially uneventful labours that needed further assistance (18).…”

Section: Discussionsupporting

confidence: 89%

Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Amadori

GRANDIOSO

Osella

et al. 2020

Preprint

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Background: the aim of this study was to identify prepartum, intrapartum and organisational risk factors for foetal asphyxia. We focused on modifiable factors such as organisational factors, maternal Body Mass Index, Assisted Reproductive Technology pregnancies, smoking and number of clinical checks.Methods: This is a retrospective analytical observational study.It was carried out in a teaching hospital in Northern Italy. The data for this study was obtained from maternal and neonatal medical records,obstetric and neonatal hospital discharge summaries and birth assistance certificates.162 cases of mothers whose children experienced foetal asphyxia were compared to 162 controls where this condition did not occur. The different variables were analysed using the Fisher test, the Mann Whitney U test and logistic regression. The association probability was estimated by the odds ratio with a confidence interval of 95%. The alpha level of 0,05 was considered significant.Results: giving birth at night (p<0.001), lack of one to one assistance during labour (p <0.001), birth on a day of high volume activity(p<0.001), Assisted Reproductive Technology obtained pregnancies (p<0.001), number of clinical checks during pregnancy (p <0.001 ), smoking during pregnancy (p<0.001), high maternal body mass index (p<0.001 ), as well as other traditionally associated risk factors like shoulder distocia (p<0.001) or age>35 (p <0.001) all increased the risk in a statistically significant way.Conclusions: giving birth on a high activity day, at night or without one-to one care are organisational factors that statistically increase the risk of foetal asphxia.Our paper proposes strategies to try and modify these risk factors and therefore limit the incidence of foetal asphyxia and of its life changing consequences like cerebral palsy.

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Section: Discussionsupporting

confidence: 89%

Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Amadori

GRANDIOSO

Osella

et al. 2020

Preprint

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“…We considered whether improving patterns of service provision might provide an alternative strategy to reduce adverse perinatal outcomes in LM-HDI settings. Studies have shown that risk of adverse perinatal outcomes is associated with service provision factors such as obstetric staff working patterns [6,7]. This has only, however, been studied extensively in well-resourced countries and so there is a need to investigate the modifiable patterns of service provision in low and medium human development index obstetric settings.…”

Section: Introductionmentioning

confidence: 99%

Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

Hughes

Namagembe

Nakimuli

et al. 2020

BMC Pregnancy Childbirth

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Background: In many low and medium human development index countries, the rate of maternal and neonatal morbidity and mortality is high. One factor which may influence this is the decision-to-delivery interval of emergency cesarean section. We aimed to investigate the maternal risk factors, indications and decision-to-delivery interval of emergency cesarean section in a large, under-resourced obstetric setting in Uganda. Methods: Records of 344 singleton pregnancies delivered at ≥24 weeks throughout June 2017 at Mulago National Referral Hospital were analysed using Cox proportional hazards models and multivariate logistic regression models. Results: An emergency cesarean section was performed every 104 min and the median decision-to-delivery interval was 5.5 h. Longer interval was associated with preeclampsia and premature rupture of membranes/oligohydramnios. Fetal distress was associated with a shorter interval (p < 0.001). There was no association between decision-to-delivery interval and adverse perinatal outcomes (p > 0.05). Mothers waited on average 6 h longer for deliveries between 00:00-08:00 compared to those between 12:00-20:00 (p < 0.01). The risk of perinatal death was higher in neonates where the decision to deliver was made between 20:00-02:00 compared to 08:00-12:00 (p < 0.01). Conclusion: In this setting, the average decision-to-delivery interval is longer than targets adopted in high development index countries. Decision-to-delivery interval varies diurnally, with decisions and deliveries made at night carrying a higher risk of adverse perinatal outcomes. This suggests a need for targeting the improvement of service provision overnight.

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“…87 000 Geburten aus den Jahren 2004 bis 2015 umfasste. In diesem Geburtenkollektiv war die Wahrscheinlichkeit für ungünstige postnatale Ereignisse nachts, unabhängig vom Wochentag, um 35 % erhöht [20].…”

Section: Diskussionunclassified

Gibt es einen negativen Nacht- oder Wochenendeffekt auf den kindlichen postnatalen Zustand bei Frauen mit Migrationshintergrund?

David

Henrich

Schlembach

et al. 2019

Z Geburtshilfe Neonatol

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Zusammenfassung Fragestellung Ist bei Frauen mit Migrationshintergrund (MH) (=Proxy-Variable für erhöhtes Risiko kultureller/sprachlicher Kommunikationsprobleme) die neonatale Morbidität außerhalb der Regelarbeitszeit erhöht? Methoden Datenerhebung an 3 Berliner Geburtskliniken mit Fragebogenset (soziodemografische, Versorgungsaspekten, Migration); Ergänzung durch Mutterpassangaben und Klinik-Perinataldaten. Surrogatmarker für kindliche Morbidität: Apgar-, Nabelschnur-pH-Wert, Verlegung in eine Kinderklinik. Deskriptive und logistische Regressions-Analysen wurden durchgeführt. Ergebnisse Datensätze von 2014 Migrantinnen der 1., 771 Frauen der 2. Generation, 2564 Frauen ohne MH wurden einbezogen, darunter 39,7% sog. Tagesgeburten (Montag – Freitag, jeweils 7:00–18:00 Uhr). In 2 Modellen wurde für die beiden Proxy-Parameter der kindlichen Morbidität der Einfluss der Geburtszeit und verschiedener anderer Parameter überprüft. Die Chancen für ungünstige Apgar- oder Nabelschnur-pH-Werte waren z. B. bei einer Geburt in den Abend- und Nachtstunden, am Wochenende und an Feiertagen (OR 1,84; 95% CI 1,23–2,76; p=0,003), bei vaginal-operativen Geburten (OR 3,36; 95% CI 2,07–5,46, p<0,001) oder einer sekundären Sectio (OR 1,94; 95 CI 1,28–2,96, p=0,002) erhöht, nicht aber bei einem MH der Gebärenden. Zusammenfassung Gebärende mit MH werden trotz möglicher interkultureller und sprachlicher Kommunikationsprobleme unabhängig von Tageszeit und Wochentag ebenso gut versorgt wie Schwangere ohne MH.

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

Abstract: Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.

Cited by 20 publications

References 41 publications

Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

Gibt es einen negativen Nacht- oder Wochenendeffekt auf den kindlichen postnatalen Zustand bei Frauen mit Migrationshintergrund?

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

Abstract: Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.

Cited by 20 publications

References 41 publications

Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

Gibt es einen negativen Nacht- oder Wochenendeffekt auf den kindlichen postnatalen Zustand bei Frauen mit Migrationshintergrund?

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