Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study

Abstract

BackgroundStudies 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.MethodsThis 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).ResultsEvening 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.ConclusionThis 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.

Predictors of mortality in nontraumatic subdural hematoma

“…16 Similarly, off hour deliveries were associated with increased perinatal mortality, especially when involving specific emergency delivery procedures. 9 While only a slight delay in the time to craniotomy was noted, our data raise the question of whether patients admitted during the weekend are less likely to be treated with, or have delays in, surgical evacuation as compared with patients admitted during the week. A difference in the timeliness of diagnosis and treatment between weekday and weekend admissions, as well as between the presence or absence of subspecialty staff, might play another role.…”

Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel

“…The concept of an "in-hours" birth was used as a measure of both the duration of induced labor and safety, recognizing the frequently reported association between evening / night-time births and increased adverse perinatal outcomes. 11,12 An "in-hours" birth was defined as a birth occurring between 08:00am and 5:00pm. Uterine hyperstimulation with fetal heart rate changes, was defined as any event of excessive uterine activity (>5 contractions in 10 minutes) 2 where PGE2 vaginal gel was removed from the vagina, or acute tocolysis was administered.…”

Can We Predict Delivery Prior to Date of a Planned Elective Caesarean Section?

“…Although we did not show any difference in maternal morbidity (possibly due to our small sample size), delivery prior to BECS performed as an emergency case may be associated with increased maternal and neonatal morbidity [14]. Particularly after-hours emergency cases, which may be associated with increased risks [6]. Perhaps counselling and advice for some women (eg.…”