Foetal Morbidity Depending on the Day and Time of Delivery

Abstract

Introduction It is known that perinatal mortality is increased with births at night and at the weekend. The aim of the study was to investigate whether there is also an association between the time of delivery (weekday, night, weekend) and perinatal morbidity. Material and Methods All births at Hannover Medical College between 2000 and 2014 were included in a retrospective data analysis. Multiple births, primary sections, severe foetal malformations and intrauterine deaths were not included. A 5-minute Apgar score ≤ 5 and cord arterial pH < 7.10 were defined as perinatal morbidity. Besides the time of delivery, different variables that are regarded as risk factors for increased perinatal morbidity were studied. Univariate logistical regression analysis was performed, followed by multivariate analysis. Results 18 394 deliveries were included in the study. Pathological prepartum Doppler, medical induction of labour and delivery at night and/or at the weekend significantly increased the probability of an Apgar score ≤ 5 after 5 minutes. The probability that a child will have cord arterial pH < 7.1 post partum is significantly increased with a BMI > 25 before pregnancy, primiparity, medical induction of labour, peripartum administration of oxytocic agents, when the delivery took place at night and weekend combined, but also when the delivery took place at night or at the weekend/on a public holiday. Multivariate regression analysis showed that a time of delivery at night and/or at the weekend or on a public holiday is not a prognostic factor for a 5-minute Apgar score ≤ 5 (p = 0.2377) but is a prognostic factor for cord arterial pH < 7.1 (p = 0.0252). Conclusion The time of delivery at night or at the weekend/on a public holiday increases the risk for cord arterial pH < 7.1 by ~ 30% compared with delivery on a weekday. However, the time of delivery at night or at the weekend/on a public holiday does not increase the risk for the baby of having a 5-minute Apgar score ≤ 5.

Weekend delivery and maternal–neonatal adverse outcomes in low‐risk pregnancies in the United States: A population‐based analysis of 3‐million live births

“…Among studies that employed the same or similar outcomes, the of this study contradict some previous studies conducted in European countries which found no significant association between weekend delivery and adverse outcomes. 4,10,11,13,32 An important factor that may explain the discrepancy between the current findings and previous research is the differences in the health care system, such as practice guidelines, access to hospitals and insurance coverage. For example, having adequate ANC was significantly associated with delivering during the weekdays (x = 373.21, P < .001) and was protective against having any neonatal adverse outcomes (OR 0.88; 95% CI 0.87-0.89).…”

“…In addition, although Palmer et al 7 and Gijsen et al 11 tried to take multiple confounders into account by adjusting for 19 risk factors, most of the previous literature [4][5][6]8,9,12,13,16 was limited to adjusting for fewer than 10 confounders that only included socio-demographics and basic characteristics of the delivery. However, birth outcomes are the result of dynamic processes that involve both maternal and neonatal factors that have accumulated over pregnancy through to the time of birth.…”

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

“…30 % erhöhten Risiko für einen Nabelschnurarterien-pH-Wert < 7,10 verbunden ist. Allerdings wirkte sich die Geburtszeit des Neugeborenen in diesem Kollektiv nicht auf das Risiko eines niedrigen 5 min.-Apgar-Wertes aus [7]. Im Widerspruch dazu stehen die Ergebnisse einer retrospektiven Auswertung von ca.…”

“…Sie kamen zu dem Ergebnis, dass eine Geburt nachts, am Wochenende oder an einem Feiertag das Risiko für einen kindlichen Nabelschnurarterien-pH-Wert unter 7,1 um ca. 30 % im Vergleich zu einer Geburt an einem Werktag erhöht, wobei die Autoren die klinische Relevanz dieses Studienresultats wegen der Seltenheit eines so niedrigen pH-Werts und einer nur in wenigen Fällen damit verbundenen erhöhten perinatalen Morbidität als gering bezeichneten [7].…”

“…In der von von Ehr et al (2018) publizierten Arbeit spielte die Einbeziehung soziodemografischer Faktoren kaum eine Rolle, weil die Autoren retrospektiv auf die routinemäßig erhobenen Daten der Perinatalerhebung zurückgegriffen haben [7]. Diese sind im Hinblick auf soziodemografische Angaben lückenhaft und ungenau und enthalten z.…”