Increased adverse perinatal outcome of hospital delivery at night

Abstract

Objective To determine whether delivery in the evening or at night and some organisational features of maternity units are related to perinatal adverse outcome.Design A 7-year national registry-based cohort study.Setting All 99 Dutch hospitals.Population From nontertiary hospitals (n = 88), 655 961 singleton deliveries from 32 gestational weeks onwards, and, from tertiary centres (n = 10), 108 445 singleton deliveries from 22 gestational weeks onwards.Methods Multiple logistic regression analysis of national perinatal registration data over the period 2000-2006. In addition, multilevel analysis was applied to investigate whether the effects of time of delivery and other variables systematically vary across different hospitals.Main outcome measures Delivery-related perinatal mortality (intrapartum or early neonatal mortality) and combined delivery-related perinatal adverse outcome (any of the following: intrapartum or early neonatal mortality, 5-minute Apgar score below 7, or admission to neonatal intensive care).Results After case mix adjustment, relative to daytime, increased perinatal mortality was found in nontertiary hospitals during the evening (OR, 1.32; 95% CI, 1.15-1.52) and at night (OR, 1.47; 95% CI, 1.28-1.69) and, in tertiary centres, at night only (OR, 1.20; 95% CI, 1.06-1.37). Similar significant effects were observed using the combined perinatal adverse outcome measure. Multilevel analysis was unsuccessful; extending the initial analysis with nominal hospital effects and hospital-delivery time interaction effects confirmed the significant effect of night in nontertiary hospitals, whereas other organisational effects (nontertiary, tertiary) were taken up by the hospital terms.Conclusion Hospital deliveries at night are associated with increased perinatal mortality and adverse perinatal outcome. The time of delivery and other organisational features representing experience (seniority of staff, volume) explain hospital-to-hospital variation.Keywords Adverse perinatal outcome, early neonatal mortality, intrapartum mortality, organisation of maternity units, seniority of staff, timing of hospital delivery, volume of deliveries.

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.…”

Adverse outcomes of (post-)term births and differences in professional organisational contexts: an integral descriptive system approach

“…In this respect, our study design distinguishes itself from many other studies in this area. [5][6][7][8][9][10] Yet there are more relevant differences. The design of the model is based on the most relevant organisational characteristics of the obstetric care system.…”

“…[5][6][7][8][9][10] In our approach the individual professional organisational contexts are categorised in such a way that they reflect the organisational structure of the national obstetric care system. Useful features for this are: the supervision of labour (first-line midwife and/or second or third line obstetrician), the location of birth and the part of the day in which the second stage of labour begins.…”

“…13 14 A responsible comparison of context-categories If the objective is to gain insight into the performance of a professional organisational context-category, the conventional method is to compare the (adverse) outcomes of births in the related patient group (transversal) with those in a reference category. [5][6][7][8][9][10] To complicate matters, the relative incidence of adverse outcomes in a context related patient group is not only affected by contextual factors, but also by patient-related factors (figure 2).…”

“…[5][6][7][8][9][10] What almost all of these comparative studies have in common is that they take only part of the obstetric care system into consideration, have a transversal design, and are based on the data of a rather large number of mostly older calendar years. This poses the question: Is the design of these studies sufficiently consistent with the complexity and the dynamics that characterise each (obstetrical) care system?…”