The relation of obstetrical volume and nursery level to perinatal mortality.

Mayfield, J A; Rosenblatt, Roger A.; Baldwin, Laura‐Mae; Chu, Julie; LoGerfo, James P.

doi:10.2105/ajph.80.7.819

Cited by 85 publications

(27 citation statements)

References 20 publications

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“…Public and mixed hospitals showed a greater supply of facilities with medium and high obstetric volume in the year 2007, where the highercomplexity hospitals were concentrated, which agrees with the tendency whereby a higher number of deliveries justifies expenditures on maintenance of equipment and staff that are trained in the use of sophisticated medical technology for managing emergency situations 23,29 . However, there were numerous public and mixed hospitals that performed more than a thousand deliveries in 2007 and that did not have an ICU.…”

Section: S8supporting

confidence: 62%

Estrutura das maternidades: aspectos relevantes para a qualidade da atenção ao parto e nascimento

et al. 2014

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Section: S8supporting

confidence: 62%

Estrutura das maternidades: aspectos relevantes para a qualidade da atenção ao parto e nascimento

et al. 2014

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“…44,45 Closure of small rural hospitals has undoubtedly a negative effect on communities. 4,11,46 It denies women the opportunity to give birth close to where they live, and this may not be cost effective. Travelling out to large centres to give birth may in fact constitute a greater risk for women and their families than the delays incurred if there is a need to transfer.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] However, there is no consensus on the safest place for women to give birth to normal birthweight infants following an uneventful pregnancy. [8][9][10][11][12][13] It is unknown whether the actual gains match the expected gains of concentrating all low risk births in large tertiary hospitals. 14 The aim of this study was to determine the association between a low volume of hospital births per annum and adverse birth outcome.…”

Section: Introductionmentioning

confidence: 99%

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

Tracy

Sullivan

Dahlen

et al. 2005

BJOG

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Objective To study the association between volume of hospital births per annum and birth outcome for low risk women.Design Population‐based study using the National Perinatal Data Collection (NPDC).Setting Australia.Participants Of 750,491 women who gave birth during 1999–2001, there were 331,147 (47.14%) medically ‘low risk’ including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae.Methods The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point.Main outcome measures Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100–500, 501–1000, 1001–2000 and >2001 births per annum.Results Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14–0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54–0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28–0.42); instrumental birth (AOR 0.80; 99% CI 0.69–0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49–0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10–0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62–0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29–0.36); instrumental birth (AOR 0.52; 99% CI 0.41–0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33–0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07–0.12).Conclusions In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.

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“…Under ideal circumstances, these infants would be transferred to a perinatal center in utero, as it has been shown that neonatal death rates are reduced when high-risk infants are born in hospitals with Level III NICUs. [6][7][8][9][10][11][12][13] Well-functioning RPS, including adequate distribution of Level III NICUs throughout a given state or region, has been considered to be necessary for optimal survival of highrisk neonates. 11 During the mid-to late 1980s, there was increased recognition that RPS were vulnerable to the complex structural changes of health care.…”

Section: Introductionmentioning

confidence: 99%

Hospital Factors and Nontransfer of Small Babies: A Marker of Deregionalized Perinatal Care?

2004

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OBJECTIVES:Our purpose was to examine the contribution of hospital factors (e.g., reimbursement sources, teaching status) to the rate of nontransfer of <1250 g infants born in nontertiary hospitals in Illinois. We chose nontransfer as a marker of the extent to which there have been structural changes in the regionalized perinatal care system in Illinois. STUDY DESIGN:Using data from live birth certificates (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996), from the American Hospital Association's Annual Survey of Hospitals (1990Hospitals ( to 1996, and Illinois hospital discharge records (1992 to 1996), we simultaneously assessed the effect of hospital and individual factors on nontransfer of infants <1250 g (n ¼ 2904). RESULTS:When adjusted for individual risk factors, several hospital factors were associated with nontransfer. These include birth in a Level II þ hospital (odds ratios(OR) 3.75; 95% CI 2.29, 5.29), high Medicaid revenues (OR 1.97; 95% CI 1.58, 2.47), high HMO revenues (OR 1.39; 95% CI 1.11, 2.28), and status as a teaching hospital (OR 1.63; 95% CI 1.30, 2.09). CONCLUSIONS:This study suggests that there should be careful consideration of the role of hospital factors in perinatal deregionalization in order to preserve the improvements in maternal and infant outcomes associated with regionalized perinatal care.

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The relation of obstetrical volume and nursery level to perinatal mortality.

Cited by 85 publications

References 20 publications

Estrutura das maternidades: aspectos relevantes para a qualidade da atenção ao parto e nascimento

Estrutura das maternidades: aspectos relevantes para a qualidade da atenção ao parto e nascimento

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

Hospital Factors and Nontransfer of Small Babies: A Marker of Deregionalized Perinatal Care?

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