Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 211
Filtrar
1.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32409481
3.
Neonatology ; 117(1): 65-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31563910

RESUMO

BACKGROUND: Characteristics of neonatal tracheal intubations (TI) may vary between the neonatal intensive care unit (NICU) and delivery room (DR). The impact of the setting on TI outcomes is not well characterized. OBJECTIVE: The aim of this study was to define variation in neonatal TI practice between settings, and identify the association between setting and TI success and safety outcomes. DESIGN: This was a retrospective cohort study of TIs in the National Emergency Airway Registry for Neonates from October 2014 to September 2017. The setting (NICU vs. DR) was the exposure of interest. The outcomes were first attempt success, course success, success within 4 attempts, adverse TI-associated events, severe desaturation, and bradycardia. We compared TI characteristics and outcomes between settings in univariable analysis. Factors significant in univariable analysis (p < 0.1) were included in a logistic regression model, with adjustment for clustering by center, to identify the independent impact of the setting on TI outcomes. RESULTS: There were 3,145 TI encounters (2279 NICU, 866 DR) in 9 centers. Almost all baseline characteristics significantly varied between settings. First attempt success rates were 48% (NICU) and 46% (DR). In multivariable analysis, the setting was not associated with first attempt success. DR was associated with a higher adjusted OR (aOR) of success within 4 attempts (1.48, 95% CI 1.06-2.08) and a lower aOR for bradycardia (0.43, 95% CI 0.26-0.71). CONCLUSION: Significant differences in patient, provider, and practice characteristics exist between NICU and DR TIs. There is substantial room for improvement in first attempt success rates. These results suggest interventions to improve safety and success need to be targeted to the distinct setting.


Assuntos
Salas de Parto/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Intubação Intratraqueal/métodos , Sistema de Registros , Serviços Médicos de Emergência/tendências , Feminino , Humanos , Recém-Nascido , Intubação Intratraqueal/tendências , Modelos Logísticos , Masculino , Philadelphia , Estudos Retrospectivos , Resultado do Tratamento
4.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
5.
Clin Pediatr (Phila) ; 58(9): 1000-1007, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31122046

RESUMO

Literature has shown hospitalized infants are not often observed in recommended safe sleep environments. Our objective was to implement a quality improvement program to improve compliance with appropriate safe sleep practices in both children's and birthing hospitals. Hospitalists from both settings were recruited to join an Ohio American Academy of Pediatrics collaborative to increase admitted infant safe sleep behaviors. Participants used a standardized tool to audit infants' sleep environments. Each site implemented 3 PDSA (Plan-Do-Study-Act) cycles to improve safe sleep behaviors. A total of 37.0% of infants in children's hospitals were observed to follow the current American Academy of Pediatrics recommendations at baseline; compliance improved to 59.6% at the project's end (P < .01). Compliance at birthing centers was 59.3% and increased to 72.5% (P < .01) at the collaborative's conclusion. This study demonstrates that a quality improvement program in different hospital settings can improve safe sleep practices. Infants in birthing centers were more commonly observed in appropriate sleep environments than infants in children's hospitals.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Cuidado do Lactente/métodos , Segurança do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Sono , Morte Súbita do Lactente/prevenção & controle , Salas de Parto/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Ohio , Estados Unidos
6.
HERD ; 12(2): 30-43, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30280606

RESUMO

OBJECTIVE: To assess the feasibility of quantifying variation in childbirth facility design and explore the implications for childbirth service delivery across the United States. BACKGROUND: Design has been shown to impact quality of care in childbirth. However, most prior studies use qualitative data to examine associations between the design of patient rooms and patient experience. There has been limited exploration of measures of unit design and its impact on care provision. METHOD: We recruited 12 childbirth facilities that were diverse with regard to facility type, location, delivery volume, cesarean delivery rate, and practice model. Each facility provided annotated floor plans and participated in a site visit or telephone interview to provide information on their design and clinical practices. These data were analyzed with self-reported primary cesarean delivery rates to assess associations between design and care delivery. RESULTS: We observed wide variation in childbirth unit design. Deliveries per labor room per year ranged from 75 to 479. The ratio of operating rooms to labor rooms ranged from 1:1 to 1:9. The average distance between labor rooms and workstations ranged from 23 to 114 ft, and the maximum distance between labor rooms ranged from 9 to 242 ft. More deliveries per room, fewer labor rooms per operating room, and longer distances between spaces were all associated with higher primary cesarean delivery rates. CONCLUSIONS: Clinically relevant differences in design can be feasibly measured across diverse childbirth facilities. The design of these facilities may not be optimally matched to service delivery needs.


Assuntos
Salas de Parto/estatística & dados numéricos , Salas de Parto/normas , Parto Obstétrico/estatística & dados numéricos , Planejamento Ambiental/estatística & dados numéricos , Arquitetura Hospitalar/estatística & dados numéricos , Arquitetura Hospitalar/normas , Adulto , Estudos de Viabilidade , Feminino , Humanos , Estados Unidos
7.
PLoS One ; 13(12): e0208252, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30540816

RESUMO

INTRODUCTION: Most infants born before 30 weeks gestational age (GA) develop respiratory distress syndrome soon after birth. Methods of surfactant administration that avoid ventilation have been recently introduced. The aim of this study was to evaluate the impact of implementing a new procedure of less invasive surfactant administration (LISA) and determine whether it is associated with an improvement in respiratory outcome. METHODS: This single center cohort quality improvement study analyzed preterm infants born before 30 weeks GA between May 2010 and April 2016. Changes in health care practices and respiratory outcomes following the implementation of a LISA, i.e. the administration of surfactant through a thin catheter, were analyzed using quality control charts. Then, the effect of LISA on respiratory outcome was assessed by propensity score matching and logistic regression weighted by the inverse of the propensity score. RESULTS: During the study period, 379 infants were included. Of those that were not intubated at ten minutes of life, 129 received surfactant and were ventilated for one hour or more (InVent), 127 received LISA, five received surfactant with tracheal mechanical ventilation for less than one hour (InSurE), and 55 were only treated with nasal continuous positive pressure during the first hour of neonatal care (nCPAP). Quality-chart analysis revealed rapid implementation of the method with a concomitant decrease in required ventilation. LISA was associated with fewer tracheal ventilation days and a lower incidence of supplemental oxygen on day 28. When controlling for the propensity to be exposed or not to LISA, this procedure was not associated with a lower risk of death or bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age. CONCLUSION: In this study, the successful implementation of the new method was associated with lower rates of mechanical ventilation, but without a significant reduction of grade I/II/III BPD or death.


Assuntos
Surfactantes Pulmonares/administração & dosagem , Displasia Broncopulmonar/terapia , Estudos de Coortes , Salas de Parto/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Respiração Artificial/métodos
8.
Gynecol Obstet Fertil Senol ; 46(10-11): 706-712, 2018 11.
Artigo em Francês | MEDLINE | ID: mdl-30318361

RESUMO

OBJECTIVE: Huge differences in cesarean delivery rate exist between maternities in a same region. In recent years, the cesarean delivery rate has increased in the low-risk population. The objective of this study was to assess the impact of organizational factors on the cesarean delivery occurence in a low-risk population. METHODS: We performed a population-based cohort study in the MYPA perinatal network from 2009 to 2015. A low-risk population was selected, keeping only groups 1 and 3 of the Robson classification. The studied organizational factors included the structural characteristics of maternity (academic or not, public or private, number of annual births, maternal intensive care unit, neonatal intensive care unit, number of delivery rooms) and the organization of the health care team (number of midwives and obstetricians, on call duty, workload and implementation of a morbi-mortality review). We used a logistic multilevel model, based on random center effect, for both univariable and multivariable analysis. RESULTS: Our study population included 64,100 women. The cesarean delivery rate ranged from 5.5 to 11.3 % among the 10 maternities. In univariate analysis, the organizational variables significantly associated with the cesarean delivery rate were maternity status (university hospital, non-university public hospital and private hospital) and the implementation of a morbi-mortality review. However, after adjustment, none of these organizational factors were significantly associated with the cesarean delivery occurence. When multivariate analysis was restricted to the nulliparous subgroup, the private status of maternity was significantly associated with a higher rate of cesarean deliveries (OR=1.39 [1.09-1.76]). Also, the probability of cesarean delivery was higher when the number of births by delivery room increased (OR=1.15 [1.01-1.31]). For the multiparous subgroup, no variable was significantly associated with cesarean delivery occurence. CONCLUSION: In our global low-risk population, no organizational factors appeared to be associated with an increase in cesarean delivery rate. On the other hand, in the low-risk nulliparous population, the private status of the maternity and a high number of births by delivery room were associated with more cesarean deliveries. Increasing the number of delivery rooms could be a way to reduce the number of cesarean deliveries. Future researches should also try to identify specific factors that can reduce differences in cesarean delivery rates between private and public maternities.


Assuntos
Cesárea/estatística & dados numéricos , Estudos de Coortes , Salas de Parto/estatística & dados numéricos , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Paridade , Gravidez , Fatores de Risco
9.
Eur J Obstet Gynecol Reprod Biol ; 228: 261-266, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30041147

RESUMO

OBJECTIVE: Illicit drug use in pregnancy may lead to adverse outcomes. Although the American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for substance use by questionnaire or conversation, it remains unclear how well these methods identify women with illicit drug use. Drug use may also be suspected based on clinical complications, such as fetal demise or placental abruption. There are currently no formal recommendations to guide targeted laboratory testing in women perceived to be at risk based on historical or clinical factors. Our objective was to determine which historical and clinical factors are associated with positive urine toxicology screens in women admitted to labor and delivery. STUDY DESIGN: Historical cohort study of all women admitted to labor and delivery at our county hospital over a 5-year period (2010-2014). All patients underwent historical and clinical risk assessment and women perceived to be at increased risk of illicit drug use and who consented to testing had urine toxicology performed. We conducted a detailed chart review on all women with a positive test during this 5-year period and compared them to all women with a negative test in 2014, reporting values significant at a p-value of ≤0.05. RESULTS: Amongst the 19,604 admissions during this period, 850 women underwent urine toxicology testing, accounting for 4.8% of all admissions. We compared the 83 women who tested positive for illicit drugs (9.8% of all women tested) to the 179 women who tested negative in 2014. Historical drug use was the factor most strongly associated with a positive test. Other historical and demographic factors associated with a positive test included single relationship status, lack of employment, lack of high school education, nulliparity and history of a prior sexually-transmitted or blood-borne infection. Regarding clinical risk factors, maternal medical complications were not associated with a positive test, and obstetrical complications, like preterm labor, were associated with a negative test. CONCLUSIONS: A positive urine toxicology test was most strongly associated with maternal historical factors, especially known drug use. No clinical risk factor was associated with a positive test. The implications of our findings in guiding targeted laboratory testing are discussed.


Assuntos
Salas de Parto/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Detecção do Abuso de Substâncias/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem
10.
Arch Pediatr ; 25(6): 383-388, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30041886

RESUMO

OBJECTIVES: Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS: Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS: A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P<0.001). Finally, the neonatal death rate of live-born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P=0.03). CONCLUSIONS: This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation.


Assuntos
Salas de Parto/estatística & dados numéricos , Mortalidade Infantil , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Feminino , França , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Sistema de Registros , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
12.
Tidsskr Nor Laegeforen ; 138(10)2018 06 12.
Artigo em Inglês, No | MEDLINE | ID: mdl-29893109

RESUMO

BAKGRUNN: Fødestuene utgjør en del av en differensiert og desentralisert fødselsomsorg i Norge. Hensikten med studien var å undersøke forekomst og karakteristika ved planlagte og ikke-planlagte fødestuefødsler og årsaker til overflytting samt resultater for mor og barn. MATERIALE OG METODE: I perioden 2008-10 ble et tilleggsskjema til rutinemeldingen til Medisinsk fødselsregister fortløpende utfylt av jordmor for 2 514 av i alt 2 556 (98,4 %) fødestuefødsler og for 220 fødsler som var planlagt i fødestue, men der fødselen foregikk andre steder. Data fra tilleggsskjema ble så koblet med rutinedata i Medisinsk fødselsregister og resultater fra fødestuefødsler sammenlignet med resultater fra en lavrisikofødepopulasjon i sykehus. RESULTATER: Av de 2 514 fødestuefødslene var 2 320 (92,3 %) planlagt å foregå der, mens 194 (7,7 %) ikke var det. Ved planlagt fødestuefødsel ble totalt 6,9 % overflyttet til sykehus under fødsel, hvorav 19,5 % blant førstegangsfødende. Det var 0,4 % operative vaginale fødsler ved vanlige fødestuer, 3,5 % ved forsterkede fødestuer og 12,7 % ved fødsler overflyttet fra fødestue til sykehus. Blant barn født i fødestue hadde 0,6 % apgarskår < 7 ved 5 minutter, mot 1,0 % blant barn født i lavrisikosammenligningsgruppen i sykehus (p = 0,04). FORTOLKNING: Fødestuer bør rapportere resultater for alle som var selektert for å føde der, uansett om fødselen endte med å foregå i fødestuen eller andre steder.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Tocologia , Índice de Apgar , Salas de Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Noruega , Paridade , Transferência de Pacientes/estatística & dados numéricos , Postura , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Sistema de Registros , Risco
13.
Int J Obstet Anesth ; 34: 56-66, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29523485

RESUMO

BACKGROUND: Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. METHODS: Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta. RESULTS: Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%). Sixty-one percent of respondents agreed that women with preoperative placental imaging that was "suspicious" of placenta accreta represented a lower risk category; all other suggested descriptions fell into a higher risk category. Seventy-nine percent of respondents indicated that lower risk cases were managed on the labor and delivery unit, while 71% indicated that higher risk cases would be managed in the main operating room. Institutions where all cases were managed on the labor and delivery unit had better access to human and technical resources, were less remote from their main operating areas, and promoted neuraxial rather than general anesthesia, even for parturients perceived to be at higher risk. CONCLUSIONS: Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases.


Assuntos
Anestesia Obstétrica/métodos , Anestesiologistas , Placenta Acreta/cirurgia , Placentação , Adulto , Cesárea/estatística & dados numéricos , Salas de Parto/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Recursos em Saúde/provisão & distribução , Humanos , Salas Cirúrgicas/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Padrões de Prática Médica , Gravidez , Medição de Risco , Estados Unidos
14.
Arch Dis Child Fetal Neonatal Ed ; 103(2): F132-F136, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28600392

RESUMO

OBJECTIVE: Neonatal resuscitation guidelines recommend that newborn infants are stimulated to assist with the establishment of regular respirations. The mode, site of application and frequency of stimulations are not stipulated in these guidelines. The effectiveness of stimulation in improving neonatal transition outcomes is poorly described. METHODS: We conducted a retrospective review of video recordings of neonatal resuscitation at a tertiary perinatal centre. Four different types of stimulation (drying, chest rub, back rub and foot flick) were defined a priori and the frequency and infant response were documented. RESULTS: A total of 120 video recordings were reviewed. Seventy-five (63%) infants received at least one episode of stimulation and 70 (58%) infants were stimulated within the first minute after birth. Stimulation was less commonly provided to infants <30 weeks' gestation (median (IQR) number of stimulations: 0 (0-1)) than infants born ≥30 weeks' gestation (1 (1-3); p<0.001). The most common response to stimulation was limb movement followed by infant cry and facial grimace. Truncal stimulation (drying, chest rub, back rub) was associated with more crying and movement than foot flicks. CONCLUSION: Less mature infants are stimulated less frequently compared with more mature infants and many very preterm infants do not receive any stimulation. Most infants were stimulated within the first minute as recommended in resuscitation guidelines. Rubbing the trunk may be most effective but this needs to be confirmed in prospective studies.


Assuntos
Salas de Parto/estatística & dados numéricos , Estimulação Física/métodos , Ressuscitação/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Tempo , Gravação de Videoteipe
15.
Birth ; 45(2): 130-136, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29251376

RESUMO

BACKGROUND: Few studies have evaluated risk factors associated with hospital birth among women planning to give birth in a birth center in the United States. This study describes the obstetrical risk factors for hospital birth among women intending to deliver in a birth center in Washington State. METHODS: We performed a retrospective cohort study of Washington State birth certificate data for women with singleton, term pregnancies planning to give birth at a birth center from 2004 to 2011. We assessed risk factors for hospital birth including demographic, obstetrical, and medical characteristics. We used multivariable logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between risk factors and hospital birth. RESULTS: Among the 7118 women planning to give birth at a birth center during the study period, 7% (N = 501) had a hospital birth, and 93% delivered at a birth center (N = 6617). The strongest risk factors for hospital transfer included nulliparity (OR 7.2 [95% CI 5.3-9.8]), maternal age >40 years (OR 3.7 [95% CI 2.1-6.7]), inadequate prenatal care (OR 3.7 [95% CI 2.7-5.0]), body mass index ≥30 (OR 2.1 [95% CI 1.6-3.0]), government health insurance (OR 9.3 [95% CI 5.0-17.1]), and hypertension (10.1 [95% CI 5.7-18.1]). Among nulliparous women, all of these demographic and obstetrical factors remained strongly associated with hospital birth. CONCLUSIONS: This information may be useful for counseling women who plan a birth center birth about the risk of hospital birth.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Salas de Parto/estatística & dados numéricos , Idade Materna , Paridade , Adolescente , Adulto , Índice de Massa Corporal , Feminino , Humanos , Seguro Saúde , Modelos Logísticos , Análise Multivariada , Gravidez , Complicações na Gravidez , Cuidado Pré-Natal/economia , Estudos Retrospectivos , Fatores de Risco , Washington , Adulto Jovem
16.
BJOG ; 125(7): 884-891, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29210161

RESUMO

OBJECTIVE: We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34+0 weeks of gestation. DESIGN: Population-based prospective cohort study. SETTING: Ten public hospitals in the Austrian province of Styria. SAMPLE: A total of 87 065 neonates delivered in the period 2004-2015. METHODS: Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority. MAIN OUTCOME MEASURES: Neonatal composite adverse and severely adverse outcome measures. RESULTS: The odds ratio for severely adverse events during the night-time (22:01-07:29 hours) compared with the daytime (07:30-15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13-1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500-1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events. CONCLUSIONS: Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period. TWEETABLE ABSTRACT: Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.


Assuntos
Salas de Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Áustria/epidemiologia , Feminino , Idade Gestacional , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Lineares , Complicações do Trabalho de Parto/epidemiologia , Razão de Chances , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de Tempo
17.
BJOG ; 125(7): 857-865, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29105913

RESUMO

Hospital administrative data are attractive for comparing performance of maternity units because of their often large sample sizes, lack of selection bias and the relatively low costs of accessing these data compared with conducting primary data collection. However, using administrative data to develop indicators can also present challenges including varying data quality, the limited detail on clinical risk factors and a lack of structural and user experience measures. This review illustrates how to develop performance indicators for maternity units using hospital administrative data, including methods to address the challenges that administrative data pose. TWEETABLE ABSTRACT: How to develop maternity indicators from administrative data.


Assuntos
Salas de Parto/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Salas de Parto/normas , Feminino , Humanos , Serviços de Saúde Materna/normas , Gravidez
18.
BMJ Open ; 7(11): e016958, 2017 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-29150465

RESUMO

OBJECTIVES: To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. DESIGN: Prospective cohort study. SETTING: Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. PARTICIPANTS: 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. MAIN OUTCOME MEASUREMENTS: The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. RESULTS: There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. CONCLUSION: The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Salas de Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Preferência do Paciente , Adulto , Centros de Assistência à Gravidez e ao Parto/normas , Feminino , Parto Domiciliar/psicologia , Humanos , Tocologia/estatística & dados numéricos , Países Baixos/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Paridade , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos
19.
BMC Pregnancy Childbirth ; 17(1): 177, 2017 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-28595580

RESUMO

BACKGROUND: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. METHODS: Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000-2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. RESULTS: The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8-11.0 vs. 13.8% 95% CI 13.6-13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75-0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25-1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. CONCLUSIONS: The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.


Assuntos
Salas de Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Mortalidade Perinatal , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Sobremedicalização , Países Baixos/epidemiologia , Gravidez , Risco Ajustado , Adulto Jovem
20.
J Perinatol ; 37(9): 1010-1016, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28661514

RESUMO

OBJECTIVE: To evaluate risk factors and impact of delivery room cardiopulmonary resuscitation (DR-CPR) on very low birth weight (VLBW) preterm infants. STUDY DESIGN: A national, population-based, observational study evaluating risk factors and short-term neonatal outcomes associated with DR-CPR among VLBW, extremely preterm infants (EPIs, 24 to 27 weeks' gestation) and very preterm infants (VPI, 28 to 31 weeks' gestation) born in 1995 to 2010. RESULTS: Among 17 564 VLBW infants, 636 (3.6%) required DR-CPR. In the group of 6478 EPI, 412 (6.4%) received DR-CPR compared with 224 of 11 086 infants (2.0%) in the VPI group. EPI who underwent DR-CPR had higher odds ratios (ORs (95% confidence interval)) for mortality compared to EPI not requiring DR-CPR (OR 3.32 (2.58, 4.29)), grades 3 to 4 intraventricular hemorrhage (IVH) (OR 1.59 (1.20, 2.10)) and periventricular leukomalacia (OR 1.81 (1.17, 2.82)). DR-CPR among VPI was associated with higher ORs for mortality (OR 4.99 (3.59, 6.94)), early sepsis (OR 2.07 (1.05, 4.09)), grades 3 to 4 IVH (OR 3.74 (2.55, 5.50)) and grades 3 to 4 retinopathy of prematurity (ROP) (OR 2.53 (1.18, 5.41)) compared to VPI not requiring DR-CPR. Only 11% of infants in the EPI DR-CPR group had favorable outcomes compared with 44% in the VPI DR-CPR group. Significantly higher ORs for mortality, IVH and ROP were found in the VPI compared to the EPI group. CONCLUSION: Preterm VLBW infants requiring DR-CPR were at increased risk of adverse outcomes compared to those not requiring CPR. This effect was more pronounced in the VPI group.


Assuntos
Reanimação Cardiopulmonar/mortalidade , Salas de Parto/estatística & dados numéricos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Doenças do Prematuro/epidemiologia , Adulto , Reanimação Cardiopulmonar/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA