Increased adverse perinatal outcome of hospital delivery at night.
BJOG
; 117(9): 1098-107, 2010 Aug.
Article
en En
| MEDLINE
| ID: mdl-20497413
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 OUTCOMEMEASURES:
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Resultado del Embarazo
/
Parto Obstétrico
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Pregnancy
País/Región como asunto:
Europa
Idioma:
En
Revista:
BJOG
Asunto de la revista:
GINECOLOGIA
/
OBSTETRICIA
Año:
2010
Tipo del documento:
Article
País de afiliación:
Países Bajos