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Birth "Out-of-Hours": An Evaluation of Obstetric Practice and Outcome According to the Presence of Senior Obstetricians on the Labour Ward.

Knight HE, van der Meulen JH, Gurol-Urganci I, Smith GC, Kiran A, Thornton S, Richmond D, Cameron A, Cromwell DA - PLoS Med. (2016)

Bottom Line: Concerns have been raised that a lack of senior obstetricians ("consultants") on the labour ward outside normal hours may lead to worse outcomes among babies born during periods of reduced cover.Taken together, the available evidence provides some reassurance that the current organisation of maternity care in the UK allows for good planning and risk management.However there is a need for more robust evidence on the quality of care afforded by different models of labour ward staffing.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Concerns have been raised that a lack of senior obstetricians ("consultants") on the labour ward outside normal hours may lead to worse outcomes among babies born during periods of reduced cover.

Methods and findings: We carried out a multicentre cohort study using data from 19 obstetric units in the United Kingdom between 1 April 2012 and 31 March 2013 to examine whether rates of obstetric intervention and outcome change "out-of-hours," i.e., when consultants are not providing dedicated, on-site labour ward cover. At the 19 hospitals, obstetric rotas ranged from 51 to 106 h of on-site labour ward cover per week. There were 87,501 singleton live births during the year, and 55.8% occurred out-of-hours. Women who delivered out-of-hours had slightly lower rates of intrapartum caesarean section (CS) (12.7% versus 13.4%, adjusted odds ratio [OR] 0.94; 95% confidence interval [CI] 0.90 to 0.98) and instrumental delivery (15.6% versus 17.0%, adj. OR 0.92; 95% CI 0.89 to 0.96) than women who delivered at times of on-site labour ward cover. There was some evidence that the severe perineal tear rate was reduced in out-of-hours vaginal deliveries (3.3% versus 3.6%, adj. OR 0.92; 95% CI 0.85 to 1.00). There was no evidence of a statistically significant difference between out-of-hours and "in-hours" deliveries in the rate of babies with a low Apgar score at 5 min (1.33% versus 1.25%, adjusted OR 1.07; 95% CI 0.95 to 1.21) or low cord pH (0.94% versus 0.82%; adjusted OR 1.12; 95% CI 0.96 to 1.31). Key study limitations include the potential for bias by indication, the reliance upon an organisational measure of consultant presence, and a non-random sample of maternity units.

Conclusions: There was no difference in the rate of maternal and neonatal morbidity according to the presence of consultants on the labour ward, with the possible exception of a reduced rate of severe perineal tears in out-of-hours vaginal deliveries. Fewer women had operative deliveries out-of-hours. Taken together, the available evidence provides some reassurance that the current organisation of maternity care in the UK allows for good planning and risk management. However there is a need for more robust evidence on the quality of care afforded by different models of labour ward staffing.

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Number of births, by hour and mode of birth.
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pmed.1002000.g002: Number of births, by hour and mode of birth.

Mentions: There were 112,458 deliveries in the sample between April 2012 and March 2013 (Fig 1). Restricting the cohort to singleton livebirths of at least 28 completed weeks of gestation excluded 7,466 records (6.6%), and dropping records with missing data in key explanatory variables removed a further 2,752 (2.4%). There was diurnal variation in the number of deliveries, with the majority of pre-labour CSs occurring between 9 a.m. and 7 p.m. (Fig 2). Included in the analysis were 87,501 deliveries following labour. Operative deliveries (intrapartum caesarean sections and instrumental deliveries) appeared to be evenly distributed throughout the day, with no evidence of a “spike” at the beginning and end of consultant shifts (Fig 2).


Birth "Out-of-Hours": An Evaluation of Obstetric Practice and Outcome According to the Presence of Senior Obstetricians on the Labour Ward.

Knight HE, van der Meulen JH, Gurol-Urganci I, Smith GC, Kiran A, Thornton S, Richmond D, Cameron A, Cromwell DA - PLoS Med. (2016)

Number of births, by hour and mode of birth.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836717&req=5

pmed.1002000.g002: Number of births, by hour and mode of birth.
Mentions: There were 112,458 deliveries in the sample between April 2012 and March 2013 (Fig 1). Restricting the cohort to singleton livebirths of at least 28 completed weeks of gestation excluded 7,466 records (6.6%), and dropping records with missing data in key explanatory variables removed a further 2,752 (2.4%). There was diurnal variation in the number of deliveries, with the majority of pre-labour CSs occurring between 9 a.m. and 7 p.m. (Fig 2). Included in the analysis were 87,501 deliveries following labour. Operative deliveries (intrapartum caesarean sections and instrumental deliveries) appeared to be evenly distributed throughout the day, with no evidence of a “spike” at the beginning and end of consultant shifts (Fig 2).

Bottom Line: Concerns have been raised that a lack of senior obstetricians ("consultants") on the labour ward outside normal hours may lead to worse outcomes among babies born during periods of reduced cover.Taken together, the available evidence provides some reassurance that the current organisation of maternity care in the UK allows for good planning and risk management.However there is a need for more robust evidence on the quality of care afforded by different models of labour ward staffing.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Concerns have been raised that a lack of senior obstetricians ("consultants") on the labour ward outside normal hours may lead to worse outcomes among babies born during periods of reduced cover.

Methods and findings: We carried out a multicentre cohort study using data from 19 obstetric units in the United Kingdom between 1 April 2012 and 31 March 2013 to examine whether rates of obstetric intervention and outcome change "out-of-hours," i.e., when consultants are not providing dedicated, on-site labour ward cover. At the 19 hospitals, obstetric rotas ranged from 51 to 106 h of on-site labour ward cover per week. There were 87,501 singleton live births during the year, and 55.8% occurred out-of-hours. Women who delivered out-of-hours had slightly lower rates of intrapartum caesarean section (CS) (12.7% versus 13.4%, adjusted odds ratio [OR] 0.94; 95% confidence interval [CI] 0.90 to 0.98) and instrumental delivery (15.6% versus 17.0%, adj. OR 0.92; 95% CI 0.89 to 0.96) than women who delivered at times of on-site labour ward cover. There was some evidence that the severe perineal tear rate was reduced in out-of-hours vaginal deliveries (3.3% versus 3.6%, adj. OR 0.92; 95% CI 0.85 to 1.00). There was no evidence of a statistically significant difference between out-of-hours and "in-hours" deliveries in the rate of babies with a low Apgar score at 5 min (1.33% versus 1.25%, adjusted OR 1.07; 95% CI 0.95 to 1.21) or low cord pH (0.94% versus 0.82%; adjusted OR 1.12; 95% CI 0.96 to 1.31). Key study limitations include the potential for bias by indication, the reliance upon an organisational measure of consultant presence, and a non-random sample of maternity units.

Conclusions: There was no difference in the rate of maternal and neonatal morbidity according to the presence of consultants on the labour ward, with the possible exception of a reduced rate of severe perineal tears in out-of-hours vaginal deliveries. Fewer women had operative deliveries out-of-hours. Taken together, the available evidence provides some reassurance that the current organisation of maternity care in the UK allows for good planning and risk management. However there is a need for more robust evidence on the quality of care afforded by different models of labour ward staffing.

Show MeSH
Related in: MedlinePlus