Abstract
BackgroundThis was a retrospective population-based study, utilizing the data of 601 247 singleton hospital deliveries collected from the Finnish Medical Birth Register (MBR) in 2006–2016. The aim of this study was to analyse the busy day effect on intrapartum adverse maternal outcomes.MethodsTo implement the study design, daily delivery frequencies and ranges (min-max) for each delivery unit (n = 26) were stratified to the daily delivery volume distributions by the delivery unit’s annual delivery volume and profile: Category (C)1 < 1000, C2 1000–1999, C3 2000–2999, C4 ≥ 3000 and C5 the profile of university hospitals. To study the busy day effect, the quiet, optimal and busy days were defined by calculating the number of days (%) with the lowest and highest daily delivery frequencies and summed to the nearest 10 % in each hospital category. Optimal days were determined by calculating approximately 80 % of deliveries occurring between the lowest 10 %, and highest 10 % in each hospital category. Crude and adjusted odd ratios (ORs) with 99 % confidence intervals (CIs) were used to analyze the busy day effect on adverse maternal outcomes, blood transfusions, manual removal of the placenta and obstetric anal sphincter injuries, separately in each hospital category.ResultsThe busy day effect was associated with the 28 % (99 % CI 8–52 %) and 25 % (99 % CI 11–40 %) increased need for blood transfusions in C2 and university hospitals (C5), respectively, whereas 22 % (99 % CI 10–31 %) less blood transfusions were needed at university hospitals during quiet days. In C3 hospitals, 83 % (99 % CI 65–92 %) less blood transfusions were needed during busy days. Obstetric and anal sphincter injury rates declined during quiet days by 22 % (99 % CI 3–38 %) only in university hospitals.ConclusionsThe findings of this study identify no specific pattern to the busy day effect for adverse maternal outcomes defined as manual removal of the placenta or obstetric and anal sphincter injuries. However, both quiet and busy days seem to be associated with increased or decreased need for blood transfusions in different sized delivery units. Findings also suggest that quiet days are associated with a decreased number of obstetric and anal sphincter injuries.
Highlights
This was a retrospective population-based study, utilizing the data of 601 247 singleton hospital deliveries collected from the Finnish Medical Birth Register (MBR) in 2006–2016
Quiet days were associated with a decreased need for blood transfusion in hospital category C5, where blood transfusion was performed 22 % less compared to optimal days
Varying daily delivery volume times were not associated with manual removal of the placenta (MRP) in any hospital category
Summary
This was a retrospective population-based study, utilizing the data of 601 247 singleton hospital deliveries collected from the Finnish Medical Birth Register (MBR) in 2006–2016. We have shown in the earlier studies the occurrence of daily delivery volume changes in particular within small delivery units (< 1000 annual deliveries), where the variation of daily patient flow is more prominent compared to the larger ones (Vilkko R, Räisänen S, Stefanovic V, Gissler M, Heinonen S: Patient flow unevenness in different sized delivery hospitals – an 11-year register study of 610 227 deliveries, unpublished). Earlier results indicate that busy days tend to produce excessive interventions during labour (Vilkko R, Räisänen S, Gissler M, Stefanovic V, Heinonen S: Busy day effect on the use of interventions during labour – A population-based register study of 601 247 singleton deliveries, unpublished) For these reasons, busy days in delivery units can be seen as a risk factor for adverse maternal outcomes. The aim of this study is to analyse the busy day effect on selected intrapartum maternal outcomes in five categories of delivery units with different annual delivery volumes or profiles
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