Abstract

BackgroundStudies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night). We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births.MethodsThis retrospective cohort study was based on data from the Netherlands Perinatal Registry, a countrywide registry that covers 99% of all hospital births in the Netherlands. Data of 449,714 infants, born at 28 completed weeks or later, in the period 2003 through 2007 were used. Infants with a high a priori risk of morbidity or mortality were excluded. Outcome measures were intrapartum and early neonatal mortality, a low Apgar score (5 minute score of 0–6), and a composite adverse perinatal outcome measure (mortality, low Apgar score, severe birth trauma, admission to a neonatal intensive care unit).ResultsEvening and night-time deliveries that involved induction or augmentation of labour, or an emergency caesarean section, were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Weekend deliveries were not associated with an increased risk when compared to weekday deliveries. It was estimated that each year, between 126 and 141 cases with an adverse perinatal outcomes could be attributed to this evening and night effect. Of these, 21 (15-16%) are intrapartum or early neonatal death. Among the 3100 infants in the study population who experience an adverse outcome each year, death accounted for only 5% (165) of these outcomes.ConclusionThis study shows that for infants whose mothers require obstetric interventions during labour and delivery, birth in the evening or at night, are at an increased risk of an adverse perinatal outcomes.

Highlights

  • Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about the quality of care provided during off-hours

  • Among infants born to mothers referred to a hospital before the onset of labour, differences were observed in the prevalence of all three adverse outcomes among all three time categorizations

  • Among infants born to mothers referred to a hospital during labour, differences were observed in the prevalence of a low Apgar score, and the composite measure within the time categorizations offhours vs. office hours, and time of the day, but not for day of the week

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Summary

Introduction

Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night). We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births. A considerable amount of literature has been published about the relationship between hospital admissions that occur in the evening, at night, or during the weekend, and morbidity and mortality. Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours (weekend, evening or night), as compared to office hours, leading to questions about the quality of care provided during off-hours. The findings of studies examining the effect of time of birth on perinatal mortality and morbidity have been inconsistent. Some studies reported increased risks for births during the weekend [3-9], during the evening or night [8-24], or during off-hours [8,25,26], while others did not find any effect [10,27-33]. Many studies did not take into consideration that interventions like induction and augmentation of labour, administration of analgesics or anaesthetics, planned and emergency caesarean sections, or instrumental deliveries, are not randomly carried out throughout the day and week, and are directed to high-risk pregnancies

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