Abstract
BackgroundQuality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths.ObjectiveTo analyze the hourly variation of maternal mortality within Mexican health institutions.MethodsWe performed a cross-sectional multivariate analysis of 3,908 maternal deaths and 10,589,444 births that occurred within health facilities in Mexico during the 2010–2014 period, using data from the Health Information Systems of the Mexican Ministry of Health. We fitted negative binomial regression models with covariate adjustment to all data, as well as similar models by basic cause of death and by weekdays/weekends. The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births. Hour of day was the main predictor; covariates were day of the week, c-section, marginalization, age, education, and number of pregnancies.ResultsRisk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2). This is almost twice the lowest risk, which occurred at noon (27.1 deaths per 100,000 live births [95% U.I.: 23.0, 32.0]). Risk shows peaks coinciding with shift changes, at 07:00, and 14:00 and was significantly higher on weekends and holidays.ConclusionsEvidence suggests strong hourly fluctuations in the risk of maternal death with during early morning hours and around the afternoon shift change. These results may reflect institutional management problems that cause an uneven quality of obstetric care.
Highlights
Maternal mortality has been studied since at least the mid-18th century, thanks to the existence of long time series of vital statistics in Sweden and the United Kingdom [1,2]]
The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births
Risk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2)
Summary
Maternal mortality has been studied since at least the mid-18th century, thanks to the existence of long time series of vital statistics in Sweden and the United Kingdom [1,2]]. In Mexico, despite counting on vital statistics of maternal deaths practically from the early 20th century, information was only consolidated beginning in 1940 [3]]. The trend in the number of births is opposite, the Maternal Mortality Ratio (MMR) fell 92.3% over this period. Important advancements in the registration of maternal deaths have occurred in Mexico. Despite the gains in the measurement of maternal mortality, the MMR has not declined as expected, which points to insufficient knowledge of its determinants. 83% of all maternal deaths occurred within these same facilities Taken together, these numbers point to the problem of lingering maternal mortality being related to the quality of obstetric care within institutions. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths
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