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General obstetrics
Increased adverse perinatal outcome of hospital delivery at night
Article first published online: 25 MAY 2010
DOI: 10.1111/j.1471-0528.2010.02611.x
© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
Issue
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 117, Issue 9, pages 1098–1107, August 2010
Additional Information
How to Cite
de Graaf, J., Ravelli, A., Visser, G., Hukkelhoven, C., Tong, W., Bonsel, G. and Steegers, E. (2010), Increased adverse perinatal outcome of hospital delivery at night. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 1098–1107. doi: 10.1111/j.1471-0528.2010.02611.x
Publication History
- Issue published online: 6 JUL 2010
- Article first published online: 25 MAY 2010
- Accepted 14 April 2010. Published Online 25 May 2010.
- Abstract
- Article
- References
- Cited By
Keywords:
- Adverse perinatal outcome;
- early neonatal mortality;
- intrapartum mortality;
- organisation of maternity units;
- seniority of staff;
- timing of hospital delivery;
- volume of deliveries
Please cite this paper as: de Graaf J, Ravelli A, Visser G, Hukkelhoven C, Tong W, Bonsel G, Steegers E. Increased adverse perinatal outcome of hospital delivery at night. BJOG 2010;117:1098–1107.
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 outcome measures 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.