Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands
Article first published online: 8 DEC 2010
© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 4, pages 457–465, March 2011
How to Cite
Ravelli, A., Jager, K., de Groot, M., Erwich, J., Rijninks-van Driel, G., Tromp, M., Eskes, M., Abu-Hanna, A. and Mol, B. (2011), Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 457–465. doi: 10.1111/j.1471-0528.2010.02816.x
- Issue published online: 10 FEB 2011
- Article first published online: 8 DEC 2010
- Accepted 30 October 2010. Published Online 8 December 2010.
- Access to care;
- gestational age;
- health facilities;
- perinatal mortality;
Please cite this paper as: Ravelli A, Jager K, de Groot M, Erwich J, Rijninks-van Driel G, Tromp M, Eskes M, Abu-Hanna A, Mol B. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG 2011;118:457–465.
Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care.
Design Population-based cohort study from 2000 up to and including 2006.
Setting The Netherlands Perinatal Registry.
Population A total of 751 926 singleton term hospital births.
Methods We assessed the impact of travel time by car, calculated from the postal code of the woman’s residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used.
Main outcome measures Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit).
Results The mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time (≥20 minutes) and total mortality (OR 1.17, 95% CI 1.002–1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13–2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17–1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81–2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29–1.80) increased the risk of mortality.
Conclusions A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care.