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      • Record: found
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      Resident consultant obstetrician presence on the labour ward versus other models of consultant cover: a systematic review of intrapartum outcomes

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          Abstract

          Background

          Several key policy documents have advocated 24‐hour consultant obstetrician presence on the labour ward as a means of improving the safety of birth. However, it is unclear what published evidence exists comparing the outcomes of intrapartum care with 24‐hour consultant labour ward presence and other models of consultant cover.

          Objectives

          To collate and critically appraise evidence of the effect of continuous resident consultant obstetrician cover on the labour ward on outcomes of intrapartum care compared with other models of consultant cover.

          Search strategy

          Studies were included which quantitatively compared intrapartum outcomes for women and babies where continuous resident consultant obstetric cover was provided with other models of consultant cover.

          Selection criteria

          Quantitative studies within healthcare systems with mixed obstetric‐midwifery models of care.

          Data collection and analysis

          Two researchers independently screened titles and full‐text publications, extracted data and assessed the quality of included studies. Meta‐analysis was performed using REVIEW MANAGER 5.3.

          Main results

          About 1508 publications were screened resulting in two papers, three conference abstracts and one letter being included. All were single‐site time‐period comparison studies. The quality of studies overall was poor with significant risk of bias. The only significant finding in meta‐analysis related to instrumental deliveries, which occurred more frequently when there was on‐call consultant cover (unadjusted risk ratio 1.14; 95% CI 1.04–1.24).

          Conclusion

          No reliable evidence of the effects of 24‐hour resident consultant presence on the labour ward on intrapartum outcomes was identified.

          Tweetable abstract

          More robust research is needed to assess intrapartum outcomes with resident consultant labour ward presence.

          Tweetable abstract

          More robust research is needed to assess intrapartum outcomes with resident consultant labour ward presence.

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          Most cited references14

          • Record: found
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          Time of birth and risk of neonatal death at term: retrospective cohort study

          Dharmintra Pasupathy, Angela Wood, Jill P. Pell … (2010)
          Objective To determine the effect of time and day of birth on the risk of neonatal death at term. Design Population based retrospective cohort study. Setting Data from the linked Scottish morbidity records, Stillbirth and Infant Death Survey, and birth certificate database of live births in Scotland, 1985-2004. Subjects Liveborn term singletons with cephalic presentation. Perinatal deaths from congenital anomalies excluded. Final sample comprised 1 039 560 live births. Main outcome measure All neonatal deaths (in the first four weeks of life) unrelated to congenital abnormality, plus a subgroup of deaths ascribed to intrapartum anoxia. Results The risk of neonatal death was 4.2 per 10 000 during the normal working week (Monday to Friday, 0900-1700) and 5.6 per 10 000 at all other times (out of hours) (unadjusted odds ratio 1.3, 95% confidence interval 1.1 to 1.6). Adjustment for maternal characteristics had no material effect. The higher rate of death out of hours was because of an increased risk of death ascribed to intrapartum anoxia (adjusted odds ratio 1.7, 1.2 to 2.3). Though exclusion of elective caesarean deliveries attenuated the association between death ascribed to anoxia and delivery out of hours, a significant association persisted (adjusted odds ratio 1.5, 1.1 to 2.0). The attributable fraction of neonatal deaths ascribed to intrapartum anoxia associated with delivery out of hours was 26% (95% confidence interval 5% to 42%). Conclusions Delivering an infant outside the normal working week was associated with an increased risk of neonatal death at term ascribed to intrapartum anoxia.
          Article 0 comments Cited 36 times – based on 0 reviews     Review now
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            Timing of birth and infant and early neonatal mortality in Sweden 1973-95: longitudinal birth register study.

            Y Luo, J Karlberg (2001)
            To assess the impact of time of birth on infant mortality and early neonatal mortality in full term and preterm births. Analysis of data from the Swedish birth register, 1973-95. 2 102 324 spontaneous live births of infants without congenital malformation. Absolute and relative risk of infant mortality, early neonatal mortality, and early neonatal mortality related to asphyxia. Infant mortality, early neonatal mortality, and early neonatal mortality related to asphyxia were higher in infants who were born during the night (9 pm to 9 am) compared with those born during the day for 1973-9, 1980-9, and 1990-5. The difference was more dramatic for preterm infants. The largest difference was observed during 1990-5, when there was a 30% increase in early neonatal mortality (relative risk 1.31, 95% confidence interval 1.10 to 1.57) and a 70% increase in early neonatal mortality related to asphyxia (1.70, 1.22 to 2.38) in preterm infants born during the night compared with rates for preterm infants born during the day. A detailed analysis over 24 hours revealed two "high risk" periods: between 5 pm and 1 am and around 9 am. Infants born during the night have a greater risk of infant and early neonatal mortality and early neonatal mortality related to asphyxia than those born during the day. There has been no improvement over the past two decades. The problem is more serious for preterm births and was even worse in the 1990s. Shift changes and the hours immediately after such changes are high risk periods for neonatal care.
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              Early neonatal mortality, asphyxia related deaths, and timing of low risk births in Hesse, Germany, 1990-8: observational study.

              Rebekah Schmidt, Steffi G. Riedel-Heller, B Misselwitz (2000)
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                M Knight: marian.knight@npeu.ox.ac.uk
                Journal
                Journal ID (nlm-ta): BJOG
                Journal ID (iso-abbrev): BJOG
                Journal ID (doi): 10.1111/(ISSN)1471-0528
                Journal ID (publisher-id): BJO
                Title: Bjog
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 1470-0328
                ISSN (Electronic): 1471-0528
                Publication date (Electronic): 28 February 2017
                Publication date (Print): August 2017
                Volume: 124
                Issue: 9 ( doiID: 10.1111/bjo.2017.124.issue-9 )
                Pages: 1311-1320
                Affiliations
                [ 1 ] National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
                Author notes
                [*] [* ] Correspondence: M Knight, Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK. Email marian.knight@ 123456npeu.ox.ac.uk
                Article
                Publisher ID: BJO14527
                DOI: 10.1111/1471-0528.14527
                PMC ID: 5574016
                PubMed ID: 28244641
                SO-VID: 4d327afe-90db-4540-ab08-8085c842c605
                Copyright © © 2017 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists
                License:

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date accepted : 06 November 2016
                Page count
                Figures: 1, Tables: 3, Pages: 10, Words: 6317
                Funding
                Funded by: NIHR Research Professorship
                Categories
                Subject: Systematic Review
                Subject: Systematic Reviews
                Custom metadata
                source-schema-version-number 2.0
                component-id bjo14527
                cover-date August 2017
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.8 mode:remove_FC converted:29.08.2017

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: delivery,obstetric labour complications,obstetric/adverse effects,obstetrics/organisation and administration
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: delivery, obstetric labour complications, obstetric/adverse effects, obstetrics/organisation and administration

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