The Effect of “Off Hours” on Maternal and Perinatal Outcomes in a Diverse U.S. Cohort

Objective This study aimed to evaluate the “off-hour effect” on maternal and neonatal adverse events in a large cohort representing U.S. population. Study Design A secondary analysis of the Consortium on Safe Labor (CSL) dataset with 208,695 women and 229,385 deliveries was performed. The study included the deliveries of ≥23 gestational weeks from 19 hospitals in the United States from 2002 to 2008. Babies with congenital anomalies were excluded from neonatal outcomes. We compared maternal and neonatal outcomes of patients delivered during weekdays versus off hours (nights and weekends). The primary outcomes of the study were composite maternal and composite neonatal adverse events. The secondary outcomes were delivery type and individual maternal and neonatal adverse events including maternal death and perinatal mortality rate. Associations between off hours and all the outcomes were analyzed in bivariable and multivariable analyses. The same analyses were performed in strata by indication for admission (spontaneous labor or induction of labor). Results Composite maternal adverse events (6.19 vs. 6.06%, p = 0.41) and maternal death (0.01 vs. 0.01%, p = 0.19) were not significantly different between off hours and weekday groups. In contrast, composite neonatal adverse events (6.91 vs. 5.84%, p < 0.001) and perinatal mortality rate (1.03 vs. 0.77%, p < 0.001) were higher in the off-hour group. After adjusting for confounding variables, only the composite neonatal outcome continued to be associated with off hours (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI]: 1.04–1.16). Stratified analyses showed that the off-hour effect for the neonatal composite outcome was not present in those presenting in spontaneous labor (6.1 vs. 5.9%, p = 0.40). Conclusion Off-hour delivery was not associated with severe maternal morbidity and was only modestly associated with severe neonatal morbidity. This association was observed in women undergoing induction, not in those presenting in spontaneous labor. These data draw into question the existence of a clinically meaningful and correctable “off-hour effect” in obstetrics. Key Points

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Perinatal outcomes in pregnant patients presenting with antepartum hemorrhage: Our experiences at a teaching hospital in Central Punjab.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.10.3152 ◽

2019 ◽

Vol 26 (10) ◽

pp. 1645-1650

Author(s):

Rabia Mushtaq ◽

Afroza Abbas ◽

Waqas Ahmed

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Low Birthweight ◽

Placenta Previa ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Cross Sectional ◽

Perinatal Mortality Rate

Objectives: Antepartum Hemorrhage is bleeding from or into the genital tract from the period of viability of fetus (28 weeks) till the end of second stage of labor. Antepartum hemorrhage is associated with a very high perinatal mortality rate. We present our experience of perinatal outcomes in cases of antepartum hemorrhage with the aim of highlighting the cause of antepartum hemorrhage and the adverse outcomes. Study Design: Descriptive Cross sectional study. Setting: Department of Gynecology & Obstetrics, Sargodha Medical College, Sargodha. Period: Jan 2018 to Jun 2018. Material and Methods: Ninety six pregnant patients between ages of 15-45 years diagnosed as cases of antepartum hemorrhage were enrolled. Patients with coagulation disorders, twin pregnancies, abnormal lie or presentation, previous scar and any known congenital anomaly. Cause of antepartum hemorrhage and mode of delivery was recorded. Perinatal outcomes were determined in terms of frequencies of perinatal mortality, stillbirth and low birthweight babies. Results: The etiology of antepartum hemorrhage in our setup was placenta previa (43.75%); placental abruption (37.5%); Toxemia (10.41%) and unclassified causes in 8.33% patients. The perinatal mortality rate was 43.75% in our study. The overall frequency of low birthweight babies and stillbirth was 62.5% and 27.08% respectively. Conclusion: Antepartum hemorrhage is a major cause of perinatal mortality in our country. A prompt diagnosis of the cause followed by early cesarean section can help reduce the overall mortality.

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Perinatal mortality rate in the Netherlands compared to other European countries: A secondary analysis of Euro-PERISTAT data

Midwifery ◽

10.1016/j.midw.2013.02.005 ◽

2013 ◽

Vol 29 (8) ◽

pp. 1011-1018 ◽

Cited By ~ 22

Author(s):

Ank de Jonge ◽

Ruth Baron ◽

Myrte Westerneng ◽

Jos Twisk ◽

Eileen K. Hutton

Keyword(s):

Mortality Rate ◽

The Netherlands ◽

Perinatal Mortality ◽

Secondary Analysis ◽

European Countries ◽

Perinatal Mortality Rate

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USE OF REFINED PERINATAL MORTALITY RATE TRENDS TO EVALUATE THE EFFECT OF A CONFIDENTIAL INQUIRY

The Lancet ◽

10.1016/s0140-6736(85)91509-0 ◽

1985 ◽

Vol 326 (8448) ◽

pp. 197-199 ◽

Cited By ~ 9

Author(s):

Joyce Thomas ◽

Joan Edwards ◽

Peter Bowen-Simpkins ◽

DewiR. Evans ◽

StuartP. Jenkins ◽

...

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Perinatal Mortality Rate

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Explanation of Perinatal Mortality Rate in Collaborative Study

PEDIATRICS ◽

10.1542/peds.52.6.891 ◽

1973 ◽

Vol 52 (6) ◽

pp. 891-891

Author(s):

Arnold S. Goldstein ◽

Henry H. Mangurten

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Umbilical Artery ◽

Collaborative Study ◽

The United States ◽

Mortality Rates ◽

Single Umbilical Artery ◽

Neonatal Deaths ◽

General Mortality ◽

Future Management

The article by Froehlich and Fujikura1 on the prognosis of single umbilical artery is a much needed and highly informative addition to the literature. It presents a great deal of information and some important implications as to future management. We question the mortality rates quoted. They are given as percentages, and include stillbirths and neonatal deaths, i.e., perinatal mortality. The figure given as the general mortality rate is 3.8% or 38 per 1,000 births. Previous figures cited for perinatal mortality in the United States have varied from approximately 19 per 1,000 to approximately 26 per 1,000.2-4 We wonder how the figure of 38 per 1,000 was determined.

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Risk factors for perinatal mortality: a case control study from Thiruvananthapuram, Kerala, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172330 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2452 ◽

Cited By ~ 1

Author(s):

Mayadevi Brahmanandan ◽

Lekshmi Murukesan ◽

Bindu Nambisan ◽

Shaila Salmabeevi

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Perinatal Mortality ◽

Case Control Study ◽

Gestational Hypertension ◽

Significant Risk ◽

Case Control ◽

Maternal Risk ◽

Perinatal Mortality Rate ◽

Control Study

Background: The greatest risks to life are in its very beginning. Although a good start in life begins well before birth, it is just before, during, and in the very first hours and days after birth that life is most at risk. This prospective case control study was designed on maternal risk factors for perinatal mortality.Methods: This was a case control study conducted in the Department of Obstetrics and Gynecology and Department of Paediatrics, Medical College Trivandrum for one year period in 2004-2005. The cases were all the fresh and macerated still births and early neonatal death cases during the study period. The controls were chosen as the next delivery entry in the OR register.Results: During this period, the total number of deliveries was 14,796 and there were 431 perinatal deaths. The perinatal mortality rate was 29.12. This was much higher compared to Kerala’s perinatal mortality rate of 10, the reason being that the study is conducted in a tertiary referral hospital with one of the best new born care nurseries and a large number of referrals. The most significant risk factors for perinatal mortality were low socio-economic status, referrals, late registration, prematurity, low birth weight, intra-uterine growth restriction, maternal diseases like gestational hypertension and gestational diabetes and intrapartum complications like abruption.Conclusions: Perinatal mortality rate serves as the most sensitive index of maternal and neonatal care. Good antenatal care and prevention of preterm birth may play a key role in further reduction of PMR.

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Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111671 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11671

Author(s):

Italla Maria Pinheiro Bezerra ◽

José Lucas Souza Ramos ◽

Micael Colodetti Pianissola ◽

Fernando Adami ◽

João Batista Francalino da Rocha ◽

...

Keyword(s):

Time Series ◽

Information System ◽

Mortality Rate ◽

Perinatal Mortality ◽

Birth Asphyxia ◽

Strong Positive Correlation ◽

Significance Level ◽

Espírito Santo ◽

Perinatal Mortality Rate ◽

Espirito Santo

This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais–Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother’s age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00–P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20–P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.

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Analysis of The Fairness of Child Health Services In China 2010-2019

10.21203/rs.3.rs-468598/v2 ◽

2021 ◽

Author(s):

Ji Wu ◽

Hao-Nan Jin ◽

Yi-Lei Lao ◽

Xian-Guo Qu

Keyword(s):

Mortality Rate ◽

Child Health ◽

Health Service ◽

Health Services ◽

Perinatal Mortality ◽

Child Health Services ◽

Child Health Service ◽

Care Services ◽

Perinatal Mortality Rate ◽

Service Projects

Abstract Background: The imbalance of child health services caused by the huge income gap between urban and rural residents and uncoordinated regional development has become increasingly prominent. This article analyzes the basic situation and equity of child care services in China from 2010 to 2019.Methods: Evaluate the equity of child health services by concentration index.Results: From 2010 to 2019, neonatal visit rate and system management rate of under-three children in Chinese child health service projects showed an upward trend, and the perinatal mortality rate decreased. The perinatal mortality rate is the highest in the western region, and the level of child health services in the central region is lower than the national average, but the gap between regions has gradually decreased. Child health services concentrate in provinces with high economic levels, and the perinatal mortality rate is the most unfair. Conclusion: The decline in the mortality rate of under-five children is related to the improvement in the child health services. We should improve the health services of perinatal infants and pay attention to the health of children aged 1 to 4 years. The fairness of child health service is affected by the two-child policy. We should rationally allocate resources and strengthen support for the central and western regions.

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FREQUENCY AND CAUSES OF PERINATAL MORTALITY IN A TERTIARY CARE HOSPITAL IN PESHAWAR, PAKISTAN

Gomal Journal of Medical Sciences ◽

10.46903/gjms/16.01.1637 ◽

2018 ◽

Vol 16 (1) ◽

pp. 15-19

Author(s):

Maimoona Qadir ◽

Sohail Amir ◽

Samina Jadoon ◽

Muhammad Marwat

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Age Groups ◽

Mortality Data ◽

Care Hospital ◽

Cross Sectional ◽

Medical Disorders ◽

Perinatal Mortality Rate

Background: Perinatal mortality rate indicates quality of care provided during pregnancy and delivery to the mother and to the neonate in its early neonatal period. The objective of this study was to determine the frequency and causes of perinatal mortality in a tertiary care hospital in Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted at Department of Gynaecology & Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 1st January 2016 to 31st December 2016. The inclusion criteria was all singleton gestation with gestational age of at least 24 weeks presenting with perinatal mortality. Data was collected for the following variables; age groups (up to 20 years, 21-30 years, 31-40 years and > 40 years), booking status (yes/ no), period of gestation (24-31+6, 32-36+6, 37-39+6 and > 40 weeks), Foetal weight ( 3.5 kg) and cause of perinatal mortality. Results: Out of 4508 deliveries there were 288 perinatal deaths, including 228 stillbirths and 60 neonatal deaths, so perinatal mortality rate was 63.8/1000 births. 90.28% women were unbooked. Most common cause was hypertensive disorders of pregnancy (27.78%) followed by antepartum haemorrhage (25.71%) and then mechanical causes (13.88%). Congenital anomalies comprised 11.8% cases, neonatal problems 10.07% and maternal medical disorders for 4.16% cases. Cause of 4.16% cases remained unexplained. Conclusion: Appropriate strategies like control of identifiable causes, proper antenatal and postnatal care, healthy delivery practices and availability of emergency neonatal care facilities can bring down perinatal mortality rates.

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