24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis

Objectives To explore the effect of introducing 24/7 resident labour ward consultant presence on neonatal and maternal outcomes in a large obstetric unit in England. Design Retrospective time sequence analysis of routinely collected data. Setting Obstetric unit of large teaching hospital in England. Participants Women and babies delivered between1 July 2011 and 30 June 2017. Births <24 weeks gestation or by planned caesarean section were excluded. Main outcome measures The primary composite outcome comprised intrapartum stillbirth, neonatal death, babies requiring therapeutic hypothermia, or admission to neonatal intensive care within three hours of birth. Secondary outcomes included markers of neonatal and maternal morbidity. Planned subgroup analyses investigated gestation (<34 weeks; 34–36 weeks; ≥37 weeks) and time of day. Results 17324 babies delivered before and 16110 after 24/7 consultant presence. The prevalence of the primary outcome increased by 0.65%, from 2.07% (359/17324) before 24/7 consultant presence to 2.72% (438/16110, P < 0.001) after 24/7 consultant presence which was consistent with an upward trend over time already well established before 24/7 consultant presence began (OR 1.09 p.a.; CI 1.04 to 1.13). Overall, there was no change in this trend associated with the transition to 24/7. However, in babies born ≥37 weeks gestation, the upward trend was reversed after implementation of 24/7 (OR 0.67 p.a.; CI 0.49 to 0.93; P = 0.017). No substantial differences were shown in other outcomes or subgroups. Conclusions Overall, resident consultant obstetrician presence 24/7 on labour ward was not associated with a change in a pre-existing trend of increasing adverse infant outcomes. However, 24/7 presence was associated with a reversal in increasing adverse outcomes for term babies.

The Adverse Impact of Maternal Obesity on Intrapartum and Perinatal Outcomes

Background. Confidential enquiries into maternal deaths in the UK have repeatedly highlighted increased maternal morbidity and mortality associated with maternal obesity. Objective. To determine the impact of increased body mass index (BMI) on intrapartum outcomes. Materials and Methods. A retrospective case-control analysis of intrapartum outcomes of the study group (100 women), with a BMI above 40 kg/m2 (class III Obesity) at booking and a control group (100 women) with a booking BMI between 20 and 25 kg/m2 was performed. Results. A statistically significant increase in delivery by caesarean section (OR 2.32, 95% CI 1.26–4.29), minor and major postpartum haemorrhage (OR 5.93, 95% CI 2.34–11.98, OR 16.11, 95% CI 2.08–125.09, resp.), perineal trauma (OR 2.59, 95% CI 1.44–4.69), and fetal macrosomia (OR 3.11, 95% CI 1.25–7.79) was noted in the study group. Babies also had an increased risk of having a lower APGAR scores in the study group as compared to the control group (OR 3.09, 95% CI 1.07–8.94). Conclusion. Women with a BMI > 40 kg/m2 experience increased incidence of intrapartum complications and hence, input of skilled birth attendants during labour is essential to improve intrapartum outcomes.