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

Morad, Sharon, Pitches, David, Girling, Alan, Taylor, Beck, Fradd, Vikki, MacArthur, Christine and Kenyon, Sara (2021) 24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis. PloS one, 16 (3). e0249233. ISSN 1932-6203. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

[img]
Preview
Text (PDF file format)
PLOS.pdf - Published Version
Available under License Creative Commons Attribution 4.0.

Download (711kB) | Preview
Official URL: https://journals.plos.org/plosone/article?id=10.13...

Abstract

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.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WB Practice of medicine
WQ Obstetrics. Midwifery
Divisions: Womens and Childrens > Paediatrics
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 16 Apr 2021 14:28
Last Modified: 16 Apr 2021 14:28
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4216

Actions (login required)

View Item View Item