24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis
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. Retrospective time sequence analysis of routinely collected data. Obstetric unit of large teaching hospital in England. Women and babies delivere...
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| Veröffentlicht in: | PloS one 2021-03, Vol.16 (3), p.e0249233-e0249233 |
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| creator | Morad, Sharon Pitches, David Girling, Alan Taylor, Beck Fradd, Vikki MacArthur, Christine Kenyon, Sara |
| description | 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.
Retrospective time sequence analysis of routinely collected data.
Obstetric unit of large teaching hospital in England.
Women and babies delivered between1 July 2011 and 30 June 2017. Births |
| doi_str_mv | 10.1371/journal.pone.0249233 |
| format | Article |
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Retrospective time sequence analysis of routinely collected data.
Obstetric unit of large teaching hospital in England.
Women and babies delivered between1 July 2011 and 30 June 2017. Births <24 weeks gestation or by planned caesarean section were excluded.
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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0249233</identifier><identifier>PMID: 33788880</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Babies ; Biology and Life Sciences ; Births ; Childbirth & labor ; Consultants ; Data analysis ; Editing ; Fatalities ; Fetuses ; Health aspects ; Health services ; Hospitals ; Hypothermia ; Infants (Newborn) ; Influence ; Information systems ; Intensive care ; Maternal mortality ; Medical research ; Medicine and Health Sciences ; Methodology ; Neonates ; Newborn babies ; Obstetricians ; Obstetrics ; Patient safety ; Physical Sciences ; Pregnant women ; Public health ; Research and Analysis Methods ; Reviews ; Social aspects ; Stillbirth ; Time series ; Trends ; Womens health</subject><ispartof>PloS one, 2021-03, Vol.16 (3), p.e0249233-e0249233</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Morad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Morad et al 2021 Morad et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-92f6e2f06c8ee58a886ff5422387cba441b537f83a20837cfa1a18c25dcad3793</citedby><cites>FETCH-LOGICAL-c692t-92f6e2f06c8ee58a886ff5422387cba441b537f83a20837cfa1a18c25dcad3793</cites><orcidid>0000-0002-3559-7922</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011758/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011758/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33788880$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morad, Sharon</creatorcontrib><creatorcontrib>Pitches, David</creatorcontrib><creatorcontrib>Girling, Alan</creatorcontrib><creatorcontrib>Taylor, Beck</creatorcontrib><creatorcontrib>Fradd, Vikki</creatorcontrib><creatorcontrib>MacArthur, Christine</creatorcontrib><creatorcontrib>Kenyon, Sara</creatorcontrib><title>24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
Retrospective time sequence analysis of routinely collected data.
Obstetric unit of large teaching hospital in England.
Women and babies delivered between1 July 2011 and 30 June 2017. Births <24 weeks gestation or by planned caesarean section were excluded.
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.
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.
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. 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care</topic><topic>Maternal mortality</topic><topic>Medical research</topic><topic>Medicine and Health Sciences</topic><topic>Methodology</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Obstetricians</topic><topic>Obstetrics</topic><topic>Patient safety</topic><topic>Physical Sciences</topic><topic>Pregnant women</topic><topic>Public health</topic><topic>Research and Analysis Methods</topic><topic>Reviews</topic><topic>Social aspects</topic><topic>Stillbirth</topic><topic>Time series</topic><topic>Trends</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morad, Sharon</creatorcontrib><creatorcontrib>Pitches, David</creatorcontrib><creatorcontrib>Girling, Alan</creatorcontrib><creatorcontrib>Taylor, Beck</creatorcontrib><creatorcontrib>Fradd, Vikki</creatorcontrib><creatorcontrib>MacArthur, Christine</creatorcontrib><creatorcontrib>Kenyon, 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analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-03-31</date><risdate>2021</risdate><volume>16</volume><issue>3</issue><spage>e0249233</spage><epage>e0249233</epage><pages>e0249233-e0249233</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
Retrospective time sequence analysis of routinely collected data.
Obstetric unit of large teaching hospital in England.
Women and babies delivered between1 July 2011 and 30 June 2017. Births <24 weeks gestation or by planned caesarean section were excluded.
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33788880</pmid><doi>10.1371/journal.pone.0249233</doi><tpages>e0249233</tpages><orcidid>https://orcid.org/0000-0002-3559-7922</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Babies Biology and Life Sciences Births Childbirth & labor Consultants Data analysis Editing Fatalities Fetuses Health aspects Health services Hospitals Hypothermia Infants (Newborn) Influence Information systems Intensive care Maternal mortality Medical research Medicine and Health Sciences Methodology Neonates Newborn babies Obstetricians Obstetrics Patient safety Physical Sciences Pregnant women Public health Research and Analysis Methods Reviews Social aspects Stillbirth Time series Trends Womens health |
| title | 24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis |
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