Goldstick Orly, Weissman Amir, Drugan Arie
Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
Isr Med Assoc J. 2003 Aug;5(8):564-6.
Even operative deliveries defined as "urgent" show marked diurnal variation with a significant increase during regular working hours.
To investigate the diurnal variation of urgent operative deliveries and its potential implications on the outcome of newborns.
We conducted a retrospective study of all deliveries in a public hospital from 1 January 1990 to 31 December 1998. Delivery mode variables analyzed were spontaneous vaginal delivery, urgent cesarean section and operative vaginal delivery. Deliveries were stratified hourly throughout the day. The rate of operative deliveries was calculated and the analysis was then performed according to the daily routine shifts of the medical staff. Birth weight and Apgar scores at 1 and 5 minutes were retrieved as outcome measures.
The rate of urgent cesarean deliveries increased significantly between 8 a.m. and 2 p.m. (150%-230%) from that predicted. The lowest rate of urgent cesarean sections was found between 5 a.m. and 6 a.m. (5.3%). Mean birth weight in spontaneous deliveries was higher in the morning hours than during the night shift (3,293 +/- 520 g vs. 3,277 +/- 510 g, respectively, P < 0.005). Apgar scores of newborns delivered by urgent cesarean section during the morning were higher compared to those delivered during night shifts and the rate of low Apgar scores was lower in the morning than in evening and night shifts.
Our results indicate a marked diurnal variation in urgent operative deliveries, caused perhaps by varying definition of "urgency" according to the time of day.
即使是定义为“紧急”的手术分娩也呈现出明显的日变化规律，在正常工作时间内显著增加。
研究紧急手术分娩的日变化规律及其对新生儿结局的潜在影响。
我们对一家公立医院1990年1月1日至1998年12月31日期间的所有分娩进行了回顾性研究。分析的分娩方式变量包括自然阴道分娩、紧急剖宫产和阴道助产。全天按小时对分娩进行分层。计算手术分娩率，然后根据医务人员的日常轮班情况进行分析。检索出生体重以及出生后1分钟和5分钟时的阿氏评分作为结局指标。
紧急剖宫产率在上午8点至下午2点之间比预测值显著增加（150%-230%）。紧急剖宫产率最低出现在凌晨5点至6点（5.3%）。自然分娩的平均出生体重在上午时段高于夜班时段（分别为3293±520克和3277±510克，P<0.005）。上午时段紧急剖宫产分娩的新生儿阿氏评分高于夜班时段分娩的新生儿，且上午时段低阿氏评分的发生率低于傍晚和夜班时段。
我们的结果表明紧急手术分娩存在明显的日变化规律，这可能是由于根据一天中的不同时间对“紧急程度”有不同定义所致。
