O'Donoghue K, Sheridan C P, O'Sullivan K, Greene R A, Higgins J R
Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital.
Ir Med J. 2008 Jul-Aug;101(7):205-7.
Several studies have reported time of birth is associated with differences in obstetric practice. We investigated the relationship between timing of birth and obstetric and neonatal outcomes, to help plan working patterns under European Working Time Directive (EWTD) legislation. This was a retrospective observational study undertaken in a tertiary-level university teaching hospital. Data were derived from the labour ward register of births for all women who delivered after 24weeks gestation in 2004. Births during on-call hours refer to those that occurred at weekends and after 1630 and before 0830 on weekdays. The majority of infants, 67.3%, were born in on-call hours. Infants were more likely to be delivered by ventouse(p<0.0001), but there was no difference in caesarean section(CS) rates. 83.0% of operative deliveries performed for failure to advance in the second stage of labour took place in on-call hours, as did 77.5% of emergency CS for fetal distress. 38.9% of infants born during on-call hours on weekdays followed induced labours, compared to 24.7% of births at weekends and 17.7% of births in non on-call hours(p<0.001), while 80.0% of deliveries by emergency CS after induction occurred during on-call hours. The majority of perinatal deaths occurred among infants born during on-call hours, even when excluding congenital malformations, and most infants with low Apgar scores were born during on-call hours. Complicated deliveries were more likely to occur in on-call hours. This study confirms previous reports that time of birth impacts on neonatal outcome. Increased demands on staff working out-of-hours have implications for healthcare, staffing and implementation of new working hours under EWTD legislation.
多项研究报告称出生时间与产科实践差异有关。我们调查了出生时间与产科及新生儿结局之间的关系，以帮助根据欧洲工作时间指令（EWTD）立法来规划工作模式。这是一项在三级大学教学医院进行的回顾性观察研究。数据来自2004年孕周24周后分娩的所有女性的产房产科登记册。值班时间内的分娩是指周末以及工作日16:30之后和08:30之前发生的分娩。大多数婴儿（67.3%）在值班时间内出生。婴儿更有可能通过胎头吸引术分娩（p<0.0001），但剖宫产（CS）率没有差异。因第二产程进展受阻而进行的手术分娩中有83.0%发生在值班时间内，因胎儿窘迫进行的急诊剖宫产中有77.5%也发生在值班时间内。工作日值班时间内出生的婴儿中有38.9%是引产分娩，而周末出生的这一比例为24.7%，非值班时间出生的为17.7%（p<0.001），而引产术后急诊剖宫产分娩中有80.0%发生在值班时间内。即使排除先天性畸形，大多数围产期死亡也发生在值班时间内出生的婴儿中，而且大多数阿氏评分低的婴儿也在值班时间内出生。复杂分娩更有可能发生在值班时间内。本研究证实了先前的报告，即出生时间会影响新生儿结局。对非工作时间工作人员需求的增加对医疗保健、人员配备以及EWTD立法下新工作时间的实施都有影响。
