Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Eur J Public Health. 2019 Dec 1;29(6):1031-1036. doi: 10.1093/eurpub/ckz013.
Severe maternal morbidity is an indicator for quality of maternal care. Recently, there has been growing interest in identifying which provision factors affect the quality of maternity care. The extent to off-hour delivery on SMM rates contributes to individual or provision factor in Korea has not been studied. This study aimed to determine the relationship between off-hour delivery and SMM during childbirth hospitalization.
This is a population-based retrospective cohort study. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 90 072 cases of delivery in Korea between 2003 and 2013. The main outcome was SMM which was determined using the Center for Disease Control and Prevention's algorithm. A generalized estimating equation model with log link was performed for the relationship with SMM and day/time of delivery adjusted covariates.
Of the 90 072 delivery cases, 2085 (2.31%) had SMM. Women who were on weekdays at night time or on weekend delivery had a higher risk of SMM compared with those who were on weekdays at daytime (RR 1.26, 95% CI 1.10-1.46, and RR 1.58, 95% CI 1.30-1.93, respectively).
Weekday at night time or weekend delivery was related to the risk of SMM. Policymakers should provide financial support and systematically allocate adequate human resources and labour facilities in vulnerable areas, as well as during weekends and night times to improve the quality of intrapartum and postpartum maternity care.
严重的孕产妇发病率是衡量孕产妇护理质量的一个指标。最近，人们越来越关注确定哪些供应因素会影响产妇护理质量。在韩国，分娩时的非工作时间分娩对严重孕产妇发病率的影响程度及其对个体或供应因素的影响尚未得到研究。本研究旨在确定分娩住院期间非工作时间分娩与严重的孕产妇发病率之间的关系。
这是一项基于人群的回顾性队列研究。数据从韩国国家健康保险服务-国家样本队列中提取，该队列包含了 2003 年至 2013 年间韩国 90072 例分娩病例。主要结局是使用疾病控制和预防中心的算法确定的严重的孕产妇发病率。使用广义估计方程模型和对数链接，对与严重的孕产妇发病率相关的分娩日/时间和调整后的协变量进行分析。
在 90072 例分娩病例中，有 2085 例（2.31%）发生了严重的孕产妇发病率。与工作日白天分娩的女性相比，工作日夜间或周末分娩的女性发生严重的孕产妇发病率的风险更高（RR 1.26，95%CI 1.10-1.46，和 RR 1.58，95%CI 1.30-1.93）。
工作日夜间或周末分娩与严重的孕产妇发病率的风险增加有关。政策制定者应提供财政支持，并系统地在脆弱地区以及周末和夜间时段分配足够的人力资源和劳动设施，以提高分娩和产后产妇护理的质量。
