Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
Am J Obstet Gynecol. 2019 Sep;221(3):257.e1-257.e9. doi: 10.1016/j.ajog.2019.04.034. Epub 2019 May 2.
Giving birth in a health care facility does not guarantee high-quality care or favorable outcomes. The working-hour phenomenon describes adverse outcomes of institutional births outside regular working hours.
The objectives of the study were to evaluate whether the time of birth is associated with adverse neonatal outcomes and to identify the riskiest time periods for obstetrical care.
This nationwide retrospective cohort study analyzed data from 2008 to 2016 from all 82 obstetric departments in Austria. Births at ≥ 23+0 gestational weeks with ≥500 g birthweight were included. Independent variables were categorized by the time of day vs night as core time (morning, day) and off hours (evening, nighttime periods 1-4). The composite primary outcome was adverse neonatal outcome, defined as arterial umbilical cord blood pH <7.2, 5 minute Apgar score <7, and/or admission to the neonatal intensive care unit. Multivariate logistic regression was used to develop a model to predict these adverse neonatal outcomes.
Of 462,947 births, 227,672 (49.2%) occurred during off hours and had a comparable distribution in all maternity units, regardless of volume (<500 births per year: 50.3% during core time vs 49.7% during off hours; ≥500 births per year: 50.7% core time vs 49.3% off hours; perinatal tertiary center: 51.2% core time vs 48.8% off hours). Furthermore, most women (35.8-35.9%) gave birth between 2:00 and 5:59 am (night periods 3 and 4). After adjustment for covariates, we found that adverse neonatal outcomes also occurred more frequently during these night periods 3 and 4, in addition to the early morning period (night 3: odds ratio, 1.05; 95% confidence interval, 1.03-1.08; P < .001; night 4: odds ratio, 1.08; 95% confidence interval, 1.05-1.10; P < .001; early morning period: odds ratio, 1.05; 95% confidence interval, 1.02-1.08; P < .001). The adjusted odds for adverse outcomes were lowest for births between 6:00 and 7:59 pm (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .006).
There is an increased risk of adverse neonatal outcomes when giving birth between 2:00 and 7:59 am. The so-called working-hour phenomenon is an attainable target to improve neonatal outcomes. Health care providers should ensure an optimal organizational framework during this time period.
在医疗机构分娩并不能保证高质量的护理或有利的结果。工作时间现象描述了非工作时间机构分娩的不良结果。
本研究的目的是评估分娩时间是否与不良新生儿结局相关，并确定产科护理风险最大的时间段。
这是一项全国性的回顾性队列研究，分析了 2008 年至 2016 年来自奥地利 82 个产科部门的所有数据。纳入≥23+0 孕周且出生体重≥500g 的分娩。自变量根据白天和夜间（核心时间：上午、白天）与夜间（傍晚、夜间 1-4 期）的时间进行分类。主要复合结局为不良新生儿结局，定义为脐动脉血 pH 值<7.2、5 分钟 Apgar 评分<7 和/或新生儿重症监护病房入院。采用多变量逻辑回归建立预测这些不良新生儿结局的模型。
在 462947 例分娩中，227672 例（49.2%）发生在非工作时间，所有产科单位的分布相似，与容量无关（<500 例/年：核心时间为 50.3%，非工作时间为 49.7%；≥500 例/年：核心时间为 50.7%，非工作时间为 49.3%；围产三级中心：核心时间为 51.2%，非工作时间为 48.8%）。此外，大多数妇女（35.8-35.9%）在凌晨 2 点至 5 点 59 分分娩（夜间 3 期和 4 期）。在调整了协变量后，我们发现除了清晨时段外，夜间 3 期和 4 期也更频繁地发生不良新生儿结局（夜间 3 期：比值比，1.05；95%置信区间，1.03-1.08；P<0.001；夜间 4 期：比值比，1.08；95%置信区间，1.05-1.10；P<0.001；清晨时段：比值比，1.05；95%置信区间，1.02-1.08；P<0.001）。下午 6 点至 7 点 59 分之间出生的不良结局调整后比值最低（比值比，0.96；95%置信区间，0.93-0.99；P=0.006）。
凌晨 2 点至 7 点 59 分之间分娩时，新生儿不良结局的风险增加。所谓的工作时间现象是改善新生儿结局的一个可实现的目标。医疗保健提供者应在此期间确保最佳的组织框架。
