BACKGROUND:Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes. METHODS:A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients' socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed for their association with time of delivery and prevalence of fresh stillbirth as a proxy for poor perinatal outcome at a significance level of p = 0.05. RESULTS:Off-hour deliveries were nearly twice as likely to occur during the night shift (odds ratio (OR), 1.62; 95% confidence interval (CI), 1.50-1.72), but were unlikely during the evening shift (OR, 0.58; 95% CI, 0.45-0.71) (all p < 0.001). Neonatal distress (O.R, 1.48, 95% CI; 1.07-2.04, p = 0.02), early neonatal deaths (OR, 1.70; 95% CI, 1.07-2.72, p = 0.03) and fresh stillbirths (OR, 1.95; 95% CI, 1.31-2.90, p = 0.001) were more significantly associated with deliveries occurring during night shifts compared to evening and morning shifts. However, fresh stillbirths occurring during the night shift were independently associated with antenatal admission from clinics or wards, referral from another hospital, and abnormal breech delivery (OR 1.9; 95% CI, 1.3-2.9, p = 0.001, for fresh stillbirths; OR, 5.0; 95% CI 1.7-8.3, p < 0.001, for antenatal admission; OR, 95% CI, 1.1-2.9, p < 0.001, for referral form another hospital; and OR 1.6; 95% CI 1.02-2.6, p = 0.004, for abnormal breech deliveries). CONCLUSION:Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of adverse perinatal outcomes, including low Apgar score, early neonatal death and fresh stillbirth, compared to morning and evening shifts. Labour room admissions from antenatal wards, referrals from another hospital and abnormal breech delivery were independent risk factors for poor perinatal outcome, particularly fresh stillbirths.

译文

背景:与办公时间相比,非工作时间不利于围产期结局的风险的证据不一致,因此有必要寻找明确的证据来证明出生时间与不良围产期结局之间的关联。
方法:在一家三级转诊医院进行的横断面研究比较了24小时内三个工作班次的围产期结局。使用检查表和调查表记录产妇的社会人口统计学和产科特征,分娩方式和围产期结局,包括第5分钟的Apgar评分和新生儿早期死亡率。不良结局的风险包括产妇年龄,胎次,转诊状况和分娩方式,并评估了它们与分娩时间和新鲜死产的发生率之间的关联,以作为围产期预后不良的指标,其显着性水平为p = 0.05。
结果:夜班期间的下班时间交付几率几乎翻倍(几率(OR)为1.62; 95%置信区间(CI)为1.50-1.72),但在晚班期间则不太可能出现(OR为0.58) ; 95%CI,0.45-0.71)(所有p <0.001)。新生儿窘迫(OR,1.48,95%CI; 1.07-2.04,p = 0.02),早期新生儿死亡(OR,1.70; 95%CI,1.07-2.72,p = 0.03)和新鲜死产(OR,1.95; 95% CI,1.31-2.90,p = 0.001)与夜班和早班相比,与夜班期间的分娩更显着相关。但是,夜班期间发生的新鲜死产与从诊所或病房的产前入院,从另一家医院转诊以及异常的臀位分娩独立相关(OR 1.9;新鲜死产的95%CI,1.3-2.9,p = 0.001;或者; 5.0; 95%CI 1.7-8.3,p <0.001(对于产前入院);或95%CI,1.1-2.9,p <0.001,对于从另一家医院转诊;或OR 1.6; 95%CI 1.02-2.6,p = 0.004,用于异常臀位)。
结论:与早班和晚班相比,非工作时间的分娩,特别是在夜班期间,与较高的围产期不良后果显着相关,包括低的Apgar评分,早期的新生儿死亡和新鲜的死产。从产前病房分娩,从另一家医院转诊以及异常的臀位分娩是围产期预后不良(尤其是新鲜死产)的独立危险因素。

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