• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Is It the Time of Day/Week or Staffing Experience that Impacts Labor Floor Outcomes?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Reif et al. (BJOG, 2017) assessed whether time of birth, unit volume, and staff seniority affected neonatal outcome among infants born ≥34w0d weeks

METHODS:

  • Population-based prospective cohort study
  • Participants: Singleton and multiple pregnancies ≥34w0d weeks
    • This gestational age cut-off used because it is the threshold found in multiple practice guidelines
  • Exposures: Time of birth | Unit volume | Staff seniority
  • Full staff size during 07:30 and 15:00 hours
    • Remaining hours were divided into an afternoon period (15:01–22:00 hours) and a night period (22:01–07:29 hours)
  • Staffing levels
    • Midwife only
    • Midwife plus intern or GP attending the delivery
    • Midwife plus ObGyn resident attending the delivery
    • Midwife plus consultant attending the delivery
  • Primary outcomes: Composite of ‘severely adverse outcomes’ measures
    • Blood pH of ≤7.00 | 5-minute Apgar score of ≤3 | Cardiac massage or CPR | Intrapartum or death within 7 days after birth
  • Secondary outcomes: Composite of ‘adverse outcomes’
    • Cord blood pH of ≤7.05 | 5-minute Apgar score ≤6 | NICU within 24 hours of birth | Respiratory support

RESULTS:

  • 87,065 neonates were included in the study
  • There were no significant differences in outcomes between weekdays and weekends
  • The risk for severely adverse events during the night-time (22:01–07:29 hours) compared with the daytime (07:30–15:00 hours) was significantly increased
    • Odds ratio (OR) 1.35 (95% CI 1.13–1.61)
  • Adverse and severely adverse neonatal outcomes were least common for midwife‐guided deliveries and increased with seniority of the staff
    • When correcting for severity of clinical situation, senior staff attending delivery and delivering in a tertiary center reduce the odds ratio for adverse events

CONCLUSION:

  • Pregnancies at night were most at risk for neonatal adverse outcome and may benefit from more balanced staffing
  • In high-risk pregnancies, more experienced staff favored a better outcome
  • Low-risk patients did not experience adverse outcomes when managed by more junior staff

Learn More – Primary Sources:

Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

image_pdfFavoriteLoadingFavorite

< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Does Changing Gloves Decrease Cesarean Wound Infection?
Social Media Distraction in the OR – Attention Must be Paid

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site