Determining obstetric patient safety indicators: the differences in neonatal outcome measures between different‐sized delivery units. (3rd December 2013)

• Record Type: Journal Article
• Authors: Pyykönen, A; Gissler, M; Jakobsson, M; Petäjä, J; Tapper, A‐M
• Is Part Of: BJOG. Volume 121:Number 4(2014:Apr.)
• Page Start: 430
• Page End: 437
• Publication Date: 2013-12-03
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12507
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12507-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12507-sec-0001" sec-type="section"> <title>Objective</title> <p>To study the differences in neonatal outcome and treatment measures in Finnish obstetric units.</p> </sec> <sec id="bjo12507-sec-0002" sec-type="section"> <title>Design</title> <p>A registry study with Medical Birth Register data.</p> </sec> <sec id="bjo12507-sec-0003" sec-type="section"> <title>Setting and population</title> <p>All births (<italic>n</italic> = 2 94 726) in Finland from 2006 to 2010 with a focus on term, singleton non‐university deliveries.</p> </sec> <sec id="bjo12507-sec-0004" sec-type="section"> <title>Methods</title> <p>All 34 delivery units were grouped into small (below 1000), mid‐sized (1000–2999) and large (3000 or more) units, and the adverse outcome rates in neonates were compared using logistic regression.</p> </sec> <sec id="bjo12507-sec-0005" sec-type="section"> <title>Main outcome measures</title> <p>Early neonatal deaths, stillbirths, Apgar scores, arterial cord pH, Erb's paralysis, respirator treatment, the proportion of post‐term deliveries (gestational age beyond 42 weeks) and the proportion of newborns still hospitalised 7 days after delivery.</p> </sec> <sec id="bjo12507-sec-0006" sec-type="section"> <title>Results</title> <p>From an analysis of term, singleton non‐university deliveries, the early neonatal mortality was significantly higher in the small relative to the mid‐sized delivery units [odds ratio (OR), 2.07; 95% confidence interval (CI), 1.19–3.60]. The rate of Erb's paralysis was lowest in the large units (OR, 0.65; 95% CI, 0.50–0.84). The use of a respirator was more than two‐fold more common in large relative to mid‐sized units (OR, 2.38; 95% CI, 2.00–2.83). The proportion of post‐term deliveries was highest in the large units (OR, 1.36; 95% CI, 1.31–1.42), where a significantly higher percentage of post‐term newborns were still hospitalised after 7 days (OR, 1.50; 95% CI, 1.19–1.89).</p> </sec> <sec id="bjo12507-sec-0007" sec-type="section"> <title>Conclusions</title> <p>There are significant differences in several neonatal indicators dependent on the hospital size. An international consensus is needed on which indicators should be used.</p> </sec> </abstract>