Date Published: June 10, 2019
Publisher: Public Library of Science
Author(s): Paul Eze, Lucky Osaheni Lawani, Chukwuemeka Ikechi Ukaegbe, Okechukwu Bonaventure Anozie, Chukwuemeka Anthony Iyoke, Sarah Saleem.
Nigeria account for a significant proportion of adverse perinatal outcome. Nigerian studies assessing impact of time of delivery on perinatal outcome are scarce. This study evaluates any associations between time of delivery and perinatal outcome.
This was a cross-sectional study at the Federal Teaching Hospital, Abakaliki from 01 January 2016 to 30 June 2018. Data were analysed with IBM SPSS version 25.0.
A total of 4,556 deliveries were analysed. Majority (72.2%) delivered on week days and 27.8% on weekends. Over 90% had 1st and 5th minutes Apgar scores ≥7. There was statistical difference in NICU admission between morning and evening hours (p = 0.009) but not between morning and night hours (p = 0.795). ENND during evening was twice higher (1.2%) than morning (0.5%); p = 0.047 and night hours (0.6%); p = 0.623.There was no difference in the risk of fresh stillbirths between morning and evening (p = 0.560), as well as morning and night hours (p = 0.75), there was also no difference in fresh stillbirths between week days and weekends (p = 0.895). There was no difference in low Apgar scores at 1st minute between morning and evening (p = 0.053) and night (p = 0.221), and between weekdays and weekends (p = 0.524). Similarly, there was no difference in low 5th minute Apgar scores between morning and evening (p = 0.165) and night (p = 0.944), as well as between week days and weekends (p = 0.529). However, ENND was twice (p = 0.085) and 1.3 times higher (p = 0.526) for evening and night hours respectively, while there was no difference between weekends and week days (p = 0.652).
NICU admission and ENND were commoner during evening hours. However, work hours did not affect the rate of stillbirth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and modify factors responsible for unfavourable outcomes during various shifts, with the aim of improving perinatal health.
Consistently delivering optimal care irrespective of the time or day of delivery is critical to sustaining the maternal and neonatal health gains achieved in the last decade, especially in resource-poor developing countries [1, 2]. Often times, there are unsubstantiated and non-evidence-based opinions among health care providers on whether labour and its outcome are associated with poorer results at night and over weekends, when hospital services may not be at their optimal best. While some scholars have reported that childbirth and its complication do not differentiate between hours of the day nor days of the week, others have reported contrary findings [3, 4]. The time of delivery may be regarded as an indirect indicator of organizational vulnerability, as conditions may be more suboptimal during evening and night or during weekend . There are reports that increased fatigue, limited access to senior obstetric support and reduced out-of-office hours resources are factors that could impact the quality of care particularly night shifts and to some extent weekends , as there may be fewer and less experienced doctors available on duty at nights and during the weekends .
This was a cross-sectional study of all the deliveries at the Federal Teaching Hospital, Abakaliki (FETHA) between 01 January, 2016 and 30 June, 2018. Ethical approval was given by the Ethics Review Board of the Federal Teaching Hospital, Abakaliki.
A total of 4,556 deliveries met the inclusion criteria and were also eligible for analysis. Fig 1: Flowchart for Selection of Study Cohorts depicts the total deliveries, selection of subjects and the numbers of subjects in each cohort. Table 1 shows that over 4/5th of parturient managed during the three different work hours was aged 20–34 years. Over 2/5th of participants in the three cohorts had secondary level of education. Most subjects (>80%) received at least one antenatal care from a skilled birth attendant. Over 4/5th of the participants had vaginal delivery, while the remainder had caesarean delivery (p = 0.449). The parity, gestational age at delivery and other socio-demographic characteristics are shown in Tables 1 and 2.
The current study determined if there were any significant differences in the perinatal outcomes; live birth, fresh stillbirth, Apgar scores, admission into NICU and ENND’s of term babies delivered during different work hours of the day and weekends. Overall, this study showed that NICU admission and ENND were commoner in neonates born during evening work hours. (4:00 pm to 11:59 pm) compared with those born during the morning hours (8:00 am to 3:59 pm). However, work hours did not affect the rate of still birth and Apgar scores during work days and between weekdays and weekends. Similar results were reported in hospitals in the Netherlands and in the United States of America [5, 18, 22, 25].
In conclusion, NICU admission and ENND were commoner during evening work hours. However, work hours did not affect the rate of still birth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and review factors responsible for unfavourable outcomes during various work hours, with the aim of correcting gaps to improve perinatal health outcomes and neonatal health indices.