Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5

BMJ 1998;316:657-660 ( 28 February )

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Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5

Editorial by Spencer

Jane H Stewart, research midwife, Joan Andrews, consultant obstetrician, Patrick H T Cartlidge, senior lecturer in child health.

Department of Child Health, University of Wales College of Medicine, Cardiff CF4 4XN

Correspondence to: Dr Cartlidge cartlidge{at}cf.ac.uk

Objectives: To investigate the relation between the timing of birth and the occurrence of death related to an intrapartumevent.
Design: Analysis of 107 206 births to Welsh residents in 1993-5, including 608 cases of stillbirth and 407 of neonataldeath identified in the all Wales perinatal survey, the causeof death classified with the clinicopathological system.
Subjects: 79 normally formed babies stillborn or who died in the neonatal period, birth weight >1499 g, for whom causeof death was related to an intrapartum event.
Main outcome measures: Relative risk of death due to an intrapartum event according to the hour, day, and month ofbirth.
Results: Mortality was higher in babies born between 9 00 pm and 8 59 am than in those born between 9 00 am and 8 59pm; relative risk (95% confidence interval) 2.18 (1.37 to 3.47).July and August births also had a higher death rate than birthsin other months; relative risk 1.99 (1.23 to 3.23). Weekend birthshad a higher death rate but it was not significant.
Conclusions: The excess of deaths at night and during months when annual leave is popular may indicate an overrelianceon inexperienced staff at these times. Errors of judgment mayalso be related to physical and mental fatigue, demanding a moredisciplined systematic approach at night. Mistakes may be amelioratedby increasing shiftwork, but shifts should be carefully designedto avoid undue disruption of circadian rhythms. In addition, greatersupervision by senior staff may be required at night and duringsummer months.

Key messages

In low risk pregnancies the incidence of death due to intrapartum asphyxia is regarded as a sensitive measure of the quality of perinatal care
Babies born at night and during summer months are at increased risk of death due to intrapartum asphyxia, raising concerns about variability in care around the time of delivery
Errors of judgment may be related to mental fatigue. Staff need to be aware of how their performance may vary, and a more disciplined systematic approach at night may be needed
Greater supervision by senior staff may be required at night and during summer months

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