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

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7132.657 (Published 28 February 1998) Cite this as: BMJ 1998;316:657
  1. Jane H Stewart, research midwife,
  2. Joan Andrews, consultant obstetrician,
  3. Patrick H T Cartlidge (cartlidge{at}cf.ac.uk), senior lecturer in child health
  1. Department of Child Health, University of Wales College of Medicine, Cardiff CF4 4XN
  1. Correspondence to: Dr Cartlidge
  • Accepted 21 November 1997

Abstract

Objectives: To investigate the relation between the timing of birth and the occurrence of death related to an intrapartum event.

Design: Analysis of 107 206 births to Welsh residents in 1993-5, including 608 cases of stillbirth and 407 of neonatal death identified in the all Wales perinatal survey, the cause of 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 cause of 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 of birth.

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 59 pm; relative risk (95% confidence interval) 2.18 (1.37 to 3.47). July and August births also had a higher death rate than births in other months; relative risk 1.99 (1.23 to 3.23). Weekend births had 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 overreliance on inexperienced staff at these times. Errors of judgment may also be related to physical and mental fatigue, demanding a more disciplined systematic approach at night. Mistakes may be ameliorated by increasing shiftwork, but shifts should be carefully designed to avoid undue disruption of circadian rhythms. In addition, greater supervision by senior staff may be required at night and during summer 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

Footnotes

  • Accepted 21 November 1997
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