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Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study
- Source :
- American Journal of Obstetrics and Gynecology, 210.e1-210.e12
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Background: Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. Objective: The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. Study Design: This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. Results: A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5–4.9) and contributed 2% (95% confidence interval, 1.2–3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time 2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. Conclusion: Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have an important impact on perinatal health in high-income countries and also for low-risk births. The results show the importance of skilled birth attendance and warrant attention from clinicians and policy makers to negative consequences of reduced access to institutions. publishedVersion
- Subjects :
- Adult
Male
0301 basic medicine
Pediatrics
medicine.medical_specialty
Referral
availability
Population
Psychological intervention
Risk Assessment
Birth rate
Young Adult
03 medical and health sciences
access
0302 clinical medicine
Pregnancy
medicine
Humans
030212 general & internal medicine
education
Perinatal Mortality
Retrospective Studies
education.field_of_study
030219 obstetrics & reproductive medicine
Norway
business.industry
Mortality rate
Infant, Newborn
Parturition
Obstetrics and Gynecology
Retrospective cohort study
General Medicine
Place of birth
Confidence interval
030104 developmental biology
perinatal mortality
Relative risk
Female
Health Facilities
emergency obstetric and newborn care
business
health systems
Demography
Subjects
Details
- ISSN :
- 00029378
- Volume :
- 217
- Database :
- OpenAIRE
- Journal :
- American Journal of Obstetrics and Gynecology
- Accession number :
- edsair.doi.dedup.....7ac4e18d660221f36762c9f226a7bdbd