Transactions of the Twenty-Sixth Annual Meeting of the Society for Maternal-Fetal Medicine
The MFMU Cesarean Registry: Impact of time of day on cesarean complications

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Objective

Studies suggest that sleep deprivation adversely affects performance. We hypothesized that cesarean delivery complications would be more frequent during the night shift (11 pm-7 am), and evaluated morbidities by delivery shift.

Study design

Eighteen thousand nine hundred and thirty-nine term women undergoing an unscheduled cesarean delivery in 13 centers from 1999 to 2000 within a prospective observational study were included. Maternal/neonatal morbidities and time from decision to cesarean delivery were evaluated by time of delivery (7 am-3 pm, 3 pm-11 pm, 11 pm-7 am). A composite of maternal morbidities was evaluated by logistic regression controlling for potentially confounding factors.

Results

Controlling for age, race, insurance, cardiac disease, preeclampsia, diabetes, previous incision type, and prenatal care, shift of delivery had no impact on maternal morbidity (11 pm-7 am OR 0.9 [95% CI 0.81-1.0]). NICU admissions were slightly increased at night but neonatal complications were not.

Conclusion

Maternal and neonatal complications of cesarean delivery do not increase with delivery during the night shift.

Section snippets

Material and methods

Women undergoing an unscheduled cesarean delivery (CD) in 13 tertiary care teaching hospitals from 1999 to 2000 within a prospective observational study were included in this secondary analysis. The details of the original study from which the data were derived have been previously published.9 We included only term unscheduled cesareans because the day shift is more likely to have elective CDs, which are less likely to have complications and might skew the results. Term pregnancies were chosen

Results

There were 18,939 term patients delivered by unscheduled cesarean delivery during the study time period. Demographic and medical characteristics are seen in Table I. Characteristics do vary by shift of delivery. Though statistically significant, the differences seen appear to be of marginal clinical importance.

Even with a large sample size, there were no differences in maternal morbidity by shift (Table II). Multivariate analysis controlling for potential confounders found a slight reduction in

Comment

In this large multicenter observational study, we found no important differences in maternal or neonatal morbidity after unscheduled cesarean delivery according to work shift. This is in sharp contrast to the Gould study, which showed that neonatal outcomes were worse at night in the State of California.8 There are several possible explanations for our findings. (1) All obstetric teaching departments are required to have an attending physician on 24 hours a day. Many studies showing that errors

Acknowledgments

The authors would like to thank the following people for their contribution to the manuscript: protocol development and protocol/data management: Sharon Gilbert, MS; protocol development and coordination between clinical research centers: Frances Johnson, RN; and manuscript development: Brian M. Mercer, MD.

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Cited by (0)

Dr Bailit is supported by the Women's Reproductive Health Research (WRHR) Career Development Program; K12: HD98004.

Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, and HD36801).

Dr Wapner is now with Columbia University, New York, NY. Dr Miodovnik is now with Washington Hospital Center, Washington, DC. Dr Sibai is now with University of Cincinnati, Cincinnati, OH. Dr Langer is now with St Luke's-Roosevelt Hospital Center, New York, NY.

Presented at the Twenty-Sixth Annual Meeting of the Society for Maternal Fetal Medicine, Miami, FL, January 30-February 4, 2006.

Other members of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network are listed in the Appendix.

Reprints not available from the authors.

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