Dataset Information

Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study.

ABSTRACT: The effect of timing of hospital admission for stillbirth delivery following late intrauterine fetal death (IUFD) has not yet been described. By this study, we aimed to gain an understanding of the impact of "immediate" (i.e., on the same day of IUFD diagnosis) versus "delayed" hospital admission (i.e., on the subsequent day or two days after IUFD diagnosis) on maternal and delivery outcome parameters. This retrospective cohort study comprised all women who suffered a singleton IUFD ≥ 21 gestational weeks and delivered the stillborn at our tertiary referral center between 2003 and 2019. We excluded all terminations of pregnancy and women presenting with acute symptoms on the day of IUFD diagnosis. In total, 183 women were included of whom 69.4% (n = 127) were immediately admitted and 30.6% (n = 56) had delayed admission. Median gestational age of IUFD was 30⁺³ (21⁺⁰-41⁺³) weeks. Whilst women with early signs of labor were more frequently admitted immediately (87.5%; 14/16), neither maternal demographic and obstetric parameters, nor day of the week or presenting symptoms influenced the timing of hospital admission. 77.6% (142/183) of women after IUFD diagnosis delivered within the first 3 days after admission. Women after immediate admission equally often delivered on admission day and the day after (26.0%; 33/127 each), women after delayed admission most commonly delivered the day after admission (39.3%; 22/56). Stillbirth delivery on the day of diagnosis was more common upon immediate admission (p = 0.006), especially in early gestational weeks (p = 0.003) and with small fetal weight (p < 0.001), requiring less induction of labor. No significant difference regarding delivery mode, labor duration, use of intrapartum analgesia, need for episiotomy and risk of perineal injury was observed between the groups. Also rate of intrapartum hemorrhage was independent of admission timing, although immediately admitted women experienced greater median blood loss after vaginal delivery. Maternal laboratory parameters (hemoglobin, thrombocytes and CRP) were independent of admission timing, except for higher levels of leucocytes, neutrophils and lymphocytes in immediately admitted women. Our study shows no clinical superiority of immediate hospital admission for stillbirth delivery. Under stable medical circumstances, it, therefore, seems feasible to allow the woman delayed admission for labor and delivery.

SUBMITTER: Muin DA

PROVIDER: S-EPMC8458494 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Background and aimsIt is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women's labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress.MethodsThis was a cohort study of 1,656 primiparous women aged 18-35 years with singleton pregnancies who began labor spontaneously at home and delivered at 52 hospitals in Pennsylvania, USA. Women who were admitted before their contractions had become regular and ≤ 5-minutes apart (early admits) were compared to those who were admitted after (later admits). Multivariable logistic regression models were used to assess associations between timing of hospital admission and active labor status on admission (cervical dilation 6-10 cm), oxytocin augmentation, epidural analgesia and cesarean birth.ResultsNearly two-thirds of the participants (65.3%) were later admits. These women had labored for a longer time period before admission (median, interquartile range [IQR] 5 hours (3-12 hours)) than the early admits (median, (IQR) 2 hours (1-8 hours), p < 0.001); were more likely to be in active labor on admission (adjusted OR [aOR] 3.78, 95% CI 2.47-5.81); and were less likely to experience labor augmentation with oxytocin (aOR 0.44, 95% CI 0.35-0.55); epidural analgesia (aOR 0.52, 95% CI 0.38-0.72); and cesarean birth (aOR 0.66, 95% CI 0.50-0.88).ConclusionsAmong primiparous women, those who labor at home until their contractions have become regular and ≤ 5-minutes apart are more likely to be in active labor on hospital admission and less likely to experience oxytocin augmentation, epidural analgesia and cesarean birth.

Project description:ObjectiveThe aim of this study is to assess whether the risk of postpartum readmission within 6 weeks of giving birth differs for women who had stillbirths compared with live births.Study designUsing data from the Office of Statewide Health Planning and Development in California, we performed a population-based cohort study of 7,398,640 births between 1999 and 2011. We identified diagnoses and procedures associated with the first postpartum hospital readmission that occurred within 6 weeks after giving birth. We used log-binomial models to estimate relative risk (RR) of postpartum readmission for women who had stillbirth compared with live birth deliveries, adjusting for maternal demographic, prepregnancy, pregnancy, and delivery characteristics.ResultsThe rate of postpartum readmission was higher among women who had stillbirths compared with women who had live births (206 and 96 per 10,000 births, respectively). After adjusting for maternal demographic and medical characteristics, the risk of postpartum readmission for women who had stillbirths was nearly 1.5 times greater (adjusted RR = 1.47, 95% confidence interval: 1.35-1.60) compared with live births. Among women with stillbirths, the most common indications at readmission were uterine infection or pelvic inflammatory disease, psychiatric conditions, hypertensive disorder, and urinary tract infection.ConclusionBased on our findings, women who have stillbirths are at higher risk of postpartum readmissions within 6 weeks of giving birth than women who have live births. Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications.Key points· Women who have stillbirths are at nearly 1.5 times greater risk of postpartum readmission than women who have live births.. · Uterine infections and pelvic inflammatory disease, and psychiatric conditions are the most common reasons for readmission among women who had a stillbirth.. · Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications..

Project description:Despite the critical role quality comprehensive emergency obstetric care (CEmOC) plays in ensuring safe motherhood, only a few studies have attempted to measure the impact of substandard and delayed care on maternal outcome thus far. This study evaluates the association between various process and timeliness indicators of CEmOC and adverse maternal outcome in Keren Hospital. This study compared women with potentially life-threatening condition (PLTC) and women with severe maternal outcome (SMO) with respect to various process and timeliness indicators. Logistic regression analysis was employed to assess the association of timeliness and process indicators with SMO using SPSS version-22 computer software. In this study, we included 491 cases of PLTC and 210 cases of SMO (171 maternal near misses and 39 maternal deaths). The following process indicators showed significant association with SMO: failure to give uterotonics for the treatment of postpartum hemorrhage, failure to administer prophylactic antibiotics, and delayed laporatomy for uterine rupture. Moreover, delays in referral, triaging, seeing an obstetrician, and receiving definitive treatement were strongly associated with SMO. The following causes of delay were also found to be independently associated with SMO: erroneous diagnosis, inappropriate management, multiple referrals between health facilities, unavailability of a senior obstetrician, and poor communication during referral. Among the miscellaneous factors, nighttime admission and referral during the rainy season showed significant association with SMO. Findings of this study indicate that huge gap exists in providing quality and timely care in Keren Hospital. In general, most incidents of substandard and delayed care were due to poor referral system, insufficiency of medical staff, inadequacy of drugs and equipment, and unavailability of standard management protocol. Improving the referral system, upgrading the technical skills of health professionals, making sure life-saving drugs and equipment are available all the time, and posting standard treatment and management protocols in the maternity and emergency rooms will play a vital role in reducing the occurrence of SMO in Keren Hospital.

Dataset Information

Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets