番茄社区

LAS VEGAS -- Rates of maternal and neonatal mortality and morbidities were higher on weekends than weekdays in the U.S., but there was no significant "July effect" observed by month of delivery, researchers said here.

In a retrospective study, the maternal mortality ratio was significantly higher on weekends than weekdays (21.4 versus 14.6 per 100,000 live births, P<0.01), reported , of Baylor College of Medicine in Houston, and colleagues.

"Several reports have addressed the concept of the 'weekend effect,' but none have directly examined this scenario in the U.S. with regards to obstetric care," said Moaddab at a at the Society for Maternal-Fetal Medicine (SMFM) annual meeting. He added that the U.S. has a maternal mortality rate "four-five times higher than any other high-resource nation," making this an important public health issue.

Rates of fetal death were also significantly higher on weekends. While the fetal mortality rate was 20.7 and 22.1 per 100,000 live births on Saturday and Sunday, respectively, Tuesday had the lowest fetal mortality rate (13.2 per 100,000 live births). Similar patterns were observed for maternal and neonatal morbidities, including admission to the neonatal intensive care unit and need for ventilation.

He also hypothesized about the underlying causes, which would be the same for all specialties; specifically, divided physician attention, lack of provider availability, provision of care by less experienced physicians or nurses and increased work hours.

However, there were no differences observed when examining maternal and fetal mortality and morbidity by month. Researchers were unable to find a "July effect" (when the house staff change), as the difference in maternal mortality ratio and fetal mortality ratio was non-significant when comparing July with other months.

Researchers examined maternal data from the CDC WONDER database, (which used data from all 50 states and Washington, and live birth and fetal death data from National Vital Statistics Service data from 2003-2013. Overall, there were a total of over 45 million live births, 7,210 maternal deaths, 277,886 fetal deaths.

There were lower rates of induction and caesarean delivery on the weekdays, as well as a greater proportion of infants with maternal complications delivered on the weekdays.

, of the University of Utah in Salt Lake City, said that several large database studies have suggested that adverse obstetric events are more common at weekend or at night.

"Teasing out whether weekend risk is higher in some studies because of differences in care or because of differences in patient characteristics is difficult but really important," Clark, who was not involved with the research, told 番茄社区 via email. "Sorting out why risk might be higher on the weekends is critically important, as it will determine whether expensive strategies that attempt to increase the quality of care, like increasing the number of staff, will work to reduce maternal and neonatal morbidity or whether the money should be better spent on other strategies."

But she also added that different researchers have come up with different conclusions on the subject. A separate at SMFM examined this issue by analyzing the Consortium on Safe Labor dataset, said Clark, and found no increase in maternal morbidity and only a slight increase in neonatal morbidity, which disappeared when only spontaneously laboring patients were analyzed.

Moaddab acknowledged that because their database was so large and approaching the size of the total population, it was possible that every relationship had statistical significance, and urged caution in assuming clinical significance of the results.