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. 2021 Mar 31;16(3):e0249233.
doi: 10.1371/journal.pone.0249233. eCollection 2021.

24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis

Sharon Morad  1 , David Pitches  2 , Alan Girling  3 , Beck Taylor  3 , Vikki Fradd  4 , Christine MacArthur  3 , Sara Kenyon  3
Affiliations

24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis

Sharon Morad et al. PLoS One. .

Abstract

Objectives: To explore the effect of introducing 24/7 resident labour ward consultant presence on neonatal and maternal outcomes in a large obstetric unit in England.

Design: Retrospective time sequence analysis of routinely collected data.

Setting: Obstetric unit of large teaching hospital in England.

Participants: Women and babies delivered between1 July 2011 and 30 June 2017. Births <24 weeks gestation or by planned caesarean section were excluded.

Main outcome measures: The primary composite outcome comprised intrapartum stillbirth, neonatal death, babies requiring therapeutic hypothermia, or admission to neonatal intensive care within three hours of birth. Secondary outcomes included markers of neonatal and maternal morbidity. Planned subgroup analyses investigated gestation (<34 weeks; 34-36 weeks; ≥37 weeks) and time of day.

Results: 17324 babies delivered before and 16110 after 24/7 consultant presence. The prevalence of the primary outcome increased by 0.65%, from 2.07% (359/17324) before 24/7 consultant presence to 2.72% (438/16110, P < 0.001) after 24/7 consultant presence which was consistent with an upward trend over time already well established before 24/7 consultant presence began (OR 1.09 p.a.; CI 1.04 to 1.13). Overall, there was no change in this trend associated with the transition to 24/7. However, in babies born ≥37 weeks gestation, the upward trend was reversed after implementation of 24/7 (OR 0.67 p.a.; CI 0.49 to 0.93; P = 0.017). No substantial differences were shown in other outcomes or subgroups.

Conclusions: Overall, resident consultant obstetrician presence 24/7 on labour ward was not associated with a change in a pre-existing trend of increasing adverse infant outcomes. However, 24/7 presence was associated with a reversal in increasing adverse outcomes for term babies.

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Conflict of interest statement

Sharon Morad reports that she is married to one of the co-authors (DP). David Pitches reports that he is married to the corresponding author (SM). Alan Girling has nothing to disclose. Vikki Fradd has nothing to disclose. Beck Taylor reports funding from the NIHR during the study duration. Christine MacArthur reports funding from the NIHR during the study duration. Sara Kenyon reports funding from the NIHR during the study duration. Our competing interests statement does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Composite neonatal outcome by month of birth, and stratified by gestation.
The fitted lines are from (segmented) logistic regressions with a slope-change in July 2014 (i.e. when 24 hour cover was initiated). The increase over time is generally unaffected by 24-hour cover, except for full-term babies (Fig 1b) where the prevalence tends to fall after July 2014.
Fig 2
Fig 2. Median number of hours of consultant presence by size of UK maternity units responding to survey.
See this image and copyright information in PMC

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