American Journal of Obstetrics & Gynecology
Volume 195, Issue 4 , Pages 1132-1137, October 2006

The MFMU Cesarean Registry: Impact of time of day on cesarean complications

  • Jennifer L. Bailit, MD, MPH

      Affiliations

    • Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH
    • ,
  • Mark B. Landon, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
    • ,
  • Elizabeth Thom, PhD

      Affiliations

    • Biostatistics Center, George Washington University, Washington, DC
    • ,
  • Dwight J. Rouse, MD, MSPH

      Affiliations

    • Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Michael W. Varner, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
    • ,
  • Atef H. Moawad, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
    • ,
  • Margaret Harper, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC
    • ,
  • Ronald J. Wapner, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
    • ,
  • Yoram Sorokin, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Menachem Miodovnik, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
    • ,
  • Mary J. O'Sullivan, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Miami, Miami, FL
    • ,
  • Baha M. Sibai, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Tennessee, Memphis, TN
    • ,
  • Oded Langer, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX
    • ,
  • for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Received 10 March 2006; received in revised form 16 May 2006; accepted 1 June 2006. published online 28 July 2006.

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.

Key words: Cesarean delivery, Work shift, Maternal morbidity, Neonatal morbidity

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 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.

PII: S0002-9378(06)00703-4

doi:10.1016/j.ajog.2006.06.009

American Journal of Obstetrics & Gynecology
Volume 195, Issue 4 , Pages 1132-1137, October 2006

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