The MFMU Cesarean Registry: Impact of time of day on cesarean complications
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.
aDepartment of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH
bDepartment of Obstetrics and Gynecology, Ohio State University, Columbus, OH
cBiostatistics Center, George Washington University, Washington, DC
dDepartment of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
eNational Institute of Child Health and Human Development, Bethesda, MD
fDepartment of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
gDepartment of Obstetrics and Gynecology, University of Chicago, Chicago, IL
hDepartment of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
iDepartment of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC
jDepartment of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
kDepartment of Obstetrics and Gynecology, Wayne State University, Detroit, MI
lDepartment of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
mDepartment of Obstetrics and Gynecology, University of Miami, Miami, FL
nDepartment of Obstetrics and Gynecology, University of Tennessee, Memphis, TN
oDepartment of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX
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.
ABSTRACT