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Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia

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Název: Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia
Autoři: Tietjen, Sophia L., Schmitz, Marie-Therese, Heep, Andrea, Kocks, Andreas, Gerzen, Lydia, Schmid, Matthias, Gembruch, Ulrich, Merz, Waltraut M.
Zdroj: BMC Pregnancy Childbirth
BMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-11 (2021)
Informace o vydavateli: Springer Science and Business Media LLC, 2021.
Rok vydání: 2021
Témata: Patient Transfer, Matched-Pair Analysis, Case-control studies, Midwifery, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Germany, Humans, Prospective Studies, Research, Delivery Rooms, Infant, Newborn, Parturition, Pregnancy Outcome, Gynecology and obstetrics, Length of Stay, Delivery, Obstetric, Obstetric Labor Complications, 3. Good health, Obstetrics, Parity, Perinatal Care, Case-Control Studies, RG1-991, Female, Infant, Newborn [MeSH], Delivery, Obstetric/methods [MeSH], Length of Stay/statistics, Obstetric Labor Complications/epidemiology [MeSH], Prospective studies, Germany/epidemiology [MeSH], Delivery rooms, Patient Transfer/statistics, Case-Control Studies [MeSH], Female [MeSH], Humans [MeSH], Prospective Studies [MeSH], Parturition [MeSH], Pregnancy Outcome/epidemiology [MeSH], Parity [MeSH], Midwifery [MeSH], Matched-Pair Analysis [MeSH], Delivery, Obstetric/statistics, Perinatal Care [MeSH], Pregnancy [MeSH], Delivery Rooms/organization
Popis: Background Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. Methods A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar Results Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% – 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p Conclusion Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.
Druh dokumentu: Article
Conference object
Other literature type
Jazyk: English
ISSN: 1471-2393
DOI: 10.1186/s12884-021-04323-1
DOI: 10.21203/rs.3.rs-254841/v1
Přístupová URL adresa: https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-021-04323-1
https://pubmed.ncbi.nlm.nih.gov/34969368
https://doaj.org/article/5c19e3e39c224ea795fe8c7e67dffb36
https://www.researchsquare.com/article/rs-254841/v1.pdf?c=1631892765000
https://europepmc.org/article/PPR/PPR295085
https://www.researchsquare.com/article/rs-254841/v1
https://repository.publisso.de/resource/frl:6443514
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....bd36462d06d973ff907bed083e2f0492
Databáze: OpenAIRE
Popis
Abstrakt:Background Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. Methods A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar Results Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% – 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p Conclusion Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.
ISSN:14712393
DOI:10.1186/s12884-021-04323-1