Resident consultant obstetrician presence on the labour ward versus other models of consultant cover: a systematic review of intrapartum outcomes

Background Several key policy documents have advocated 24‐hour consultant obstetrician presence on the labour ward as a means of improving the safety of birth. However, it is unclear what published evidence exists comparing the outcomes of intrapartum care with 24‐hour consultant labour ward presenc...

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology Vol. 124; no. 9; pp. 1311 - 1320
Main Authors: Henderson, J, Kurinczuk, JJ, Knight, M
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01.08.2017
John Wiley and Sons Inc
Subjects:
Childbirth & labor
Clinical outcomes
Consultants
Data processing
Delivery
Delivery, Obstetric - education
Delivery, Obstetric - methods
Evidence-based medicine
Female
Health care delivery
Humans
Infant, Newborn
Internship and Residency - organization & administration
Obstetric Labor Complications - therapy
obstetric labour complications
obstetric/adverse effects
Obstetrics
Obstetrics - education
Obstetrics - methods
Obstetrics - organization & administration
Obstetrics and Gynecology Department, Hospital - organization & administration
obstetrics/organisation and administration
Patient Safety
Physicians
Pregnancy
Pregnancy Outcome
Systematic Review
Systematic Reviews
United Kingdom
Delivery
obstetrics/organisation and administration
obstetric/adverse effects
obstetric labour complications
ISSN:1470-0328, 1471-0528, 1471-0528
Online Access:Get full text
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Summary:Background Several key policy documents have advocated 24‐hour consultant obstetrician presence on the labour ward as a means of improving the safety of birth. However, it is unclear what published evidence exists comparing the outcomes of intrapartum care with 24‐hour consultant labour ward presence and other models of consultant cover. Objectives To collate and critically appraise evidence of the effect of continuous resident consultant obstetrician cover on the labour ward on outcomes of intrapartum care compared with other models of consultant cover. Search strategy Studies were included which quantitatively compared intrapartum outcomes for women and babies where continuous resident consultant obstetric cover was provided with other models of consultant cover. Selection criteria Quantitative studies within healthcare systems with mixed obstetric‐midwifery models of care. Data collection and analysis Two researchers independently screened titles and full‐text publications, extracted data and assessed the quality of included studies. Meta‐analysis was performed using REVIEW MANAGER 5.3. Main results About 1508 publications were screened resulting in two papers, three conference s and one letter being included. All were single‐site time‐period comparison studies. The quality of studies overall was poor with significant risk of bias. The only significant finding in meta‐analysis related to instrumental deliveries, which occurred more frequently when there was on‐call consultant cover (unadjusted risk ratio 1.14; 95% CI 1.04–1.24). Conclusion No reliable evidence of the effects of 24‐hour resident consultant presence on the labour ward on intrapartum outcomes was identified. Tweetable More robust research is needed to assess intrapartum outcomes with resident consultant labour ward presence. Tweetable More robust research is needed to assess intrapartum outcomes with resident consultant labour ward presence.
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Linked articles This article is commented on by WF Rayburn. To view this mini commentary visit https://doi.org/10.1111/1471-0528.14685. This article is also commented on by M Prior et al. To view this mini commentary visit https://doi.org/10.1111/1471-0528.14686.
ISSN:1470-0328
1471-0528
1471-0528
DOI:10.1111/1471-0528.14527