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PA.16 Maternal and neonatal outcomes after the amalgamation of two maternity units and consequent increased consultant labour ward presence: a retrospective population-based study
  1. FL Mackie1,
  2. F Afadapa2,
  3. J Moise3,
  4. O Amu2
  1. 1Obstetrics and Gynaecology Department, Birmingham Women’s Hospital, Birmingham, UK
  2. 2Obstetrics and Gynaecology Department, Royal Oldham Hospital, Oldham, UK
  3. 3Neonatal Department, Royal Oldham Hospital, Oldham, UK

Abstract

Objective To assess the effect on maternal and neonatal outcomes of the amalgamation of two maternity units (Category A and B) to form a C2 “super-centre”, and the subsequent increase in consultant labour ward cover from 40 h/week to 111 h/week.

Methods Pre- and post-amalgamation data were extracted from an electronic Maternity Information System and analysed using the relative risk.

Results N = 5422 deliveries pre-amalgamation, n = 5046 post-amalgamation. No significant difference was seen in mode of delivery, apart from an increase in the number of planned homebirths (RR 1.22 [1.01,1.46] p = 0.04), and attended homebirths (RR 1.26 [1.04,1.52] p = 0.02). There was a trend for a decrease in the number of failed instrumental deliveries (RR 0.86 [0.50,1.47] p = 0.58) but no change in success rate (RR 0.91 [0.80,1.03] p = 0.15), or emergency caesarean section rate (RR 0.96 [0.87, 1.06] p = 0.39) post-amalgamation. The only significant difference in outcomes was a 1% increase (RR 1.34 [1.09, 1.64] p = 0.005) in the number of unexpected transfers to the neonatal unit at >37 weeks gestation (p < 0.005). There was no difference in maternal transfers to the high-dependency unit, maternal deaths, or stillbirths.

Conclusions Amalgamation has improved maternal choice as there were significantly more planned/attended homebirths, however it has had little effect on maternal and neonatal outcomes in the hospital environment. Although the Royal College of Obstetrics and Gynaecologists advises 168 h/week obstetric consultant cover in large maternity units, there is conflicting evidence to support this and our data failed to demonstrate a positive effect of increased consultant presence.

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