(1153) Do we practice delivery room obstetrics differently throughout the day? A retrospective cohort study

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Working long shifts affects the decision-making process of physicians and nurses. Adverse health consequences and serious medical errors are associated with both sleep deprivation and shift work. Doctors in Israel work 26-hour shifts, and this may affect how they practice medicine. We aimed to evaluate differences in obstetric management in the delivery room at different times of the day.

Study Design: We retrospectively reviewed computerized medical records of all patients who gave birth at our institution between 2012 and 2020. Elective cesarean deliveries (CD) were excluded. We divided parturients into three groups according to time of delivery – morning (08:00-16:00), evening (16:00-00:00) and night (00:00-08:00) – and compared data and outcomes between groups. These time slots coincide with midwives’ 8-hour shifts.

Results: A total of 41,408 deliveries following a trial of labor were included. Of them, 83.8% were vaginal deliveries (VD), 10.3% were assisted vaginal deliveries (AVD) and 5.1% were non-elective cesarean deliveries (CD). Only 30% of CDs were performed at night. For VDs, second stage of labor was shortest for the night group (30±35 minutes vs. 37±38 for morning and 35±36 for evening, p< 0.001). The largest proportion of AVDs took place in the morning (37% of AVDs). There was no difference in length of second stage of labor between the groups. For AVDs performed for non-reassuring fetal heart rate (NRFHR), the second stage of labor was shorter at night compared to other groups (83±63 minutes vs. 93±62 for morning, p=0.011; and 96±61 for evening, p< 0.001). A total of 2,130 CDs following a trial of labor were performed, of them 13.5% were performed at full dilatation. When examining common indication for CDs such as NRFHR and arrest of descent, there was no difference throughout the day.

Conclusion: In spite of long work hours, there does not seem to be a significant difference in the rate of major obstetric interventions such as operative or cesarean deliveries, or in their indications, throughout the day.

Primary & Presenting Author(s)

Shay Sukenik, MD, MHA
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel

Coauthor(s)

SD
Sarah Dollinger, MD, MHA
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel
Hadas Zafrir danieli, MD
Resident
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel
Ohad Houri, MD (he/him/his)
Doctor
Rabin Medical Center
Tel Aviv, Israel, Israel
EH
Eran Hadar, Prof.
Helen Schneider Hospital for Women, Rabin Medical Center
Kfar Sirkin, HaMerkaz, Israel