Article Figures & Tables
Tables
- Table 1:
Characteristics of hospitals and pregnancies in communities with and without closures of local planned obstetric services in British Columbia, 1998–2014
Characteristic Median (IQR) or no. (%) Communities without closures Communities with closures Hospital No. of hospitals 12 21 Annual 1998 delivery volume* 48 (26–84) 29 (15–43) Next closest hospital with planned obstetric services Driving distance, km 107 (64–148) 79 (41–128) Driving time, min 72 (58–102) 58 (34–110) Rural Birth Index score 8 (8–10) 8 (6–10) Pregnancy Preclosure Postclosure No. of deliveries 8925 5796 6153 Delivery at local hospital 5064 (56.7) 2874 (49.6) 169 (2.7) Maternal age, yr 27 (23–31) 27 (23–31) 28 (24–32) Nulliparity 3725 (41.7) 2277 (39.3) 2507 (40.7) Pre-pregnancy BMI† 24 (21–28) 24 (21–28) 24 (21–27) Birthweight, g 3478 (3151–3800) 3502 (3170–3830) 3464 (3130–3795) Gestational age at delivery, wk 39 (38–40) 39 (38–40) 39 (38–40) - Table 2:
Risk of adverse pregnancy outcomes before and after closure of local planned obstetric services in British Columbia, 1998–2014
Outcome No. (risk per 100)* Estimated effect of closure Communities without closures Communities with closures (preclosure) Communities with closures (postclosure) Incidence rate ratio (95% CI) Excess adverse events per 100 deliveries (95% CI)* No. of deliveries 8925 5796 6153 Adverse Outcome Index 546 (6.1) 379 (6.5) 372 (6.0) 0.9 (0.7 to 1.2) −0.4 (−2.0 to 1.1) Severe components of Adverse Outcome Index† 25 (0.3) 15 (0.3) 12 (0.2) 0.6 (0.2 to 1.5) −0.1 (−0.4 to 0.1) Maternal transfer 117 (1.3) 58 (1.0) 55 (0.9) 1.1 (0.6 to 1.9) 0.1 (−0.5 to 0.7) Neonatal transfer 186 (2.1) 99 (1.7) 109 (1.8) 1.4 (0.9 to 2.0) 0.6 (−0.2 to 1.3) Maternal antepartum length of stay, median (IQR), h 5.1 (2.3–11.6) 5.7 (2.5–12.4) 5.7 (2.5–11.8) – 0.6 (0.1 to 1.0)‡ Cesarean delivery 2331 (26.1) 1387 (23.9) 1579 (25.7) 1.1 (0.98 to 1.2) 1.7 (−1.0 to 4.3) Instrumental delivery 681 (7.6) 528 (9.1) 536 (8.7) 1.0 (0.8 to 1.2) −0.3 (−2.0 to 1.6) Epidural use 1474 (16.5) 991 (17.1) 1436 (23.3) 1.2 (1.0 to 1.4) 3.4 (0.4 to 6.3) Labour induction 1776 (19.9) 1125 (19.4) 1417 (23.0) 1.1 (0.97 to 1.3) 2.4 (−0.4 to 5.1) Labour augmentation 3089 (34.6) 2100 (36.2) 2436 (39.6) 1.1 (0.99 to 1.2) 2.3 (−0.01 to 4.7) Out-of-hospital birth 309 (3.5) 30 (0.5) 109 (1.8) 1.9 (0.6 to 6.0) 0.1 (−1.5 to 1.7) - Table 3:
Adverse Outcome Index components before and after closure of local planned obstetric services in British Columbia, 1998–2014
Adverse Outcome Index component Severity points per adverse event No. (risk per 100)* Communities without closures Communities with closures Preclosure Postclosure No. of deliveries 8925 5796 6153 Maternal Maternal death† 750 < 5 (< 0.06) < 5 (< 0.09) < 5 (< 0.08) Uterine rupture† 100 9 (0.10) < 5 (< 0.09) 5 (0.08) Maternal ICU admission† 65 < 5 (< 0.06) < 5 (< 0.09) < 5 (< 0.08) Unanticipated operative procedure 40 57 (0.64) 74 (1.28) 70 (1.14) Blood transfusion 20 74 (0.83) 53 (0.91) 46 (0.75) Third- or fourth-degree perineal tear 5 208 (2.33) 136 (2.35) 174 (2.83) Fetal/neonatal Intrapartum stillbirth or in-hospital death of newborn ≥ 2500 g with no congenital anomalies or fetal hydrops 400 15 (0.17) 11 (0.19) < 5 (< 0.08) Birth trauma 60 24 (0.27) 22 (0.38) 12 (0.20) Neonatal ICU admission > 2 d or transfer within 24 h of birth to a facility with an ICU for newborn ≥ 2500 g 35 76 (0.85) 68 (1.17) 28 (0.46) 5-minute Apgar score < 7 25 149 (1.67) 71 (1.22) 85 (1.38) Weighted Adverse Outcome Score, mean‡ 2.19 2.69 1.67
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