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Availability and access in modern obstetric care: a retrospective population‐based study
Objective To assess the availability of obstetric institutions, the risk of unplanned delivery outside an institution and maternal morbidity in a national setting in which the number of institutions declined from 95 to 51 during 30 years. Design Retrospective population‐based, three cohorts and two...
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Published in: | BJOG : an international journal of obstetrics and gynaecology 2014-02, Vol.121 (3), p.290-299 |
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Main Authors: | , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Objective
To assess the availability of obstetric institutions, the risk of unplanned delivery outside an institution and maternal morbidity in a national setting in which the number of institutions declined from 95 to 51 during 30 years.
Design
Retrospective population‐based, three cohorts and two cross‐sectional analyses.
Setting
Census data, Statistics Norway. The Medical Birth Registry of Norway from 1979 to 2009.
Population
Women (15–49 years), 2000 (n = 1 050 269) and 2010 (n = 1 127 665). Women who delivered during the period 1979–2009 (n = 1 807 714).
Methods
Geographic Information Systems software for travel zone calculations. Cross‐table and multiple logistic regression analysis of change over time and regional differences. World Health Organization Emergency Obstetric and Newborn Care (EmOC) indicators.
Main outcome measures
Proportion of women living outside the 1‐hour travel zone to obstetric institutions. Risk of unplanned delivery outside obstetric institutions. Maternal morbidity.
Results
The proportion of women living outside the 1‐hour zone for all obstetric institutions increased from 7.9% to 8.8% from 2000 to 2010 (relative risk, 1.1; 95% confidence interval, 1.11–1.12), and for emergency obstetric care from 11.0% to 12.1% (relative risk, 1.1; 95% confidence interval, 1.09–1.11). The risk of unplanned delivery outside institutions increased from 0.4% in 1979–83 to 0.7% in 2004–09 (adjusted odds ratio, 2.0; 95% confidence interval, 1.9–2.2). Maternal morbidity increased from 1.7% in 2000 to 2.2% in 2009 (adjusted odds ratio, 1.4; 95% confidence interval, 1.2–1.5) and the regional differences increased.
Conclusions
The availability of and access to obstetric institutions was reduced and we did not observe the expected decrease in maternal morbidity following the centralisation. |
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ISSN: | 1470-0328 1471-0528 |
DOI: | 10.1111/1471-0528.12510 |