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Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study

BACKGROUND: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. METHODS: Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the...

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Autores principales: van der Kooy, Jacoba, Birnie, Erwin, Denktas, Semiha, Steegers, Eric A.P, Bonsel, Gouke J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/
https://www.ncbi.nlm.nih.gov/pubmed/28595580
http://dx.doi.org/10.1186/s12884-017-1348-y
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author van der Kooy, Jacoba
Birnie, Erwin
Denktas, Semiha
Steegers, Eric A.P
Bonsel, Gouke J.
author_facet van der Kooy, Jacoba
Birnie, Erwin
Denktas, Semiha
Steegers, Eric A.P
Bonsel, Gouke J.
author_sort van der Kooy, Jacoba
collection PubMed
description BACKGROUND: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. METHODS: Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000–2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. RESULTS: The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8–11.0 vs. 13.8% 95% CI 13.6–13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75–0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25–1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. CONCLUSIONS: The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.
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spelling pubmed-54654532017-06-09 Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study van der Kooy, Jacoba Birnie, Erwin Denktas, Semiha Steegers, Eric A.P Bonsel, Gouke J. BMC Pregnancy Childbirth Research Article BACKGROUND: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. METHODS: Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000–2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. RESULTS: The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8–11.0 vs. 13.8% 95% CI 13.6–13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75–0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25–1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. CONCLUSIONS: The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs. BioMed Central 2017-06-08 /pmc/articles/PMC5465453/ /pubmed/28595580 http://dx.doi.org/10.1186/s12884-017-1348-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
van der Kooy, Jacoba
Birnie, Erwin
Denktas, Semiha
Steegers, Eric A.P
Bonsel, Gouke J.
Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study
title Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study
title_full Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study
title_fullStr Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study
title_full_unstemmed Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study
title_short Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study
title_sort planned home compared with planned hospital births: mode of delivery and perinatal mortality rates, an observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465453/
https://www.ncbi.nlm.nih.gov/pubmed/28595580
http://dx.doi.org/10.1186/s12884-017-1348-y
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