[Effect of birth timing on perinatal mortality]

Several reports show increased risk of perinatal/neonatal mortality for night time, weekend and holiday births. Intrapartum-related deaths were attributed to physical and mental fatigue, reduced availability of skilled and experienced staff and inadequate supervision by senior staff. The incidence of intrapartum and neonatal deaths related to intrapartum asphyxia is regarded to be a sensitive indicator of the quality of care during labor. Continuity of care is regarded as a major element in providing quality medical care. Several reports indicate the occurrences of potentially preventable adverse events which are associated with cross coverage by physicians who are less familiar with the patients than their usual providers. There is no conclusive evidence regarding clustering of high risk cases during night, weekend and holiday births. Clinical studies data suggests that resident work-hour restrictions have minimal impact on improving quality medical care. Carefully designed shift work, greater supervision by experienced staff and routine attendance of neonatologist should be considered in order to reduce early neonatal mortality during night times, weekends and holidays. More studies evaluating factors affecting birth outcome are needed.