Births outside obstetric institutions up mortality risk
Hilde M. Engjom, M.D., from the University of Bergen in Norway, and colleagues assessed all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birth weight ≥500 g in order to assess peripartum mortality by place of birth and travel time to obstetric institutions.
The researchers identified 1,586 peripartum deaths (2.5 per 1,000 births). Compared with institutional births, unplanned birth outside an institution had a three-fold higher mortality (2.4 versus 8.4 per 1,000; relative risk, 3.5). The risk of unplanned birth outside an institution increased from 0.5 percent for less than one hour of travel time to 3.3 percent for one to two hours and 4.5 percent for more than two hours. For comparison, mortality rates at term in obstetric institutions ranged from 0.7 to 0.9 per 1,000.
"The results show the importance of skilled birth attendance and warrant attention from clinicians and policy makers to negative consequences of reduced access to institutions," the authors write.
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