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) |