Abstract
Objective: To evaluate the effect of hospital closures on critical obstetrical interventions and perinatal outcomes in rural communities in Nova Scotia, Canada.Methods: A population-based cohort study was carried out for the years 1988 to 2002, using data extracted from the Nova Scotia Atlee Perinatal Database. Regions of maternai residence were defined geographically and administratively as Eastern, Northern, Western, and Central. The ti me periods of 1988 to 1993 and 1996 to 2002 were chosen based on the timing of hospital closures. Changes in rates of several perinatal outcornes were examined by region in relation to the extent of hospital closures experienced by that region.Results: The majority of hospital closures occurred in 1994 to 1995 with the establishment of new health regions, and affected the Western region most profoundly. ln comparison with the Central region (relative risk [RR], 0.56; 95% confidence interval [Cl], 0.53-0.59), the temporal reduction in the rate of forceps-assisted vaginal delivery was smaller in the Western region (RR, 0.83; 95% Cl, 0.76-0.91; P < .001 ), but greater in the Northern (RR, 0.36; 95% Cl, 0.32-0.41; P < .001) and Eastern (RR, 0.26; 95% Cl, 0.23-0.30; P < .00 1) regions. The temporal increase in the rate of breastfeeding at discharge from hospital was smaller in the Northern region (RR, 1.36; 95% Cl, 1.29-1.45; P < .001) compared to that in the Central region (RR, 1.55; 95% Cl, 1.49-1.61 ). The decrease in the rate of fetal growth restriction was smaller in the Western (RR, 0.95; 95% Cl, 0.87-1.02; P = .002) and Eastern (RR, 0.90; 95% Cl, 0.82-0.98; P = .002) regions of residence compared to the Central region (RR, 0.75; 95% Cl, 0.71-0.79). There were no significant regional differences in temporal patterns of preterm induction and/or preterm Caesarean delivery, or perinatal mortality.Conclusion: Although trends over time demonstrated sorne regional differences in obstetrical interventions and perinatal outcomes, our retrospective evaluation did not reveal a consistent relationship between reductions in maternity services associated with hospital closures and systematic, population-level adverse perinatal consequences in Nova Scotia.
| Original language | English |
|---|---|
| Pages (from-to) | 1077-1085 |
| Number of pages | 9 |
| Journal | Journal of Obstetrics and Gynaecology Canada |
| Volume | 26 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 2004 |
Bibliographical note
Funding Information:The authors would like to acknowledge the IWK Health Centre and the H. B. Arlee Foundation for financial support, and Pamela Zimmer, MHSA, Coordinator, Fetal Anomaly Database, for providing data on prenatal diagnosis and pregnancy terminations. Dr Joseph and Dr Dodds are supported by a Clinical Scholar award from the Faculty of Medicine, Dalhousie University. Dr Joseph is supported by a Peter Lougheed/CIHR New Investigator award from the Canadian Institutes of Health Research. Dr Dodds is supported by a New Investigator award from the Canadian Institutes of Health Research.
Publisher Copyright:
© 2004.
ASJC Scopus Subject Areas
- Obstetrics and Gynaecology