Maternal-Fetal Medicine Units Network cesarean registry: impact of shift change on cesarean complications.
OBJECTIVE
This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery.


METHODS
17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6 AM-8 AM, 2 PM-4 PM, 10 PM-12 AM vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 AM-8 AM, 5 PM-7 PM vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors.


RESULTS
Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08).


CONCLUSIONS
Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.
Bailit
Jennifer L
JL
Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA.
Landon
Mark B
MB
Lai
Yinglei
Y
Rouse
Dwight J
DJ
Spong
Catherine Y
CY
Varner
Michael W
MW
Moawad
Atef H
AH
Simhan
Hyagriv N
HN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
O'Sullivan
Mary Jo
MJ
Sibai
Baha M
BM
Langer
Oded
O
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D020220:Facial Nerve Injuries; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009726:Nurses; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D010820:Physicians; D011247:Pregnancy; D011446:Prospective Studies; D012042:Registries; D014481:United States / Q000453:epidemiology; D014940:Work Schedule Tolerance