The effect of senior obstetric presence on maternal and neonatal outcomes in UK NHS maternity units: a systematic review and meta-analysis.
BACKGROUND
There is little consensus regarding the hypothesised link between obstetric consultant presence and maternal and neonatal outcomes.


OBJECTIVE
To pool existing data on the impact of consultant presence on the outcomes of women who have given birth in UK National Health Service (NHS) maternity units.


METHODS
Twelve databases, grey literature, and reference lists were searched.


METHODS
Studies conducted in UK NHS maternity units comparing outcomes during lesser consultant presence versus increased consultant presence that reported mode of delivery and adverse maternal or neonatal outcomes.


METHODS
Studies were divided into three groups by type of comparison: (1) hours of rostered consultant presence during the weekend versus hours of rostered consultant presence during the week; (2) hours per week of rostered consultant presence pre-increase versus hours per week of rostered consultant presence post-increase; and (3) no rostered consultant presence versus rostered consultant presence. A random-effects meta-analysis was performed.


RESULTS
Fifteen studies fulfilled the inclusion criteria, presenting data from 125 856 births. Overall, there was no significant difference between lesser and increased consultant presence for any outcome. When data were stratified by comparison type, the likelihood of emergency caesarean section was significantly lower (odds ratio, OR 0.91; 95% confidence interval, 95% CI 0.86-0.96) and the likelihood of non-instrumental vaginal delivery was significantly higher (OR 1.07; 95% CI 1.02-1.12) when the rostered hours of consultant presence per week were increased.


CONCLUSIONS
Increased consultant presence has some effect on mode of delivery, but no evidence for a benefit for adverse outcomes was found.


CONCLUSIONS
Increasing hours of NHS obstetric consultant presence may increase chance of non-instrumental vaginal delivery.
Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.|Greater Manchester Mental Health NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.
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Reid
Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Hayes
Greater Manchester Mental Health NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.|Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Wittkowski
Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.|Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK.
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Vause
Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK.
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J
Whitcombe
Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.|Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK.
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Heazell
D003253:Consultants; D036861:Delivery, Obstetric / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency / Q000458:organization & administration*; D015233:Models, Statistical; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000628:therapy; D009774:Obstetrics / Q000193:education* / Q000379:methods / Q000458:organization & administration; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
Consultants; maternal outcomes; meta-analysis; neonatal outcomes; obstetrics