How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women

Abstract

ObjectivesAccess to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea.DesignNationwide cross-sectional study.SettingWe used the National Health Insurance System database of South Korea.ParticipantsWe analysed the data of 371 341 women who had experienced pregnancy in 2013.Primary and secondary outcome measuresAccess time to hospital was defined as the time required to travel from the patient’s home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT.ResultsThe OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41–50 min; preeclampsia, 51–60 min; placental abruption, 51–60 min; preterm delivery, 31–40 min; postpartum transfusion, 31–40 min; uterine artery embolisation, 31–40 min; admission to intensive care unit, 31–40 min; and caesarean hysterectomy, 31–40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT.ConclusionsOur results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality.

Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará

“…Travel time to the maternity hospital is a factor cited in the literature as important for carrying out adequate care management in a timely manner, reducing bad prognoses ( 22 ) . Greater distances and travel time may be associated with births that occur during the maternity hospital ( 23 ) as well as adverse birth outcomes, such as the need for admission to Intensive Care Units, postpartum transfusion, post-cesarean hysterectomy, among others ( 24 ) . In the USA, a cohort study carried out with a total of 662,245 birth records showed that greater distances to the birth hospital were associated with a greater risk of adverse maternal outcomes and admission to the Neonatal Intensive Care Unit ( 25 ) .…”

Fatores associados à peregrinação anteparto em maternidadede referência no Ceará

“…O tempo de deslocamento até a maternidade é um fator citado na literatura como importante para realizar o manejo adequado da assistência em tempo hábil, reduzindo os maus prognósticos (22) . Maiores distâncias e tempo de deslocamento podem ter associação com nascimentos ocorridos ainda no percurso da maternidade (23) , bem como desfechos adversos no parto, como necessidade de admissão em Unidades de Terapia Intensiva, transfusão pós-parto, histerectomia pós-cesariana, entre outros (24) . Nos EUA, estudo de coorte realizado com um total de 662.245 registros de nascimento evidenciou que maiores distâncias até o hospital de parto foram associadas a maior risco de desfechos maternos adversos e internação em Unidade de Terapia Intensiva Neonatal (25) .…”

Impact of maternal late hospital arrival on adverse outcome of offspring affected by placental abruption: A regional multicenter nested case–control study in Japan

“…To shorten TIME 1, the accessibility of patients to obstetrical institutions should be assured. Indeed, several epidemiological studies about the relationship between maternal travel time and pregnancy complications have been reported 19,20,21 ; however, there is no report about the maternal travel time focused on perinatal outcomes in placental abruption. Recently, the consolidation of dispersed functions of public delivery facilities has been initiated all over Japan for the reform of future work systems of obstetric health care workers.…”