Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

Abstract

Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care.Design Population-based cohort study from 2000 up to and including 2006.Setting The Netherlands Perinatal Registry.Population A total of 751 926 singleton term hospital births. MethodsWe assessed the impact of travel time by car, calculated from the postal code of the woman's residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used.Main outcome measures Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit). ResultsThe mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time ( ‡20 minutes) and total mortality (OR 1.17, 95% CI 1.002-1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13-2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17-1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81-2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29-1.80) increased the risk of mortality.Conclusions A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care.

Availability and access in modern obstetric care: a retrospective population‐based study

“…When analysing the availability of institutions, we considered hourly time categories to be a realistic approach to the Norwegian demographics. In the Netherlands, an estimated travel time exceeding 20 minutes was associated with increased risk of adverse neonatal outcome in home deliveries with subsequent hospital transfer 11. Compared with a recent study from the USA, the proportion of women who lived outside the 1-hour travel zone was three times higher in Norway when including all obstetric institutions, and almost twice as high when including only emergency obstetric care institutions 27.…”

“…In obstetrics, however, delivery in large institutions has been associated with an increased frequency of interventions for low-risk women and the benefit for neonatal outcome in low-risk infants remains a matter of debate 1,9,10. With the exception of access to neonatal intensive care units and neonatal outcome, the availability of and access to obstetric institutions has received little attention in high-income countries 11,12. Treatment of obstetric complications requires skills and medical and technical resources, and thus access to institution-based care 13.…”

Obstetric Ethics

“…5 In addition, it has recently been reported (again, probably too late to be included in the College statement) that a transport time from the site of home birth to the hospital of greater than 20 minutes is associated with an increased risk of mortality and "adverse outcomes." 5,7 Two of the authors, who have practiced in the Netherlands and in Germany (B.A.) and in New York City (F.A.C.…”

A Model-Based Cost-Minimization Analysis as a Decision Tool in Obstetric Care in Helgeland, Northern Norway

“…In a Dutch study (Ravelli et al, 2011), the impact of travel time by car was analyzed. They revealed a positive relationship between travel time (>20 minutes) and mortality, neonatal mortality within 24 hours and with adverse outcomes.…”