The effect of senior obstetric presence on maternal and neonatal outcomes in UK NHS maternity units: a systematic review and meta-analysis

Abstract

Background: There is little consensus regarding the hypothesised link between obstetric consultant presence and maternal and neonatal outcomes.

Objectives: 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.

Search strategy: Twelve databases, grey literature, and reference lists were searched.

Selection criteria: 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.

Data collection and analysis: 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.

Main 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.

Tweetable abstract: Increasing hours of NHS obstetric consultant presence may increase chance of non-instrumental vaginal delivery.

Keywords: Consultants; maternal outcomes; meta-analysis; neonatal outcomes; obstetrics.