Patient safety in maternity hospitals in Finland

The number of delivery units in Finland has been decreasing and care has been centralized to larger units. The main reasons for this are: the decreasing number of babies born annually, the legislation for 24/7 readiness for emergency Caesarean section and the legislation to close units with less than 1000 annual deliveries. To improve the obstetric care in Finland, this study investigated the influence of delivery unit size and physician on-call arrangements on the outcomes of low-risk deliveries, evaluated the impact of time and day of birth on neonatal asphyxia and intrapartum and early neonatal mortality, examined the effect of increased hospital volume on maternal and perinatal outcome in a high-volume delivery unit, and demonstrated the rate and causes of pregnancy-associated mortality. The risk of asphyxia was lower in units having ≥2000 deliveries annually (17/1000) than in university hospitals (21/1000) (AOR 0.83, 95% CI 0.78–0.89). Compared with university hospitals, in units having 1000-1999 annual deliveries, intrapartum mortality rate was higher (2.4/1000 vs. 2.9/1000) (AOR 1.31, 95% CI 1.07–1.61); this was also the case for units in which physicians were at home when on-call (3.0/1000) (AOR 1.25, 95% CI 1.02–1.52). The risk of asphyxia was higher (ARR 1.23, 95% CI 1.15–1.30) outside office hours (22.7/1000) than during office hours (18.4/1000). In emergency Caesarean sections, the risk of asphyxia was higher outside office hours (60.7/1000) than during office hours (52.9/1000, ARR 1.17, 95% CI 1.02–1.34). Instrumental vaginal delivery had higher risk of intrapartum and early neonatal mortality outside office hours (1.9/1000) than during office hours (0.6/1000, ARR 3.31, 95% CI 1.01–10.82). As the number of deliveries increased in the high-volume unit, the proportion of babies receiving 5-minute Apgar score