Perinatal outcomes and care patterns after centralisation of acute obstetric care in three Dutch regions: a retrospective cohort study.

OBJECTIVE

To evaluate the impact of centralisation of acute obstetric care (AOC) on perinatal outcomes, care patterns, and obstetric interventions in three Dutch regions, while accounting for temporal trends.

STUDY

DESIGN

This retrospective cohort study used data from the Perined registry covering three regions that had closure of 24/7 obstetric units in 2018. Data were analysed for 1.5 years before and 1 year after centralisation. Perinatal outcomes included neonatal mortality, Apgar scores, prematurity, and postpartum haemorrhage. Care patterns and obstetric interventions comprised level of care, place of birth, mode of birth and induction of labour. Multivariable logistic regression analyses were performed, adjusting for ethnicity and time trends. We evaluated potential effect modification by time trends.

RESULTS

The effects of centralisation varied across regions. Region 1 showed an increased odds of an Apgar score <7 at 5 min (aOR 2.11, 95% CI 1.02-4.36) after centralisation. In Region 2 lower rates of neonatal mortality were observed based on unadjusted analyses restricted by a small sample size. After centralisation several care patterns changed: Region 1 had higher rates of midwife-led care, Region 2 showed increases in obstetrician-led care and unplanned caesarean sections, while Region 3 demonstrated higher rates of obstetrician-led care at labour onset alongside fewer birth centre deliveries.

CONCLUSION

Centralisation of AOC did not have consistent effects on perinatal outcomes, care patterns and obstetric interventions across Dutch regions. The heterogeneous findings suggest that local context and organisational responses substantially influence centralisation outcomes.