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The impact of obstetric unit closures on maternal and infant pregnancy outcomes
Scott Lorch, Sindhu Srinivas, Corinne Ahlberg, Dylan Small
Abstract:
Objective: To define the association between large-scale obstetric unit closures and relative changes in maternal and neonatal
outcomes.
Data Sources/Study Setting: Birth and death certificates were linked to maternal and neonatal hospital discharge records for all
births between 1/1/1995 and 6/30/2005 in Philadelphia, which experienced the closure of 9 of 19 obstetric units between 1997 and
2005, and five surrounding counties and eight urban counties that did not experience a similar reduction in obstetric units.
Design: A before-and-after study design with an untreated control group compared changes in perinatal outcomes in Philadelphia to
five surrounding control counties and eight urban control counties after controlling for casemix differences and secular trends
(N=3,140,782).
Results: Relative to the pre-closure years, the difference in neonatal mortality (odds ratio (OR) 1.49, 95% CI 1.12-2.00) and all
perinatal mortality (OR 1.53, 95% CI 1.14-2.04) increased for Philadelphia residents compared to both control groups between 1997
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and 1999. After 2000, there was no statistically significant change in any outcome in Philadelphia county compared to the pre-closure
epoch.
Conclusions: Obstetric unit closures were initially associated with adverse changes in perinatal outcomes, but these outcomes
ameliorated over time.