Investigating the Factors Influencing the Duration of Beginning Delivery to Hospital Discharge using Cox Regression Model

Document Type : Original Article

Authors

1 Ph.D. Student of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran.

2 Associate Professor, Department of Midwifery, Research Center for Child and Maternity Care, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.

3 Professor, Department of Biostatistics and Epidemiology, Research Center of Health Sciences, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran.

4 B.Sc. Student of Midwifery, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.

Abstract

Introduction: Pregnancy and childbirth is a great experience in a woman's life. There are several factors that increase the rate of cesarean section such as patient unawareness, financial incentives and doctors' preferences. The aim of this study was to investigate the factors influencing the duration of beginning delivery to hospital discharge using Cox regression model in Fatemiyeh Hospital of Hamadan, Iran.
Methods: This study was a prospective historical cohort. Data on 11246 pregnancies were extracted by a researcher made checklist from the files in the records department of Fatemiyeh hospital of Hamadan, Iran during 2010-2012. The response variable was hospitalization duration due to childbirth. Data were analyzed using SAS (version 9.2) and SPSS (version 19) softwares, Kaplan-Meier method, log-rank test, Cox proportional hazards, Cox-Snell residual and Schoenefeld residual. P value less than 0.05 was considered significant.
Results: The mean age of women in normal vaginal and cesarean delivery groups were 25.68±6.27 and 27.17±6.23 years, respectively. The mean of birth weight in normal and cesarean delivery groups were 2984.71±601.92 and 3030.60±554.94 grams, respectively, Median of hospitalization duration in normal and cesarean delivery groups were 29.84±18.06 and 41.46±24.59 hours, respectively. Based on the log-rank test and Cox regression model, the differences of hospitalization duration were significant in the variables including maternal age, gestational age, birth weight, number of previous pregnancies and delivery method (p<0.05).
Conclusion: With increasing birth weight, duration of postpartum hospitalization increases. Also with increasing the number of previous pregnancies, duration of post partum hospitalization decreased. Finally duration of postpartum hospitalization in cesarean delivery method is more than normal vaginal delivery method.

Keywords

References

  1. 1 Shobeiri F, Mohammadi N, Nazari M. [The effect of some factors on duration of third stage of labor] [Article in Persian]. Sci J Hamadan Nurs Midwiufery Facul 2010;17(12): 9-19.
  2. Driessen M, Bouvier-Colle MH, Dupont C, Khoshnood B, Rudigoz RC, Deneux-Tharaux C. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 2011 Jan;117(1):21-31.
  3. Scott JR, di Saia PJ, Hammond CB, Spellacy WN. Labour,Delivery&Postpartum. In: Kirsten J, editor.Danforth's obstetrics & gynecology 8th ed. Philadelphia:Lippincott Williams & Wilkins;1999:123-138.
  4. Sonia N. Molina Jem too many sections. Am J Obstet Gynecol 2000;183:1144-51.
  5. Malone FD, Geary M, Chelmow D, Stronge J, Boylan P, D'Alton ME. Prolonged labor in nulliparas: lessons from the active management of labor. Obstet Gynecol 1996 Aug;88(2):211-5.
  6. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetrics. 23rd ed. New York:McGraw-Hill;2010.
  7. Rahnama P, Faghihzadeh S, Garshasbi E. [Admission primiparous women between the active and latent the rate of cesarean section delivery] [Article in Persian]. Tehran Univ Med J 2005 63(12):980-5.
  8. اACOG Practice Bulletin Number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol 2003 Dec;102(6):1445-54.
  9. Holmes P, Oppenheimer LW, Wen S. The relationship between cervical dilatation at initial presentation in labour and subsequent intervention. BJOG 2001 Nov;108(11):1120-4.
  10. Hemminki E, Simukka R. The timing of hospital admission and progress of labor. Eur J Obstet Gynecol Reprod Biol 1986 Jun;22(1-2):85-94.
  11. Alexander JM, MCIntire DD, Leveno KJ. Prolonged pregnancy: induction of labor and cesarean births. Obstet Gynecol 2001 Jun;97(6):911-5.
  12. Rafiee M, Ayatollahi MT, Bhbvdyan J, [A negative binomial model with accumulation than-expected performance in the analysis of zero maternal postpartum period] [Article in Persian]. Lorestan Univ Med Sci J 2004;23:47-58.
  13. Ravangard R, Arab M, Rashidian A, Akbarisari A, Niromand N, Mansouri S. [A study of patient length of stay in Tehran University of Medical Sciences Obstetrics and Gynecology Specialty Hospital and its associated clinical and nonclinical factors] [Article in Persian]. Hakim Res J 2010;13(2):59-66.
  14. Oteng-Ntim E, Kopeika J, Seed P, Wandiembe S, Doyle P. Impact of obesity on pregnancy outcome in different ethnic groups: calculating population attributable fractions. PLoS One 2013;8(1):e53749.
  15. Osava RH, Silva FM, Vasconcellos de Oliveira SM, Tuesta EF, Amaral MC. [Meconium-stained amniotic fluid and maternal and neonatal factors associated] [Article in Portuguese]. Rev Saude Publica 2012 Dec;46(6):1023- 9.
  16. Liu S, Heaman M, Kramer MS, Demissie K, Wen SW, Marcoux S. Length of hospital stay, obstetric conditions at childbirth, and maternal readmission: a population-based cohort study. Am J Obstet Gynecol 2002 Sep;187(3):681-7.
  17. Ravangard R, Arab M, Rashidian A, Akbarisari A, Zare A, Zeraati H. Comparison of the results of Cox proportional hazards model and parametric models in the study of length of stay in a tertiary teaching hospital in Tehran, Iran. Acta Med Iran 2011;49(10):650-8.

Files

Share

How to cite

Statistics