The impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review

Reem Malouf, Claire Tomlinson, Jane Henderson, Charles Opondo, Peter Brocklehurst, Fiona Alderdice, Angaja Phalguni, Janine Dretzke

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To systematically review a) The effect of obstetric unit (OU) closures on maternal and
neonatal outcomes; b) The association between travel distance/time to an OU and maternal and
neonatal outcomes.
Design: Systematic review of any quantitative studies with a comparison group.
Data sources: Embase, MEDLINE, PsycINFO, Applied Social Science Index and Abstracts, CINAHL and
grey literature were searched.
Methods: Eligible studies explored the impact of closure of an OU or the effect of travel
distance/time on pre-specified maternal or neonatal outcomes. Only studies of women giving birth
in high-income countries with universal health coverage of maternity services comparable to the UK
were included. Identification of studies, extraction of data and risk of bias assessment were
undertaken by at least two reviewers independently. The risk of bias checklist was based on the
Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa scale
(NOS). Heterogeneity across studies precluded meta-analysis and synthesis was narrative, with key
findings tabulated.
Results: 31 studies met the inclusion criteria. There was some evidence to suggest an increase in
babies born before arrival (BBA) following OU closures and/or associated with longer travel
distances or time. This may be associated with an increased risk of perinatal or neonatal mortality,
but this finding was not consistent across studies. Evidence on other maternal and neonatal
outcomes was limited but did not suggest worse outcomes after closures or with longer travel
times/distances. Interpretation of findings for some studies was hampered by concerns around how
accurately exposures were measured, and/or a lack of adjustment for confounders or temporal
changes.


Conclusion: It is not possible to conclude from this review whether OU closure, increased travel
distances or times are associated with worse outcomes for the mother or the baby.
Prospero registration number: CRD42017078503.
Original languageEnglish
JournalBMJ open
Publication statusAccepted/In press - 22 Sept 2020

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