WEEKEND EFFECT ON OBSTETRIC REFERRAL PATTERNS AND MATERNAL–PERINATAL OUTCOMES AT SKIMS MCH, BEMINA, SRINAGAR: A ONE-YEAR COMPARATIVE OBSERVATIONAL STUDY
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Keywords
Weekend effect, obstetric referral, maternal outcomes, perinatal complications, tertiary care hospital, Kashmir
Abstract
The “weekend effect” refers to poorer clinical outcomes among patients admitted during weekends compared to weekdays. Multiple studies across various specialties have shown increased morbidity and mortality on weekends, potentially due to reduced staffing, limited diagnostic availability, and delays in treatment initiation. Obstetric patients are particularly vulnerable, as labour and delivery are time-sensitive and can occur at any time. Understanding whether a weekend effect exists in obstetric referrals is critical, especially in regions where referral systems play a central role in maternal healthcare.
Objective: To determine whether differences exist in obstetric referral patterns between weekdays and weekends, and to compare maternal and perinatal outcomes among referred patients based on the day of referral.
Methods: A one-year comparative observational study was conducted at SKIMS MCH, Bemina, Srinagar. All obstetric referrals from primary and secondary health facilities were included. Data were collected using a structured proforma. Arrival time, referral reason, treatment provided, maternal complications, and perinatal outcomes were recorded. Referrals were categorized as weekday (Monday–Friday) or weekend (Saturday–Sunday). Statistical analysis was performed using Chi-square and t-tests; p
Results: Of 1100 obstetric referrals, 78.1% occurred on weekdays and 21.9% on weekends. Non-medical reasons for referral (non-availability of doctors, NICU, or infrastructure) were significantly more common on weekends (73.0% vs. 65.1%; p=0.018). Maternal complications such as obstetric infection (adjusted OR ~1.4) and composite maternal adverse outcomes (adjusted OR ~1.3) were higher on weekends. Perinatal outcomes, including depressed Apgar score (adjusted OR ~1.5) and composite neonatal morbidity (adjusted OR ~1.4), were also worse among weekend referrals.
Conclusion: A weekend effect was observed in both referral patterns and maternal–perinatal outcomes. Timely identification, early intervention, continuous staffing, and strengthened referral systems—especially on weekends—are essential to improving maternal and neonatal outcomes.
References
2. Kaye D, Mirembe F, Aziga F, Namulema B. Maternal mortality and near-misses among emergency intrapartum referrals. East Afr Med J. 2003;80(3):144–149.
3. Nyamtema AS, Urassa DP, van Roosmalen J. Maternal health interventions in resource-limited countries. BMC Pregnancy Childbirth. 2011;11:30.
4. Chaturvedi S, Randive B, Diwan V, De Costa A. Quality of obstetric referral services in India. PLoS One. 2014;9(5):e96773.
5. MacFarlane A. Variations in births and perinatal mortality by day of week. Br Med J. 1978;2:1670–1673.
6. Aylin P, Bottle A, Majeed A, Bell D. Weekend mortality for emergency admissions. Qual Saf Health Care. 2010;19(3):213–217.
7. Bell D, Lambourne A, Percival F. Consultant input and outcomes. PLoS One. 2013;8(4):e61476.
8. Metcalfe D, et al. Weekend effect in emergency general surgery. J Surg Res. 2018;222:219–227.
9. Clark SL, et al. Obstetric intervention and temporal patterns. Obstet Gynecol. 2014;124(5):873–880.
10. Das A, et al. Delays and referral patterns in obstetric emergencies in India. Reprod Health. 2018;15:79.
11. Singh S, Doyle P, Campbell OMR. Interfacility transfer and maternal outcomes. Int J Gynaecol Obstet. 2014;126(3):256–260.
12. Pasupathy D, et al. Time of birth and neonatal death. BMJ. 2010;341:c3498.
13. Palmer WL, Bottle A, Aylin P. Day of delivery and obstetric outcomes. BMJ. 2015;351:h5774.
14. Gould JB, et al. Neonatal mortality and weekend births. JAMA. 2003;289:2958–2962.
15. Chauhan AR, Chamariya S, Prasad M. The Saturday effect in obstetrics. J Obstet Gynaecol India. 2018;68(2):148–150.
16. Knight M, et al. Saving Lives, Improving Mothers’ Care. UKOSS; 2019.
17. World Health Organization. Strategies toward ending preventable maternal mortality. WHO; 2015.
18. Hogan MC, et al. Maternal mortality worldwide. Lancet. 2010;375:1609–1623.
19. Rao P, et al. Delays in accessing emergency obstetric care in India. J Obstet Gynaecol India. 2018;68(3):201–207.
20. Main EK, et al. Hospital-level factors affecting maternal outcomes. Obstet Gynecol. 2016;128:485–492.
21. National Health Mission. Referral Transport Guidelines. MoHFW, India; 2017.
22. McConnell KJ, et al. Management practices and quality of care. JAMA Intern Med.
2013;173:684–692.
23. Bradley EH, et al. Hospital strategies to reduce mortality. Ann Intern Med. 2012;156:618–626.
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Dr Sieqa Shah
Associate Professor, Skims Medical College and Hospital, Bemina,
Dr Lakshmi Priya Harikrishnan
PG scholar, Department of OBG, Skims Medical College, Bemina, J&K,
Dr Fiza Amin
Senior resident, Skims Medical College, Bemina,
