แนวโน้มและผลลัพธ์ของการผ่าตัดคลอดฉุกเฉินในโรงพยาบาลตติยภูมิ:  การวิเคราะห์ข้อมูลย้อนหลัง 3 ปี

Sarunya Sirisuwan; Wimoun Saengkaew; Nuttaya Pornmalairungruang

Authors

Sarunya Sirisuwan Ramathibodi Hospital, Faculty of Medicine, Mahidol University
Wimoun Saengkaew Ramathibodi Hospital, Faculty of Medicine, Mahidol University
Nuttaya Pornmalairungruang Ramathibodi Chakri Naruebodindra Hospital, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Keywords:

emergency cesarean section, decision-to-incision interval, neonatal outcomes, tertiary hospital

Abstract

Introduction: Emergency cesarean section is associated with risks of maternal and neonatal complications. The decision-to-incision interval (DDI) is a critical quality indicator for emergency obstetric care systems.

Research objectives: To examine trends, indications, DDI duration, and outcomes of emergency cesarean sections in a tertiary hospital.

Research methodology: A retrospective descriptive study was conducted using medical records of 800 patients who underwent emergency cesarean sections between 2021 and 2023. Data were analyzed using descriptive and inferential statistics.

Results: Emergency cesarean sections were evenly distributed over the three-years period. According to the Royal College of Obstetricians and Gynaecologists (RCOG) criteria, 20.10% of cases were Category 1, 49.30% were Category 2 and 30.60% were Category 3. Category 4 was excluded from the study. A total of 7.30% of cases could not be classified due to incomplete documentation. The main indications were failure to progress in labor (38.33%), fetal hypoxia (17.80%), and previous cesarean section (15%). The mean DDI was 66.05 minutes, longer than the standard. Factors associated with delays included occupied operating room, nighttime surgery, and anesthesia team unavailability NICU admission rates increased with DDI: 24.75% (DDI ≤ 60 minutes), 32.86% (DDI 61 - 90 minutes), and 41.50% (DDI > 90 minutes) (p < .001). After adjusting for confounding factors, DDI > 75 minutes increased the likelihood of NICU admission 2.23 - fold (95% CI: 1.45 - 3.42, p < .001).

Conclusions: DDI duration was longer than the standard and was associated with adverse neonatal outcomes. Delays were related to system limitations, including operating room unavailability, nighttime service delivery, and insufficient anesthesia team coverage.

Implications: Developing the measures to reduce DDI, including appropriate operating room allocation, enhanced anesthesia team availability, and implementation of standardized emergency response protocols. DDI should be used as a continuous quality indicator for emergency obstetric care in tertiary hospitals.

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