Methods
With the approval of Siriraj Institutional Review Board, a retrospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, which is the largest university-based tertiary hospital in Thailand. A total of 300 pregnant women underwent emergency cesarean section were included. Study group consisted of 150 pregnant women underwent emergency cesarean section after implementation of the “code blue” protocol (during 2017-2018) and comparison group consisted of another 150 women before the implementation (during 2015-2016). Indications for emergency cesarean section included in this study were according to current institutional guideline which are abnormal fetal heart rate in NICHD Category III, hypovolemic shock, amniotic fluid embolism, umbilical cord prolapsed and uterine rupture.
Medical records were reviewed and related clinical information were extracted, including maternal characteristics, antenatal and intrapartum characteristics, indications for cesarean section, and neonatal outcomes. Time from decision until delivery in each woman was evaluated. Time intervals were determined, including decision-to-room interval (DRI), decision-to-incision interval (DII), and decision-to-delivery interval (DDI). The DDIs were classified into 3 groups, which are ≤30, 31–75 , and >75 minutes. 1,2,9
Descriptive statistics were used to describe various characteristics. Comparisons between groups were performed using Student’s t-test, Mann-Whitney U test, and chi square test, as appropriate. Subgroup analysis was also performed according to time of decision, either during or after office hours. P-values less than 0.05 were considered statistically significant. All statistical analyses were performed using IBM® SPSS® Statistics version 24 (IBM Corp., Armonk, NY, USA).