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).