Association Between Time of Day of Unscheduled Caesarean Section and Outcomes

Abstract

Objective: To evaluate the association between the time of day of unscheduled Caesarean section and maternal and perinatal outcomes.
Methods: This retrospective study was conducted at a regional hospital in Hong Kong. All unscheduled Caesarean sections performed between January 2014 and December 2016 were reviewed. Maternal outcomes included blood loss, postpartum haemorrhage, need for intra-operative blood transfusion, duration of operation, operative complications, postpartum fever, wound complications, and severe maternal morbidities. Perinatal outcomes included birthweight, Apgar scores, admission to the special care baby unit, birth trauma, stillbirths, and neonatal deaths. Data were stratified and compared according to three duty shifts: day shift (08:30-16:30), evening shift (16:31-00:30), and overnight shift (00:31-08:30).
Results: During the study period, 1631 unscheduled Caesarean sections were performed, accounting for 54.7% of all Caesarean sections. The highest proportion (40.4%) of unscheduled Caesarean sections were performed during the day shift. Blood loss was significantly more in the overnight shift than the day or evening shift (444 vs. 366 vs. 386 ml, p=0.005), although the rate of postpartum haemorrhage did not differ significantly. The rate of wound complications requiring re-suturing was higher in the overnight shift than the day or evening shift (3.2% vs. 0.3% vs. 0.16%, p<0.001). For perinatal outcomes, birthweight was lower in the day shift, probably related to the slightly earlier gestation at delivery (p<0.001). There were no significant differences among shifts in terms of Apgar score, special care baby unit admission, birth trauma, or perinatal mortality.
Conclusion: Unscheduled Caesarean sections performed during the overnight shift did not significantly increase maternal or perinatal complications. The current practice is safe for both mothers and neonates.