| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學研究所 === 96 === Objectives: Severe acute fetal distress (SAFD) is the most urgent event for the pregnant women in the delivery room, and the correct timing is most essential for the proper treatment. In this study, we approximated the critical time point (Distress-to-Delivery Time, DDT) between the finding of SAFD and the time of emergency delivery by screening the clinical data of patients with SAFD and investigated the prognostic factors for the patients, who received the emergency cesarean delivery (ECD).
Methods: This is a retrospective study collecting data of 349 patients, who had SAFD during pre-delivery and received Cesarean sections for the emergency delivery. The study period is from January 1, 2000 to April 30, 2008. A description and binominal analysis were performed according to maternity background, ECD, DDT, health condition of neonates, and Hospital facilities. The golden time for the proper ECD was approximated using Kaplan-Meier plot, and the prognostic factors for neonates were estimated by logistic regression.
Results: Calculated from 349 patients, the average DDT was 60.8 minutes, and the Decision to Delivery Interval (DDI), the time between obstetrician’s decisions to the incision, was 49.2 minutes. Using Kaplan-Meier plot, the reference golden time for DDT was approximated to 56 minutes, and that for DDI was 48 minutes. The health condition of neonates was positively correlated with (1) gestation weeks and (2) intervals between the mothers arrived at operation room and the initiation of anesthesia. However, it was negatively correlated with (1) intra-uterine growth retardation of fetus during prenatal examination, (2) method of general anesthesia, (3) the presence of meconium stain, (4) intervals between discovery of SAFD and the mothers arriving at operation room, (5) intervals between decision and the mothers arriving at operation room, (6) intervals between discovery of SAFD and the baby delivery time, and (7) intervals between decision and the baby delivery time.
Conclusions: The study results showed that health conditions of the neonates were significantly correlated with the timing of treatment. The multiple time points and their durations of DDT of this study could, therefore, affect the fetal survival. The previous other countries’ reports showed that when DDI was over 75 minutes, health conditions of the neonates would certainly turn worse. Our results showed that in Taiwan the average DDI is 49.2 minutes, and the time intervals are permissible for quality of obstetric care. If the DDI could be shortened to 35 minutes, survival rate of fetal care should be able to increase to 75%.
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