Background and Aims When there is an immediate threat to maternal or fetal life, it is recommended to deliver within 30 min of the decision to have favorable perinatal outcomes. However, there is no data on the delivery intervals for Category‐I emergency cesarean section in Bhutan. The study evaluated the decision to delivery interval (DDI) and its effect on perinatal and maternal outcomes in Category‐I emergency cesarean section. Methods A retrospective cross‐sectional study was conducted at the Phuentsholing General Hospital, Bhutan, from January 1, 2020 to December 31, 2020. Mothers who underwent Category‐I emergency cesarean section were included. The demographic variables, patient transfer time, anesthesia time, operation time, DDI, and maternal and perinatal outcomes were recorded in a standard proforma. The data were analyzed using SPSS version 23. Results Of 78 Category‐I emergency cesarean sections, only 23 (29.5%) of the cases were able to perform within 30 min of the DDI. The median (interquartile range) DDI was 37 (30–44) min. More time was taken by anesthetists to administer anesthesia (20 [15–8] min). Fetal distress (40, 51.3%) was the commonest indication. The longest DDI was around 39 min for prolonged labor, and the shortest was 26 min for failed instrumental delivery. Over half of the newborns delivered more than 30 min of DDI had low APGAR scores (25, 32.1%) at 1 min and meconium was present (23, 29.5%). Intensive care was required in 11 (14.1%), of which there was 1 (1.3%) neonatal death. Conclusion The Category‐I emergency cesarean sections performed within recommended DDI of 30 min were much less. The main delay was due to the longer time taken for the patient transfer and time taken by the anesthetists to administer anesthesia. Perinatal outcomes were favorable when the deliveries were conducted within 30 min of DDI.
Background COVID‐19 pandemic has derailed health care services. The health resources and manpower were prioritized and diverted to curb the COVID‐19 infections at the cost of routine medical services to the people. The impact of the COVID‐19 pandemic on maternal and child health is unknown. This study aimed to assess the impact of the Covid‐19 pandemic on maternal and child health care services in Phuentsholing General Hospital. Methods A descriptive retrospective study was conducted at Phuentsholing General Hospital from January 1 to June 30, 2022. The patient medical records were reviewed for the prepandemic years 2018, and 2019, and the pandemic years 2020, and 2021. The medical records of all the female patients and newborns who came to the Maternal and Child Health Unit (MCH), those who were admitted to the gynecology ward, and who underwent obstetrical and gynecological surgeries were reviewed. The data were analyzed using SPSS version 23. Descriptive statistics such as frequencies and percentages were used to describe the study variables. The line graph and bar graph were used to determine the trends and to compare the impact of COVID‐19 on MCH services between the pre‐pandemic and pandemic years. Results During the COVID‐19 pandemic, the total admission dropped by 10% to 14.4%; the total deliveries dropped by 16.1%; Cesarean section rate dropped to 12.9%; and fewer gynecological surgeries were performed (13.9% from 20.6%). There was a significant drop in antenatal and postnatal follow‐up visits (31.5% and 24.51%) respectively; Pap smear dropped by 93% and colposcopy by 52%. The overall immunization coverage has dropped drastically during the pandemic period. Conclusion The pregnant mothers and newborn babies missed antenatal and postnatal follow‐up visits, missed immunization, and women were not able to be screened for cervical cancers during the pandemic. These negative impacts of the COVID‐19 pandemic on maternal and child health care were profound.
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