Pre-eclampsia and eclampsia are diseases in pregnancy, which contribute significantly to maternal and foetal mortality and morbidity. Severe pre-eclampsia poses substantial risks for the obstetric patient and her baby. Utero-placental perfusion is severely compromised, which puts the fetus at high risk for problems such as pre-term birth and perinatal mortality. It may also lead to severe maternal hypertension and multi-systemic organ dysfunction and damage, including eclampsia and abruption placentae.
The incidence of eclampsia in KKH has dropped significantly from 101.3 per 100,000 births in 1995 to 6.9 per 100,000 deliveries in 2004. This rate is likely to be the lowest for a tertiary maternity hospital. The implementation of improvement strategies for the reduction of eclampsia, and an introduction of regular medical education for doctors involved in antenatal care of pre-eclampsia, have led to this low rate.
KKH's Cesarean section rate in 2005 was 27%, lower than most hospitals in Singapore.
In 1995, the Royal College of Obstetrics and Gynaecology published an organisational standard for maternity service in which they proposed a maximum 30-minute interval time between the decision and time of delivery for urgent Caesarean sections.
In 1997, KKH established a protocol named < Code Green > for extremely urgent Caesarean section (“crash” CS). Once the decision for “crash” CS was made, a public announcement system was used to activate the obstetrician, the anaesthetist, the neonatologist as well as the operating theatre staff that a “crash” CS was required.
Following this protocol, an internal audit was conducted by the hospital from February 2003 to February 2004 and it revealed that the hospital was able to achieve 100% of deliveries within 30mins with the < Code Green > protocol, reliably achieving the standards laid down by the Royal College of Obstetrics and Gynaecology.
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