Perinatal Mortality Rates.
The hospital is recognized for its Integrated Labour Ward Risk Management Programme, a comprehensive risk management programme that features speedy staff mobilization, constant reviews and audits, training as well as a computerized early-warning system. The programme identifies and manages potential risks in the delivery suite, thus helping to improve the safety of women in labour and their newborns.
So successful is the programme in ensuring patient safety that KKH’s perinatal mortality rate for 2005 is 4.92 per 1,000 births – one of the lowest in the world.
Eclampsia Rates
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 preterm 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.
Trends of Eclampsia in KKH
Period 1955 1957 1968 1981 1990-1993 1994-1999 1999-2003
Incidence per 100,000 deliveries 337.5 288.4 140 33.1 45.3 67.2 16.2
Risk of Eclampsia 1:296 1:348 1:715 1:3025 1:2270 1:1489 1:6160
Maternal Mortality – (%) 7.8 - - - 3.7 1.6 0
Perinatal Mortality – (%) 26 - - - - 9.7 - 0
Cesarean Section in KKH
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-min interval time between the decision and time of delivery for urgent Caesarean sections.
In 1997, KKH established a protocol named
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 Feb 2003 – Feb 2004 and it revealed that the hospital was able to achieve 100% of deliveries within 30mins with the protocol, reliably achieving the standards laid down by the Royal College of Obstetrics and Gynaecology.
1998 (1 year audit) 2003 (6 months audit)
Total no. of deliveries 16,267 7,512
Total no. of caesarean sections 3,367 1,728
Crash Caesarean 113 45
Mean Delivery Time (mins) 14.9 7.5
Patients delivered < 30 mins 112/113 45/45
