Analysis of maternal and neonatal outcomes of emergency cesarean sections performed during daytime versus nighttime: A retrospective observational comparative study

Background: Emergency cesarean section (CS) is one of the most commonly performed life-saving obstetric procedures in modern obstetric practice. Maternal and neonatal outcomes following emergency cesarean delivery may vary according to the timing of surgery, severity of obstetric emergencies, and referral patterns. In tertiary referral hospitals, night time emergency cesarean sections are frequently associated with high-risk obstetric indications such as fetal distress, meconium-stained liquor, cephalopelvic disproportion in labor, prolonged rupture of membranes, previous LSCS in labor, antepartum hemorrhage, and referrals due to non-availability of cesarean section facilities at peripheral centers and First Referral Units (FRUs). Aim: To compare maternal and neonatal outcomes of emergency cesarean sections performed during daytime and nighttime in a tertiary care teaching hospital. Methods: This retrospective observational comparative study was conducted in the Department of Obstetrics and Gynecology Chamarajanagar institute of Medical Sciences over a one-year period (between Jan 2025 to Dec 2025). Medical records of women undergoing emergency cesarean section were reviewed. A total of 840 emergency cesarean sections were included in the study. Group A consisted of 640 daytime emergency cesarean sections performed between 8 AM and 8 PM, while Group B included 200 nighttime emergency cesarean sections performed between 8 PM and 8 AM. Maternal variables, neonatal outcomes, indications for surgery, operative complications, referral patterns, and intensive care requirements were analyzed. Results: Nighttime emergency cesarean sections were more frequently associated with severe obstetric emergencies including fetal distress, meconium-stained liquor prolonged PROM, CPD in labor, and previous cesarean section in labour and more. Referrals from peripheral FRUs were significantly higher during nighttime hours. Mean intraoperative blood loss, postpartum hemorrhage, maternal ICU admission, NICU admission, low APGAR scores, and neonatal mortality were comparatively higher in the nighttime group. However, the increased morbidity appeared to be predominantly related to the greater severity and urgency of obstetric emergencies rather than deficiencies in institutional care. Conclusion: Nighttime emergency cesarean sections were associated with slightly increased maternal and neonatal morbidity compared to daytime emergency surgeries. The increased adverse outcomes were primarily attributable to greater obstetric acuity and increased nighttime referrals from peripheral FRUs rather than differences in surgical expertise or quality of emergency obstetric care.