Ratree J-Orh, MD¹, Thitayaporn Chimpleepuk, RN¹

Background: Pattani Province has long reported maternal and perinatal outcomes poorer than the national averages due to fragmented intrapartum services, delayed referrals, and limited access to obstetric specialists. High proportions of preventable maternal deaths in the southern-border region further highlighted the need for system-wide restructuring. The “One Labor Room, One Province” (OLOP) model was developed to integrate real-time specialist teleconsultation, standardized clinical guidelines, and a seamless referral pathway across district hospitals. Early performance led to Pattani becoming the first province in Thailand to receive Hospital Network Accreditation (HNA) for a province-wide obstetric service network, followed by Provincial Network Certification (PNC), confirming readiness for full-scale implementation.

Objective: To compare adverse maternal and perinatal outcomes Before and After implementation of the OLOP model.

Materials and Methods: A Before and After comparative analysis was conducted among referred deliveries to Pattani Provincial Hospital, including 2,357 cases in 2015 to 2017 (Before) and 2,990 cases in 2021 to 2023 (After). Categorical outcomes were analyzed using chi-square tests, with odds ratios (OR) and 95% confidence intervals (CI) calculated for the After versus Before periods.

Results: Following implementation, severe pregnancy-induced hypertension increased from 14.5% to 18.1% (OR 1.30, 95% CI 1.12 to 1.51), reflecting earlier detection and referral. Antepartum hemorrhage rose from 0.13% to 0.57% (OR 6.33, 95% CI 1.46 to 27.58), and NICU admissions increased from 21.7% to 24.3% (OR 1.16, 95% CI 1.02 to 1.32). Birth asphyxia decreased significantly from 6.41% to 4.35% (OR 0.66, 95% CI 0.52 to 0.85). Direct maternal mortality declined from 61.66 to 26.14 per 100,000 live births, consistent with improved timely referral and intrapartum management. Rates of preterm labor and thick meconium showed no statistically significant change.

Conclusion: Implementation of the OLOP model, grounded in an accredited provincial obstetric service network (HNA and PNC), enhanced early detection and referral of high-risk pregnancies while significantly reducing birth asphyxia and direct maternal mortality. Centralized specialist oversight combined with standardized referral pathways represents an effective system-level strategy for improving intrapartum safety in resource-limited provincial settings.

Received 5 September 2025 | Revised 4 December 2025 | Accepted 15 December 2025

DOI: 10.35755/jmedassocthai.2026.1.03205