Target decision to delivery intervals for emergency caesarean section based on neonatal outcomes and three year follow-up.

Journal article

OBJECTIVE: To investigate current target decision to delivery intervals (DDIs) for 'emergency' caesarean section. STUDY DESIGN: Prospective observational cohort study in a teaching hospital providing district and tertiary maternity services delivering 6000 babies per annum. RESULTS: 68% Category 1 deliveries were achieved within 30min and 66% Category 2 within 75min (26% for antepartum Category 2 deliveries). Category 1 deliveries were quicker using general rather than regional anaesthesia (21 vs. 29min, odds ratio [OR] for delivery <30min 4.2, 95%CI 1.3-14.2). 8% Category 1 and 4% Category 2 neonates were acidotic or asphyxiated. The risk of acidosis was not reduced by delivery within 30min for Category 1 (OR 0.56; 0.11-2.81), or within 75min for Category 2 (OR 2.72; 0.6-25.1). Three babies were registered with developmental impairment by three years of age; none were Category 1 deliveries. CONCLUSIONS: Our data suggest that clinical triage is effective, with the more compromised fetus delivered more rapidly using general anaesthesia. For Category 1 deliveries a 30min target DDI is appropriate, although those born after longer DDI did not show developmental impairment. For Category 2 caesarean sections performed for acute fetal distress or concerns, failed instrumental delivery, failure to progress or placental bleeding, a 75min DDI may be an appropriate target but did not protect against acidosis, asphyxia or developmental impairment. Longer DDIs did not result in unfavourable outcomes for other Category 2 indications.

Authors: Pearson, G; Kelly, B; Russell, R; Dutton, S; Kurinczuk, J

• Publication status: Published
• Journal: European journal of obstetrics, gynecology, and reproductive biology
• Volume: 159
• Issue: 2
• Pages: 276-281
• Publication date: 2011-12-01
• DOI: 10.1016/j.ejogrb.2011.07.044
• EISSN: 1872-7654
• ISSN: 0301-2115
• Language: English
• Keywords: Prospective Studies; Child Development; Apgar Score; Acidosis; Humans; Triage; Cesarean Section; Infant, Newborn; Female; Time Factors; Pregnancy; Hospitals, Teaching; Male; Follow-Up Studies; Asphyxia Neonatorum; Anesthesia, Obstetrical; Pregnancy Complications; Pregnancy Outcome; Cohort Studies; Great Britain