Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital

Effect of Decision-to-Delivery Time of Emergency Cesarean Section on Adverse Newborn Outcomes at East Gojjam Zone Public Hospital, Ethiopia, March 2023: Multicenter Prospective Observational Study Design

Background

An emergency cesarean section requires prompt delivery to reduce the risk for a pregnant woman or newborn. Studies have been conducted to investigate the relationship between decision-to-delivery time and neonatal outcomes, but the findings are contradictory. Therefore, this study aimed to assess the average of decision-to-delivery time of an emergency cesarean section and its effect on adverse neonatal outcomes at East Gojjam Zone Public Hospital.

Methods

A multicenter prospective study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 352 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. Measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05.

Results

Decision-to-delivery time interval within 30 minute was seen in 21.9% of emergency cesarean delivery. The study found a significant relationship between the first-minute low Apgar score and the delayed decision-to-delivery time interval (OR = 2.6, 95% CI: 1.1-6, p = 0.03). In addition, determinant factors for poor 1st-minute Apgar scores include danger signs during pregnancy (AOR: 2.9, 95% CI: 1.1-7.8, p = 0.03), women referred from another facility (AOR: 2.6, 95% CI: 1.5-4.6, p = 001), and non-reassuring fetal heart rate (AOR: 4.2, 95% CI: 1.1-17, p = 0.04). A delayed decision-to-delivery time interval is not statistically significantly associated with a low 5th-minute Apgar score or neonatal intensive care unit (NICU) admission.

Conclusion

The study found unfavorable 1st-minute Apgar score and a longer decision-to-delivery period than recommended. This duration and negative newborn outcomes may be reduced by increasing and involving comprehensive obstetric and neonatal care facilities with skilled emergency obstetric surgeons, such as clinical midwife, integrated emergency surgeon officers, and physician.

Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital

BACKGROUND

In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members.

OBJECTIVE

To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored.

METHODS

Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1-3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression.

RESULTS

Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13-2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32-0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001).

CONCLUSIONS

In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.

Analysis of the application effect of a rapid response team in emergency cesarean section

INTRODUCTION

Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical effect of constructing a Rapid Response Team (RRT) in emergency cesarean section.

METHODS

This is a pre- and post-implementation study. The patients who underwent emergency cesarean section were retrospectively analyzed and divided into an experimental group and a control group. There were 52 patients (June-December 2020) in the control group who underwent routine emergency cesarean section without an RRT, and 51 patients (January-June 2021) in the experimental group who underwent emergency cesarean section with an RRT. The operation time indexes (DOI, decision-to-operating room interval; O-I, operating room-to-incision interval; DII, decision-to-incision interval; I-D, incision-to-delivery interval; DDI, decision-to-delivery interval), DDI pass rate, neonatal Apgar score and maternal complications in the two groups were compared. Moreover, the management time trends (DOI, DII, and DDI) in the experimental group were analyzed.

RESULTS

The DDI, DII, DOI, and O-I of the experimental group were shorter than those of the control group, and the differences were significant (p < 0.05). The DDI pass rate in the experimental group was higher than that in the control group, and the difference was significant (p < 0.01). The 1-min Apgar score of the experimental group was higher than that of the control group (p < 0.05). The key intervals of emergency cesarean section in the experimental group leveled off after approximately 3 to 4 months.

CONCLUSION

In the face of emergency situations, the implementation of an emergency cesarean section RRT can improve delivery intervals for emergency cesarean and would be conducive to maternal and infant safety.

Prevalence, indications, and complications of caesarean section in health facilities across Nigeria: a systematic review and meta-analysis

BACKGROUND

Over 80,000 pregnant women died in Nigeria due to pregnancy-related complications in 2020. Evidence shows that if appropriately conducted, caesarean section (CS) reduces the odds of maternal death. In 2015, the World Health Organization (WHO), in a statement, proposed an optimal national prevalence of CS and recommended the use of Robson classification for classifying and determining intra-facility CS rates. We conducted this systematic review and meta-analysis to synthesise evidence on prevalence, indications, and complications of intra-facility CS in Nigeria.

METHODS

Four databases (African Journals Online, Directory of Open Access Journals, EBSCOhost, and PubMed) were systematically searched for relevant articles published from 2000 to 2022. Articles were screened following the PRISMA guidelines, and those meeting the study's inclusion criteria were retained for review. Quality assessment of included studies was conducted using a modified Joanna Briggs Institute's Critical Appraisal Checklist. Narrative synthesis of CS prevalence, indications, and complications as well as a meta-analysis of CS prevalence using R were conducted.

RESULTS

We retrieved 45 articles, with most (33 (64.4%)) being assessed as high quality. The overall prevalence of CS in facilities across Nigeria was 17.6%. We identified a higher prevalence of emergency CS (75.9%) compared to elective CS (24.3%). We also identified a significantly higher CS prevalence in facilities in the south (25.5%) compared to the north (10.6%). Furthermore, we observed a 10.7% increase in intra-facility CS prevalence following the implementation of the WHO statement. However, none of the studies adopted the Robson classification of CS to determine intra-facility CS rates. In addition, neither hierarchy of care (tertiary or secondary) nor type of facility (public or private) significantly influenced intra-facility CS prevalence. The commonest indications for a CS were previous scar/CS (3.5-33.5%) and pregnancy-related hypertensive disorders (5.5-30.0%), while anaemia (6.4-57.1%) was the most reported complication.

CONCLUSION

There are disparities in the prevalence, indications, and complications of CS in facilities across the geopolitical zones of Nigeria, suggestive of concurrent overuse and underuse. There is a need for comprehensive solutions to optimise CS provision tailor-made for zones in Nigeria. Furthermore, future research needs to adopt current guidelines to improve comparison of CS rates.

Blood reservation and utilisation practice for Caesarean section in Ilorin, Nigeria

Most blood units routinely cross-matched for patients undergoing Caesarean section (CS) in Nigeria are not used for transfusion. Over-ordering increases blood wastage, blood bank running costs, surgery costs and waiting times. A one-year review of all CS performed in the University of Ilorin Teaching Hospital (UITH), Nigeria, was thus conducted to evaluate blood reservation and utilisation practice. Efficiency of blood utilisation was evaluated using a cross-match to transfusion (C/T) ratio, transfusion probability (TP) and transfusion index (TI). The overall C/T ratio, TP and blood wastage were, respectively, 3.1, 24.6%, and 68%, indicative of inefficient blood utilisation. Establishing a Maximal Surgical Blood Order Schedule (MSBOS), which estimates the units of blood required for specific CS indications, is recommended to minimise blood over-ordering. Blood grouping alone should be done for patients at low risk for transfusion. For moderate risk patients, blood type and screen without cross-matching should be done, reserving cross-matching for high-risk patients.

A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section

The achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section (CS) is relatively low in developing countries. This study was aimed to compare DDI in emergency CS before and after the implementation of a specific care process improvement protocol, called 'code blue'. A total of 300 women underwent emergency CS were included; 150 consecutive cases before (during 2015-2016) and the other 150 consecutive cases after (during 2017-2018) 'code blue' implementation. Timing of decision-to-delivery process was compared. The results showed that median DDI was significantly shorter after 'code blue' implementation (22 vs. 52.5 minutes, p<.001). DDI of ≤30 minutes was achieved in 80% of the women under 'code blue' compared to 8% before implementation (p<.001). Significant improvements were observed regardless of decision time. Pregnancy and neonatal outcomes were comparable between the two periods. The implementation of 'code blue' protocol for emergency CS results in significantly shorter DDI and other time intervals.Impact StatementWhat is already known on this subject? Achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section is relatively low in developing countries. Various setting-specific care improvement processes have been reported to shorten DDI.What do the results of this study add? A multidisciplinary care improvement process ('code blue') that developed according to specific evidence and based on a hospital's context can significantly shorten DDI as well as other time intervals in women requiring emergency CS.What are the implications of these findings for clinical practice and/or further research? The 'code blue' protocol could be used as a model for other hospitals and health care settings to develop their own specific quality improvement process in order to shorten DDI for emergency CS. Collaboration and communication between all staff members could help in better identification of significant barriers as well as development of appropriate solutions. Further studies are also needed to determine whether the shortened DDI could improve neonatal outcomes.

Effect of decision to delivery interval on perinatal outcomes during emergency cesarean deliveries in Ethiopia: A prospective cohort study

Background

The National guidelines of most developed countries suggest a target of 30 minutes of the decision to delivery interval for emergency cesarean section. Such guidelines may not be feasible in poorly resourced countries and busy obstetric settings. It is generally accepted that the decision to delivery interval should be kept to the minimum time achievable to prevent adverse outcomes. Therefore, this study aimed to determine the average decision to delivery interval and its effect on perinatal outcomes in emergency cesarean section.

Methods

A prospective cohort study was conducted from May to July 2020 at Bahir Dar City Public Hospitals. A total of 182 participants were enrolled, and data were collected using a structured and pre-tested questionnaire. A systematic sampling technique was applied to select the study subjects. Data were cleaned and entered into Epi-Data version 4.6 and exported to SPSS version 25 software for analysis. Logistic regression analysis was performed to identify predictors of outcome variables, and variables with a p-value of <0.05 were considered statistically significant.

Results

The average decision to delivery interval was 43.73 ±10.55 minutes. Anesthesia time [AOR = 2.1, 95%CI = (1.3–8.4)], and category of emergency cesarean section [AOR = 3, 95% CI = (2.1–11.5)] were predictors of decision to delivery interval. The prolonged decision to delivery interval had a statistically significant association with composite adverse perinatal outcomes (odds ratio [OR] = 1.8, 95% confidence interval [CI] = (1.2–6.5).

Conclusion

The average decision to delivery interval was longer than the recommended time. It should always be considered an important factor contributing to perinatal outcomes. Therefore, to prevent neonatal morbidity and mortality, a time-dependent action is needed.

Defining the decision-to-delivery interval at caesarean section: narrative literature review and proposal for standardisation

The decision-to-delivery interval is a widely used term at non-elective caesarean section. While the definition may appear self-evident, there is no universally agreed consensus about when this period begins and ends. We reviewed the literature for original research utilising the terms 'decision-to-delivery', 'decision-to-incision' or 'incision-to-delivery' and examined definitions used for decision, delivery, incision, as well as any additional time intervals that were assessed. Our analysis demonstrated an inconsistent non-standardised approach to defining these intervals, which might have clinical practice and medicolegal ramifications. We propose that the decision-to-delivery interval should be defined as follows: the interval between the time at which the senior obstetrician makes the decision that a caesarean section is required and the time at which the fetus (or first fetus in the case of multiples) is delivered. The decision time should ideally be recorded contemporaneously in the medical notes or partogram.

Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study

Background

Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD.

Methods

A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant.

Results

The overall mean DDI was 233.99±132.61 minutes (range 44–725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes.

Conclusion

Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI.

Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020

PURPOSE

Although its fetal outcomes and practicality are unclear time interval between decision-to-delivery ≤30 minutes in emergency caesarean section (CS) is the internationally accepted standard of practice. This study aimed to determine whether a decision to delivery interval (DDI) of approximately 30 minutes was achieved in daily practice, its fetal outcomes, and associated factors among emergency caesarean section delivery at South Gondar Zone Hospitals, Northwest Ethiopia.

PATIENTS AND METHODS

Retrospective cross-sectional study was carried out from August 1-30/2020 among emergency caesarean sections. Information was collected from the birth register book and individual files of standardized facility booking forms. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. A bivariable and multivariable logistic regression analysis was conducted and a significant association was recorded at p<0.05.

RESULTS

Only 17.5% of parturients attained a decision-to-delivery interval ≤30 minutes. The average median of decision to delivery interval was 54 minutes with interquartile range (IQR) of 48-80 minutes. Time taken to collect material with Adjusted odds ratio (AOR=10.3, 95% CI 5.87-45.7), time of decision (AOR=0.32, 95% CI, 0.15-0.67), and time taken from decision to delivery to delivery of anesthesia (AOR=4.74, 95% CI, 1.30-17.3) were the predictors of prolonged delivery time interval. Significant fetal adverse outcomes were not observed in a decision to delivery interval higher than 30 minutes.

CONCLUSION

In most cases, delivery was not completed within the prescribed ≤30-minutes interval, particularly in developing countries with infrastructural challenges, however, fetal outcomes were not directly correlated. Despite lack of substantial linkage between the delivery time declaration and fetal events, an unreasonable gap from the decision-making to birth of the child is not appropriate and should be discouraged.

Decision to delivery interval and associated factors for emergency cesarean section: a cross-sectional study

Background

Emergency cesarean section is a commonly performed surgical procedure in pregnant women with life-threatening conditions of the mother and/or fetus. According to the Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists, decision to delivery interval for emergency cesarean sections should be within 30 min. It is an indicator of quality of care in maternity service, and if prolonged, it constitutes a third-degree delay. This study aimed to assess the decision to delivery interval and associated factors for emergency cesarean section in Bahir Dar City Public Hospitals, Ethiopia.

Method

An institution-based cross-sectional study was conducted at Bahir Dar City Public Hospitals from February to May 2020. Study participants were selected using a systematic random sampling technique. A combination of observations and interviews was used to collect the data. Data entry and analysis were performed using Epi-data version 3.1 and SPSS version 25, respectively. Statistical significance was set at p < 0.05.

Result

Decision-to-delivery interval below 30 min was observed in 20.3% [95% CI = 15.90–24.70%] of emergency cesarean section. The results showed that referral status [AOR = 2.5, 95% CI = 1.26–5.00], time of day of emergency cesarean section [AOR = 2.5, 95%CI = 1.26–4.92], status of surgeons [AOR = 2.95, 95%CI = 1.30–6.70], type of anesthesia [AOR = 4, 95% CI = 1.60–10.00] and transfer time [AOR = 5.26, 95% CI = 2.65–10.46] were factors significantly associated with the decision to delivery interval.

Conclusion

Decision-to-delivery intervals were not achieved within the recommended time interval. Therefore, to address institutional delays in emergency cesarean section, providers and facilities should be better prepared in advance and ready for rapid emergency action.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03706-8.

Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement

Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.

Decision-to-Delivery Time and Perinatal Complications in Emergency Cesarean Section

BACKGROUND

A decision-to-delivery interval (DDI) of no more than 20 minutes has long been considered a requirement for cesarean sections, even though there have hardly been any studies on this topic. We retrospectively investigated data relevant to DDI for emergency cesarean sections performed for the most common indications, namely, suspected and documented fetal asphyxia.

METHODS

We analyzed data on emergency in-hospital cesarean sections in the period 2008-2015. Low 5- and 10-minute Apgar scores (a scheme with points awarded for breathing, heart rate, muscle tone, skin coloration, and the elicitability of reflexes) were the primary endpoints; acid-base status in arterial cord blood and in-hospital neonatal death were the secondary endpoints. The raw analysis was supplemented by an analysis adjusted for various factors including gestational age, maternal age, and obstetrical presentation.

RESULTS

Data from 39 291 neonates were included. The DDI was up to 10 minutes in 64.6% of cases, from 11 to 20 minutes in 34.3%, and over 20 minutes in 1.1%. Low Apgar scores were less common in children whose emergency cesarean sections were performed within 10 minutes or within 20 minutes. For example, the adjusted odds ratio for a 10-minute Apgar score below 4 was 0.49 (95% confidence interval [0.25; 0.96] when a DDI of more than 20 minutes was used as the reference criterion.

CONCLUSION

This is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so.

Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand

Objective

To determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and associated factors.

Methods

A total of 431 pregnant women who were indicated for emergency cesarean delivery were included. Clinical information and timing of process after decision until delivery and pregnancy outcomes were evaluated.

Results

Mean age was 30 years, and 59.4% were nulliparous. Mean gestational age at delivery was 37.9 weeks. The decision was made during normal office hour in 33.2%. Median decision-to-operating room interval, decision-to-incision interval, and DDIs were 45, 70, and 82 minutes, respectively. Only 3.5% of patients had DDI ≤30 minutes, while 52.0% had DDI >75 minutes. During after office hours, every time interval was significantly shorter and 4.9% had DDI ≤30 minutes compared to 0.7% in normal office hours (P=0.001). Compared to other indications, time intervals were significantly shorter in those with non-reassuring fetal heart rate (FHR), and DDI ≤30 minutes was achieved in 18.8% vs. 0.8% (P<0.001). Shortest DDI was observed among those with non-reassuring FHR during after office hours. Neonatal outcomes were comparable between different DDIs.

Conclusion

Only 3.5% of emergency cesarean delivery had a DDI ≤30 minutes (median 82 minutes). Significant shorter time intervals were observed in those with non-reassuring FHR during after office hours.

The decision delivery interval in emergency caesarean section and its associated maternal and fetal outcomes at a referral hospital in northern Tanzania: a cross-sectional study

Background

Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania.

Methods

This was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant.

Results

A total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40–120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5^thminute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63–1.64) and hospital stay (OR: 1.02; 95% 0.63–1.64).

Conclusions

Contrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the urgency of caesarean section in order to prevent maternal and neonatal morbidity and mortality.

Decision-to-delivery interval in pregnant women with intrapartum non-reassuring fetal heart rate patterns

RATIONALE, AIMS AND OBJECTIVES

It has been proposed that delivery should be accomplished within 30 minutes after diagnosis of fetal distress. The objective of this study was to determine the decision-to-delivery interval (DDI) in emergency caesarean delivery for non-reassuring fetal heart rate (FHR).

METHODS

A total of 272 term, singleton pregnant women who underwent an emergency caesarean section for non-reassuring FHR were included. Patient characteristics and clinical data were reviewed. The timing of the decision-to-delivery process was reviewed.

RESULTS

The mean age was 28.7 years; the mean gestational age at delivery was 38.4 weeks; and 93.7% were in FHR category 2. The decision for emergency caesarean delivery was made during normal office hours in 31.6%. Median time for decision-to-operating room, decision-to-incision and decision-to-delivery was 42.3, 48.5 and 56 minutes, respectively. Only 6.6% of women had a DDI of <30 minutes, whereas 30.5% had a DDI of >75 minutes. Significantly shorter intervals were observed for every endpoint among patients in FHR category 3, and they were significantly more likely to deliver within 30 minutes than were those in FHR category 2 (41.2% vs. 4.3%, P < 0.001). Similar results were observed for cases that occurred during normal and after hours. Neonatal outcomes were comparable among different DDI categories.

CONCLUSION

Only 6.6% of women with non-reassuring FHR achieved the 30-minute goal for caesarean delivery (median 56 minutes). Better performance was observed among patients in FHR category 3 regardless of diagnosis time, with 41.2% of these patients having a DDI of <30 minutes.