Evaluating the Decision-to-Delivery Interval in Emergency Cesarean Sections and its Impact on Neonatal Outcome

Abstract

Background/Aim: In Germany, performance of an emergency Cesarean section (ECS) is recommended within an interval of ≤20 min from decision to delivery (DDI). The aim of the study was to assess the duration of DDI in ECS as well as its impact on neonatal outcome. Patients and Methods: Data from 437 patients at a single, tertiary care hospital were retrospectively analysed regarding influence on the duration of DDI. Subsequently the impact of DDI on neonatal outcome and incidence of adverse neonatal outcome was analysed. Results: DDI of ECS performed outside core working hours was significantly prolonged (p<0.001). Shorter DDI showed a statistically worse arterial cord blood pH (p=0.001, r=0.162) and base excess (p=0.05; r=0.094). Duration of DDI had no significant impact on the incidence of adverse neonatal outcome (p=0.123). Conclusion: Awareness of influence on DDI might contribute to expediting DDI, but duration of DDI showed no impact on the incidence of adverse neonatal outcome. Data were not adequate to suggest a recommendation for DDI time standards.Cesarean section is the most commonly performed major surgery in obstetrics. In an emergency its immediate performance seems to be necessary in order to minimize the risk of permanent fetal damages and to prevent fatal complications. Emergency Cesarean section (ECS) is required in approximately 1% of pregnancies (1).In Germany the time interval from indicating an ECS until the actual delivery of the neonate, also known as decision to delivery interval (DDI), is recommended to be ≤20 min (2).

To Determine the Decision to Delivery Interval in Category I Emergency Caesarean Sections in A Tertiary Care Hospital of Peshawar

“…10 Likewise it was responsible for delay in most cases in a study by Brandt JA. 13 Non availability of Caesarean medications and consumables was the cause of delay in 16% of cases, according to our study, whereas it was the most common reason for the delay in a few other studies. 14,15,16 15% of patients could not provide investigations in the time leading to delay in their surgery.…”

Decision to delivery interval in emergency cesarean section and its association with perinatal outcome

“…This is an especially pertinent question for resource constrained settings, where, in the best of circumstances we might not be able to hasten DDI due to system limitations. 13 did a retrospective study in a Germany, on 437 women who underwent CS and found that they could adhere to a DDI of 20 minutes in 98.7% cases and had a mean DDI of 7.66 minutes. However, the same parameters would not be appropriate in the context of a resource limited country.…”

Application of the Plan–Do–Check–Act Cycle in Shortening the Decision to Delivery Interval Time

“…10 A study conducted by Brandt et al suggested that the duration of DDI time had no impact on the incidence of adverse neonatal outcomes. 17 Another study indicated that the Apgar scores of newborn infants after an immediate C-delivery were lower than those in the control group and that the operation had specific adverse impacts on the newborn infants. 14 However, such results may be associated with specific classifications of “C-delivery” or caused by specific diseases.…”

“…18 Understanding the impacts of DDI time can help to accelerate the DDI reduction process. 17 Measures such as continuous training and optimization can be implemented to shorten the DDI time for an emergency C-delivery. The unnecessary delay of an operation may occur if the obstetrician and the anesthetist disagree about aspects of the operation; therefore, a unified judgment criterion and good multi-disciplinary communication are required.…”