Timing of caesarean section according to urgency

Implementation of the Four-Category Classification of Cesarean Section Urgency in Clinical Practice. A Prospective Study

“…Despite several differences between our study and those reported in risk classification, communication techniques, obstetric setting and practice, these data suggest that, with a dedicated program, the target DDI can be achieved in >90% of women. These findings represent a marked clinical improvement when compared to the 30 min DDI reported in 45-65% patients of category 1 in an earlier study [6,[10][11][12] , and confirm that each obstetric unit should produce a program for urgent cesarean sections [20] . Our study confirmed that anesthesia technique is one of the main cause of delay in achieving 30 min target time in category 1.…”

Decision-to-delivery intervals and total duration of surgery for Caesarean sections in a tertiary general hospital

“…Leung and Lao found that, although all studies had investigated perinatal outcome with DDI, the onset of fetal hypoxia does not start at the time of decision but around the time of onset of fetal bradycardia. (14) Thus, if the analysis was limited to DDI instead of insult-to-delivery, any association between perinatal outcomes and the duration of fetal hypoxia would remain masked. (14) However, there are no established standards on the insult-todelivery timing, and such a parameter is likely to vary signifi cantly depending on the severity of the insult.…”

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

“…Although a 30‐minute goal has been advocated, no scientific evidence supports this threshold . The latest Guideline for Perinatal Care, which is jointly published by the AAP and ACOG , refers only to an obstetric unit's capability to respond to an obstetric emergency, with no mention about requirements for delivery within any time frame.…”

“…However, better performance was observed among women in FHR category 2, with as many as 67.5% of patients having DDI <75 minutes, which is the suggested time for non-life-threatening caesarean section [18]. Although a 30-minute goal has been advocated, no scientific evidence supports this threshold [2]. The latest Guideline for Perinatal Care, which is jointly published by the AAP and ACOG [22], refers only to an obstetric unit's capability to respond to an obstetric emergency, with no mention about requirements for delivery within any time frame.…”

“…Many authorities, including the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetrics and Gynaecology (RCOG) and the American Academy of Pediatrics (AAP) have suggested that delivery should be accomplished within 30 minutes after the decision for caesarean delivery [3,4]. However, scientific evidence supporting this 30-minute recommendation is lacking, especially evidence that specifically addresses adverse neonatal outcomes [2,[5][6][7][8][9].…”