Document Detail


What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries.
MedLine Citation:
PMID:  12066937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine how long it takes from the decision to achieve delivery by non-elective caesarean section (DDI), the influences on this interval, and the impact on neonatal condition at birth. DESIGN: Twelve months prospective data collection on all non-elective caesarean sections. METHODS: Prospective collection of data relating to all caesarean sections in 1996 in a major teaching hospital obstetric unit was conducted, without the knowledge of the other clinicians providing clinical care. Details of the indication for section, the day and time of the decision and the interval till delivery were recorded as well as the seniority of the surgeon, and condition of the baby at birth. RESULTS: The mean time from decision-to-delivery for 100 emergency intrapartum caesarean sections was 42.9 minutes for fetal distress and 71.1 minutes for 230 without fetal distress (P < 0.0001). For 22 'crash' sections the mean time from decision-to-delivery was 27.4 minutes; for 13 urgent antepartum deliveries for fetal reasons it was 124.7 minutes and for 21 with maternal reasons it was 97.4 minutes. The seniority of the surgeon managing the patient did not appear to influence the interval, nor did the time of day or day of the week when the delivery occurred. Intrapartum sections were quicker the more advanced the labour, and general anaesthesia was associated with shorter intervals than regional anaesthesia for emergency caesarean section for fetal distress (P < 0.001). Babies born within one hour of the decision tended to be more acidaemic than those born later, irrespective of the indication for delivery. Babies tended to be in better condition when a time from decision-to-delivery was not recorded than those for whom the information had been recorded. CONCLUSION: Fewer than 40% intrapartum deliveries by caesarean section for fetal distress were achieved within 30 minutes of the decision, despite that being the unit standard. There was, however, no evidence to indicate that overall an interval up to 120 minutes was detrimental to the neonate unless the delivery was a 'crash' caesarean section. These data thus do not provide evidence to sustain the recommendation of a standard of 30 minutes for intrapartum delivery by caesarean section.
Authors:
I Z MacKenzie; Inez Cooke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  109     ISSN:  1470-0328     ISO Abbreviation:  BJOG     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-06-17     Completed Date:  2002-07-15     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  498-504     Citation Subset:  AIM; IM    
Affiliation:
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Obstetrical / methods
Cesarean Section / methods*
Decision Making*
Emergencies
Female
Fetal Blood / chemistry
Fetal Death / etiology
Humans
Hydrogen-Ion Concentration
Labor Stage, First
Obstetric Labor Complications / surgery*
Pregnancy
Pregnancy Outcome
Professional Competence
Prospective Studies
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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