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

Implementation of a crash cesarean section policy and its impact on maternal and neonatal outcomes at King Abdulaziz University Hospital: A retrospective study

A typical surgical technique for pregnant women with potentially fatal problems affecting the mother or fetus is an emergency cesarean section (ECS). The decision-to-delivery interval (DDI) for ECS should be within 30 minutes. The objective of this study was to investigate crash ECS indications and effects on maternal and neonatal outcomes. In this retrospective study, all women undergoing crash cesarean section (CS) at Obstetrics and Gynecology department at King Abdulaziz University hospital, Jeddah, Saudi Arabia during 2022 and 2023 were evaluated. Data about demographic and obstetric characteristics of mother, ECS indications, DDI, and outcomes for mothers and newborns was gathered from the patient's sheet. One hundred 3 crash CS were performed during study period. Crash CS indications were fetal bradycardia (64.1%), prolapsed cord (24.3%), uterine rupture (6.8%), and severe antepartum hemorrhage (4.9%). D-D time range from 2 to 30 minutes. DDI was ≤15 minutes in 90 patients (87.4%) and >15 minutes in 13 patients (12.6%). Gestational age was <32 weeks (16.7%), between 32 and <37 weeks (15.5%), and ≥37 weeks (68.0%). Good maternal outcome was reported in 89 (86.4%), while 24 (13.6%) had complications. Intensive care unit maternal admission was significantly higher in gestational age 32 to <37 weeks versus <32 weeks and ≥37 weeks of gestation (18.8% vs 5.9% and 2.9%, P = .050). Fetal outcome was good in 69 (67.0%), while 34 (33.0%) had complications. Neonatal body weights, Apgar score at 1, 5, 10 minutes, and umbilical cord arterial pH were significantly decreased in preterm versus termed neonates (P < .0001, P < .0001, P < .0001, P = .014, and P = .003). Moreover, respiratory distress syndrome, jaundice, intubation, neonatal deaths, and sepsis were significantly higher in preterm versus term deliveries (P < .0001, P = .029, P < .0001, P = .010, and P = .031). Good neonatal outcome was significantly higher (P < .0001); while respiratory distress syndrome was significantly lower (P = .007) in deliveries with DDI ≤ 15 minutes versus > 15 minutes. The 30-minute standard for DDI time interval may be a feasible guideline at least for level-3 hospitals. Crash CS indication was mostly due to fetal bradycardia. The maternal and neonatal outcomes were better in term than preterm deliveries. The positive effect of very short intervals on neonatal outcome still needs to be proven.

Decision to delivery interval for emergency caesarean section in Eastern Uganda: A cross-sectional study

INTRODUCTION

The decision to delivery interval is a key indicator of the quality of obstetric care. This study assessed the decision to delivery interval for emergency cesarean sections and factors associated with delay.

METHODS

We conducted a cross-sectional study between October 2022 and December 2022 in the labor ward at Mbale regional referral hospital. Our primary outcome variable was the decision to delivery interval defined as the time interval in minutes from the decision to perform the emergency caesarean section to delivery of the baby. We used an observer checklist and interviewer administered questionnaire to collect data. Stata version 14.0 (StataCorp; College Station, TX, USA) was used to analyze the data.

RESULTS

We enrolled 352 participants; the mean age was 25.9 years and standard deviation (SD) ±5.9 years. The median (interquartile range) decision to delivery interval was 110 minutes (80 to 145). Only 7/352 (2.0%) participants had a decision to delivery time interval of ≤30 minutes. More than three quarters 281 /352 (79.8%) had a decision to delivery interval of greater than 75 minutes. Emergency cesarean section done by intern doctors compared to specialists [Adjusted Prevalence Ratio (aPR): 1.26; 95% CI: (1.09-1.45)] was associated with a prolonged decision to delivery interval.

CONCLUSION

The average decision to delivery interval was almost 2 hours. Delays were mostly due to health system challenges. We recommend routine monitoring of decision to delivery interval as an indicator of the quality of obstetric care.

Timing of emergency caesareans - what's the rush? A retrospective multi-centred observational study into decision-to-delivery interval and maternal and fetal outcomes

This study primarily aims to investigate the relationship between decision-to-delivery interval (DDI) and fetal and maternal outcomes in patients undergoing an emergency caesarean section. A secondary aim was to investigate if any maternal or labour features adversely affected outcomes. Two-hundred and forty-six patients underwent an emergency caesarean section within a 9 month period. Outcomes considered included estimated blood loss, need for special care baby unit admission, need for neonatal resus in the form of continuous positive airway pressure and initial APGARs. A multivariate regression analysis was used. This study found no relation between DDI and outcomes.

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

Objective

To discuss the application value of the plan–do–check–act (PDCA) cycle in shortening the decision to delivery interval (DDI) time.

Methods

A total of 106 DDI cases from the Ningbo Women and Children’s Hospital (China) from January 2019 to December 2020 were selected as the subjects of this study. The causes for the prolongation of DDI were analyzed and protocols were developed. Through continuous summaries and improvement, a standardized process was established to direct clinical application, ie, the PDCA cycle.

Results

The DDI was shortened from 14.26 min in 2019 to 12.18 min in 2020 and the neonatal asphyxia rate significantly decreased from 34.69% in 2019 to 12.50% in 2020 (P < 0.05).

Conclusion

The PDCA cycle management mode effectively shortened the DDI time and reduced the neonatal asphyxia rate, without increasing adverse maternal outcomes.

The evaluation of decision-to-delivery interval in category-1 emergency cesarean section: a report of six cases

Background

In category-1 emergency cesarean section, decision-to-delivery interval (DDI) is an important indicator for evaluating the quality of maternity care. I thus evaluated DDI and neonatal outcome in category-1 emergency cesarean section in our institution.

Case presentation

I collected data from the six patients undergoing category-1 emergency cesarean section performed between October 1, 2019, and December 31, 2021. The average age and gestational age were 32 years old (range, 21–42) and 34 weeks (range, 26–40), respectively. Three patients suffered from abruptio placenta and the others fetal distress. All the surgeries were performed under general anesthesia, and the average DDI was 21 min (range, 10–29). The morality was 25% in neonates whose gestational ages of >35 weeks, and that was 67% in neonates whose gestational ages of <27 weeks.

Conclusions

DDI was achieved within 30 min in all the patients, and the mortality of neonate might depend on gestational age.

Non-reassuring fetal status and anesthetic impact on cesarean section-delivered very-low-birthweight infants

BACKGROUND

There is limited evidence concerning the impact on neonatal outcomes of different types of anesthesia used for cesarean delivery due to non-reassuring fetal status (NRFS). We aimed to assess the impact of NRFS and general anesthesia (GA) on neonatal outcomes in very-low-birthweight (VLBW) infants delivered by cesarean section.

METHODS

Data were collected relating to VLBW infants admitted to our institution. Infants were grouped into no-NRFS and NRFS groups and further subcategorized into GA and regional anesthesia (RA) subgroups. Neonatal outcomes were evaluated based on the presence of NRFS and the type of anesthesia.

RESULTS

A total of 356 infants were included. The GA subgroup in the no-NRFS group had higher requirements for respiratory support. However, GA was not associated with adverse neonatal outcomes based on the multivariable logistic regression analysis except for 5 min Apgar score <5. On the other hand, NRFS was associated with an increased risk of 5 min Apgar score <5 [adjusted odds ratio (aOR) 2.062, 95% confidence interval (CI) 1.064-3.997], use of high-frequency ventilation (aOR: 2.891, 95% CI: 1.477-5.658), and pulmonary hypertension (aOR: 2.890, 95% CI: 1.436-5.819).

CONCLUSIONS

In our cohort of VLBW infants, NRFS was a significant risk factor for a low 5 min Apgar score, increased respiratory support requirement, and pulmonary hypertension. Accurate assessment of fetal well-being, timely delivery, and presence of a resuscitation team fully aware of perinatal conditions and anesthetic impact is important.