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Shi X, Xu C, Wen Y, Jiang M, Yu H, Wang X, Yuan H, Feng S. Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis. BMC Anesthesiol 2024; 24:33. [PMID: 38243205 PMCID: PMC10797910 DOI: 10.1186/s12871-024-02412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE An emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes. METHOD This was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured. RESULTS Of the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed. CONCLUSION Compared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.
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Affiliation(s)
- Xueduo Shi
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Chenyang Xu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Yazhou Wen
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Ming Jiang
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Huiling Yu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Xian Wang
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Hongmei Yuan
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China.
| | - Shanwu Feng
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China.
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Vandenberghe G, Vercoutere A, Cuvellier N, Van Oost E, Leroy C, Goemaes R, Laubach M, Boulvain M, Daelemans C. Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study. BMC Pregnancy Childbirth 2023; 23:684. [PMID: 37736714 PMCID: PMC10515028 DOI: 10.1186/s12884-023-05984-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Trial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section. METHODS We collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions. RESULTS Of the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman' rho = 0.50 and 0.42, p value < 0.001). CONCLUSIONS Organizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean.
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Affiliation(s)
- Griet Vandenberghe
- Department of Obstetrics, Ghent University Hospital, Vrouwenkliniek, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - An Vercoutere
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
| | - Nadège Cuvellier
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
- Present Address: Department of Gynaecology and Obstetrics, Centre Hospitalier EpiCURA Site Ath, Ath, Belgium
| | - Elke Van Oost
- Department of Obstetrics, Ghent University Hospital, Vrouwenkliniek, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Present Address: Department of Obstetrics, AZ Maria Halle, Halle, Belgium
| | - Charlotte Leroy
- Centre d'Epidémiologie Périnatale (CEpiP) Clos Chapelle-Aux-Champs, 30 Bte, B1.30.04 1200, Brussels, Belgium
| | - Régine Goemaes
- Study Centre for Perinatal Epidemiology (SPE), Koning Albert II-Laan 35 Bus 29, 1030, Brussels, Belgium
| | - Monika Laubach
- Study Centre for Perinatal Epidemiology (SPE), Koning Albert II-Laan 35 Bus 29, 1030, Brussels, Belgium
- Service of Obstetrics and Prenatal Medecine, Universitair Ziekenhuis Brussel, Laarbeklaan 101, 1090, Brussels, Belgium
| | - Michel Boulvain
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
- Service of Obstetrics and Prenatal Medecine, Universitair Ziekenhuis Brussel, Laarbeklaan 101, 1090, Brussels, Belgium
| | - Caroline Daelemans
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
- Present Address: Obstetrics Division, Department of Woman, Child and Adolescent Medecine, Geneva University Hospitals, Boulevard de la Cluse, 30, 1205, Geneva, Switzerland
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Houri O, Walfisch A, Shilony A, Zafrir-Danieli H, Hendin N, Matot R, Navon I, Hadar E. Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse. BMC Pregnancy Childbirth 2023; 23:463. [PMID: 37349738 DOI: 10.1186/s12884-023-05788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial. OBJECTIVE The aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome. STUDY DESIGN The database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman's rank correlation coefficient. RESULTS Of the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0-15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24-7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman's Ρ = - 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman's Ρ = .425; Ρ = .079, Ρ = - .205; Ρ = .336, Ρ = - .324; Ρ = .122 for groups 1-3, respectively). CONCLUSION Intrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH.
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Affiliation(s)
- Ohad Houri
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asnat Walfisch
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Shilony
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Zafrir-Danieli
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natav Hendin
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Matot
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Navon
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Paily VP, Girijadevi RR, George S, Tawab A, Sidhik A, Sudhamma A, Neelankavil JJ, Usha MG, George R, Ramakrishnan S, Cheriyan S, Pradeep M, Mathai A. Crash Caesarean Delivery: How to Optimise Decision-to-Delivery Interval by Initiating a Novel Code? A Clinical Audit. J Obstet Gynaecol India 2023; 73:132-138. [PMID: 37073227 PMCID: PMC10105804 DOI: 10.1007/s13224-022-01693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022] Open
Abstract
Background Many resource-constrained centres fail to meet the international standard of 30 min of decision-to-delivery interval (DDI) of Category-1 crash caesarean deliveries. However, specific scenarios like acute foetal bradycardia and antepartum haemorrhage necessitate even faster interventions. Methods A multidisciplinary team developed a "CODE-10 Crash Caesarean" rapid response protocol to limit DDI to 15 min. A multidisciplinary committee analysed a retrospective clinical audit of maternal-foetal outcomes over 15 months (August 2020-November 2021), and expert recommendations were sought. Results The median DDI of twenty-five patients who underwent a "CODE-10 Crash Caesarean delivery" was 13 ± 6 min, with 92% (23/25) of DDIs falling below 15 min. Seven neonates required intensive care for more than 24 h with no maternal or neonatal mortality. DDIs during office and non-office hours were not significantly different (12.5 ± 6 min vs 13 ± 5 min, p = 0.911). Transport delays caused the two instances of DDI > 15 min. Conclusion The novel "CODE-10 Crash Caesarean" protocol may be feasible for adoption in a similar tertiary-care setting with appropriate planning and training.
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Affiliation(s)
- Vakkanal Paily Paily
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Raji Raj Girijadevi
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Sachin George
- Department of Anaesthesiology, Rajagiri Hospital, Kochi, Kerala India
| | - Abdul Tawab
- Department of Neonatology, Rajagiri Hospital, Kochi, Kerala India
| | - Afshana Sidhik
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | | | | | - M. G. Usha
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Raymond George
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Soumya Ramakrishnan
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Sara Cheriyan
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Manu Pradeep
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
| | - Anu Mathai
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala India
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Vetier O, Yanni MA, Lassel L, Isly H, Beuchee A, Nyangoh-Timoh K, Lavoue V, Beranger R, Le Lous M. Assessment of compliance with a color code protocol for non-elective cesarean section and its impact on time to delivery interval and neonatal outcomes. J Gynecol Obstet Hum Reprod 2023; 52:102520. [PMID: 36543301 DOI: 10.1016/j.jogoh.2022.102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION We set out to assess the compliance with a cesarean section color code protocol and its impact on maternal and neonatal outcomes since its implementation in our maternity ward. METHODS This was a retrospective study including a sample of 200 patients per year who underwent a non-elective cesarean section delivery in Rennes University Hospital from January 1, 2015 to December 31, 2018. Patients were grouped by year and by color code (red, orange or green). The main outcome was compliance with the protocol (color code in accordance with indication for cesarean section) and compliance with the corresponding decision-delivery interval. Secondary outcomes were maternal and neonatal outcomes. RESULTS Eight hundred patients were included during the study period. There was no significant difference in patient characteristics over the years. There was a significant improvement in protocol compliance: full compliance increased from 22.4% in 2015 to 76.5% in 2018 (p < 0.0001). The respect of the 15 min decision-delivery interval in red code protocol increased between 2015 and 2018 (p = 0.0020). CONCLUSION We observed a significant improvement in compliance with the color code protocol between 2015 and 2018 and in the 15 min decision-delivery deadline for the red code.
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Affiliation(s)
- Oriane Vetier
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Marie-Alice Yanni
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Linda Lassel
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Hélène Isly
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Alain Beuchee
- Department of Pediatry, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - Krystel Nyangoh-Timoh
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - Vincent Lavoue
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - Rémi Beranger
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, EHESP, Irset-UMR_S, Rennes 1085, France
| | - Maela Le Lous
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France.
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Ayeni OM, Aboyeji AP, Ijaiya MA, Adesina KT, Fawole AA, Adeniran AS. Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study. Malawi Med J 2021; 33:28-36. [PMID: 34422231 PMCID: PMC8360283 DOI: 10.4314/mmj.v33i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Omotayo M Ayeni
- Obstetrics & Gynaecology Department, Lagoon Hospitals, PMB 101, Lagos, Nigeria
| | - Abiodun P Aboyeji
- Obstetrics & Gynaecology Department, University of Ilorin/University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria
| | - Munirdeen A Ijaiya
- Obstetrics & Gynaecology Department, University of Ilorin/University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria
| | - Kikelomo T Adesina
- Obstetrics & Gynaecology Department, University of Ilorin/University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria
| | - Adegboyega A Fawole
- Obstetrics & Gynaecology Department, University of Ilorin/University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria
| | - Abiodun S Adeniran
- Obstetrics & Gynaecology Department, University of Ilorin/University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria
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Deltombe-Bodart S, Grabarz A, Ramdane N, Delporte V, Depret S, Deruelle P, Garabedian C. [Compliance to the color codes protocol according to the indication of cesarean and to the decision-to-delivery interval]. ACTA ACUST UNITED AC 2018; 46:575-579. [PMID: 29983276 DOI: 10.1016/j.gofs.2018.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evaluation of the compliance of the color codes protocol according to the indication of ceasarean section and on the decision-to-delivery interval according to the color code, the operator and the period. METHODS This is a retrospective monocentric study including women who had to undergo an emergency cesarean section after 37 weeks of amenorrhea in the Jeanne-de-Flandre hospital between 2015 and 2017. Three groups were created: cesarean section with green code, orange code and red code. We compared population characteristics and obstetrical data, then drew up a reassessed color code and analyzed the correspondence between the initial color code and the reassessed one. Finally, we considered the respect of decision-to-delivery interval according to color code, operator level and period. RESULTS Eight hundred and eighty-one patients were included, amongst which 303 (34%) fell into the green c-section, 353 (40%) into the orange c-section and 225 (26%) into the red c-section. In the three groups, there was a significant consistency between the initial color code and the reassessed one, with a kappa agreement test of 95% 0.95 (0.93-0.97). The average decision-to-delivery interval was 37±20min for the green c-section, 20±6min for the orange c-section and 12±3min for the red c-section with a significant respect of the decision-to-delivery interval according to color code P<0.001. The decision-to-delivery interval was similar considering the operator level and the period. CONCLUSION In our study, we observed the compliance with color code regarding the indication of ceasarean section and the respect of the decision-to-delivery interval whatever the time of occurrence and the operator.
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Affiliation(s)
- S Deltombe-Bodart
- Département d'obstétrique, hôpital Jeanne-de-Flandre, centre hospitalier universitaire de Lille, 59000 Lille, France.
| | - A Grabarz
- Département d'obstétrique, hôpital Jeanne-de-Flandre, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - N Ramdane
- EA 2694, département de biostatistiques, université de Lille, centre hospitalier universitaire de Lille, santé publique, épidémiologie et qualité de la santé, 59000 Lille, France
| | - V Delporte
- Département d'obstétrique, hôpital Jeanne-de-Flandre, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - S Depret
- Département d'obstétrique, hôpital Jeanne-de-Flandre, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - P Deruelle
- Département d'obstétrique, hôpital Jeanne-de-Flandre, centre hospitalier universitaire de Lille, 59000 Lille, France; EA 4489, université de Lille, santé périnatale et environnement, 59000 Lille, France
| | - C Garabedian
- Département d'obstétrique, hôpital Jeanne-de-Flandre, centre hospitalier universitaire de Lille, 59000 Lille, France; EA 4489, université de Lille, santé périnatale et environnement, 59000 Lille, France
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Dekker L, Houtzager T, Kilume O, Horogo J, van Roosmalen J, Nyamtema AS. Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania. BMC Pregnancy Childbirth 2018; 18:164. [PMID: 29764384 PMCID: PMC5952645 DOI: 10.1186/s12884-018-1814-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Methods Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. Results During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Conclusions Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.
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Affiliation(s)
- Luuk Dekker
- Department of Obstetrics and Gynaecology, St. Francis Referral Hospital, Ifakara, Tanzania.,Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tessa Houtzager
- Department of Obstetrics and Gynaecology, St. Francis Referral Hospital, Ifakara, Tanzania.,Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Omary Kilume
- Department of Obstetrics and Gynaecology, St. Francis Referral Hospital, Ifakara, Tanzania.,St. Francis University College of Health and Allied Sciences, P.O Box 175, Ifakara, Tanzania
| | - John Horogo
- Department of Obstetrics and Gynaecology, St. Francis Referral Hospital, Ifakara, Tanzania
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Angelo Sadock Nyamtema
- Department of Obstetrics and Gynaecology, St. Francis Referral Hospital, Ifakara, Tanzania. .,St. Francis University College of Health and Allied Sciences, P.O Box 175, Ifakara, Tanzania.
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9
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Lafitte AS, Vardon D, Morello R, Lecerf M, Stewart Z, Dreyfus M. [Can we reduce the decision-to-delivery interval in case of emergency cesarean sections by optimizing the premises' architecture?]. ACTA ACUST UNITED AC 2017; 45:590-595. [PMID: 29111291 DOI: 10.1016/j.gofs.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 09/15/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the influence of architectural premises' improvements on decision-to-delivery interval (DDI) in case of emergency cesarean sections. METHODS A retrospective observational Before-After study conducted in a type III maternity, first from 2004 to 2009 (Period 1, P1) then after moving our unit to new premises from 2009 to 2013 (P2). DDI, maternal and neonatal outcomes of every emergency cesarean section were studied. RESULTS The mean DDI of extremely urgent cesarean significantly decreased from 21.3±10.3minutes during P1 (n=294) to 14.9±7.14minutes during P2 (n=165). During P2 there was an increase in the proportion of extreme emergency cesarean sections done in less than 30minutes (85.1% versus 93.5%, P=0.003) as according to the ACOG recommendations, and also an increase of DDI of less than 15minutes (25.8% versus 61.1%, P<0.001). Also during P2 if there was a reduction of umbilical cord pHs, which were correlated to DDI, we observed a reduction of neonatal hospitalizations (42.2% versus 35.7%, P<0.001). Apgar score was correlated to umbilical cord pH and birth weight, but not to DDI. CONCLUSION The space optimization has allowed our level III maternity to improve the rate of extreme emergency cesarean sections performed with DDI of less than 30 and even 15minutes, according to international recommendations. These results were obtained by reducing the transfer time to the operating room. Despite a positive correlation between DDI and umbilical cord pH, there was an improvement in neonatal outcomes associated with a decrease of neonatal hospitalizations.
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Affiliation(s)
- A-S Lafitte
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle femme-enfant, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - D Vardon
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle femme-enfant, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - R Morello
- Unité de biostatistique et recherche clinique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - M Lecerf
- Maternité du centre hospitalier de Saint-Malo, bâtiment la Rotonde, 1, rue de la Marne, 35400 Saint-Malo, France
| | - Z Stewart
- Service de gynécologie-obstétrique, centre hospitalier de Marne-la-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - M Dreyfus
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle femme-enfant, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France
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10
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Iitani Y, Tsuda H, Ito Y, Moriyama Y, Nakano T, Imai K, Kotani T, Kikkawa F. Simulation training is useful for shortening the decision-to-delivery interval in cases of emergent cesarean section. J Matern Fetal Neonatal Med 2017; 31:3128-3132. [PMID: 28782405 DOI: 10.1080/14767058.2017.1365126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We examined the effect of simulation training for medical staff on the decision-to-delivery interval (DDI) in cases of emergent cesarean delivery and the effect of a shortened DDI on maternal and neonatal outcomes. MATERIAL AND METHODS Our hospital is a tertiary perinatal center. As the simulation training was performed in March 2014, the study population was divided into two groups: pretraining group (November 2011-March 2014, 29 months: n = 15) and post-training group (April 2014-August 2016, 29 months: n = 35). RESULTS The DDI was significantly shorter in the post-training group than in the pretraining group (p = .009). In particular, the decision-to-entering the operating room interval was significantly shorter in the post-training group than in the pretraining group (p = .003). The umbilical artery pH was significantly better in post-training group than in the pretraining group (p = .019). Furthermore, the umbilical artery pH was significantly improved by simulation training only in "irreversible" cases (p = .012). CONCLUSIONS The DDI was significantly shortened by introducing simulation training. We also demonstrated a beneficial effect of the simulation training on the umbilical artery pH, especially in "irreversible" cases, without increasing the rate of maternal adverse outcome.
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Affiliation(s)
- Yukako Iitani
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Hiroyuki Tsuda
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan.,b Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan
| | - Yumiko Ito
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yoshinori Moriyama
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Tomoko Nakano
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kenji Imai
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Tomomi Kotani
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Fumitaka Kikkawa
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan
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Gupta S, Naithani U, Madhanmohan C, Singh A, Reddy P, Gupta A. Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital. J Anaesthesiol Clin Pharmacol 2017; 33:64-70. [PMID: 28413274 PMCID: PMC5374832 DOI: 10.4103/0970-9185.202197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: The American College of Obstetricians and Gynecologists (ACOG) committee on professional standards and the National Institute of Clinical Excellence (NICE) guidelines suggest that decision-to-delivery interval (DDI) and emergency cesarean section (CS) should not be more than 30 min, and a delay of more than75 min in the presence of maternal or fetal compromise can lead to poor outcome. This prospective 1-year study was conducted on emergency CS in a tertiary care hospital to evaluate the DDI, factors affecting it and to analyze their effects on maternal and neonatal outcome. Material and Methods: A structured proforma was used to analyze the data from all women undergoing emergency CS, during a 1-year period, included in Category 1 and 2 of NICE guidelines for CS. Results: A total of 453 emergency CSs were evaluated, with a mean DDI of 36.3 ± 17.2 min for Category 1 CS and 38.1 ± 17.7 min for Category 2 CS (P > 0.05). Only 42.4% emergency CSs confirmed to the 30 min DDI while 57.6% had a DDI of more than 30 min. Reasons of delay were identified as a delay in shifting the patient to operation theater (22.1%), anesthesia factors (18.1%), and lack of resources or manpower (16.1%). Maternal complications occurred in 15 (3.3%) patients with 3 (0.7%) nonsurvivors having a DDI of 91.0 ± 97.0 min as compared to survivors with a DDI of 36.8 ± 15.7 min, P = 0.001. There was no significant association between DDI and occurrence of neonatal complications. Conclusion: Failure to meet the current recommendations was associated with adverse maternal outcomes, but not with adverse neonatal outcome.
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Affiliation(s)
- Sunanda Gupta
- Department of Anesthesiology and Critical Care, Geetanjali Medical College, Udaipur, Rajasthan, India
| | - Udita Naithani
- Department of Anethesiology, Critical Care and Pain Management, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - C Madhanmohan
- Department of Anethesiology, Critical Care and Pain Management, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Ajay Singh
- Department of Anethesiology, Critical Care and Pain Management, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Pradeep Reddy
- Department of Anethesiology, Critical Care and Pain Management, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Apoorva Gupta
- Department of Anesthesiology and Critical Care, Geetanjali Medical College, Udaipur, Rajasthan, India
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Maneschi F, Biccirè D, Santangelo G, Perrone S, Scaini A, Cosentino C. Implementation of the Four-Category Classification of Cesarean Section Urgency in Clinical Practice. A Prospective Study. Gynecol Obstet Invest 2016; 82:371-375. [PMID: 27684889 DOI: 10.1159/000449159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE This study is aimed at investigating the clinical efficacy of the 4-category classification of urgent cesarean section. METHODS Women giving birth from September 2012 to December 2014 were prospectively investigated. Urgency C-section categories were color-coded: red - maternal/fetal life threat; yellow - maternal/fetal compromise, not life-threatening; and green - early delivery necessary. Results were audited. RESULTS A total of 4,754 women gave birth in the period considered, 1,313 (27.6%) with C-section of which 867 were urgent. The code was red in 0.98% of women, and 91.5% of newborns were delivered ≤30'; yellow in 5.1%; and green in 11.7%. The mean decision-to-delivery interval (DDI) ± SD was 19.6 ± 9.5 min, 36.6 ± 15.3 (p < 0.01), and 80.3 ± 52.8 (p < 0.01), respectively; and mean umbilical pH was 7.24 ± 0.10, 7.29 ± 0.08 (p < 0.05), and 7.33 ± 0.04 (p < 0.01) in the red, yellow, and green groups, respectively. Two (4.2%) red and 4 (2.2%) yellow newborns were acidotic. Mean DDI ± SD decreased from 21.7 ± 9.7 min in the period September 2012 to February 2013 to 17.4 ± 9.7 min in the period February to December 2014 (p = NS). CONCLUSIONS Four-category classification led to achieving the target time in >90% of category 1 emergency C-sections, and stratified newborns with significantly different acidosis levels.
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13
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Bello FA, Tsele TA, Oluwasola TO. Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital. Int J Gynaecol Obstet 2015; 130:279-83. [PMID: 26058530 DOI: 10.1016/j.ijgo.2015.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/25/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the decision-to-delivery interval (DDI) for emergency cesarean deliveries (CDs) at a tertiary center in Nigeria, to evaluate causes of delay, and to assess the effects of delays on perinatal outcomes. METHODS Between September and November 2010, a prospective, observational study was undertaken at University College Hospital, Ibadan. Events that occurred after a decision to perform an emergency CD were recorded. Associations between outcomes and the DDI were analyzed. RESULTS Among 235 emergency CDs included, 5 (2.1%) occurred within 30 minutes and 86 (36.6%) within 75 minutes. The mean DDI was 119.2±95.0 minutes. Among CDs with a DDI of more than 75 minutes, logistic factors were the reason for delay in 65 (43.6 %) cases. No significant associations were recorded between DDI and the 5-minute Apgar score, admission to the special-care baby unit, or perinatal mortality (P>0.05 for all). In multivariate analysis, neonates delivered after 75 minutes were significantly less likely to die during the perinatal period than were those delivered within this period (odds ratio 0.13, 95% confidence interval 0.03-0.66; P=0.01). CONCLUSION Institutional delays in CDs need to be addressed. However, the DDI could be less important for perinatal outcome than are some other factors, such as the severity of the indication.
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Affiliation(s)
- Folasade A Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
| | - Taiwo A Tsele
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
| | - Timothy O Oluwasola
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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14
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Onuoha O, Ramaswamy R, Srofenyoh EK, Kim SM, Owen MD. The effects of resource improvement on decision-to-delivery times for cesarean deliveries in a Ghanaian regional hospital. Int J Gynaecol Obstet 2015; 130:274-8. [PMID: 25983211 DOI: 10.1016/j.ijgo.2015.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/12/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effects of having a dedicated obstetric operating room (OR) on the decision-to-delivery interval (DDI) in a large referral hospital in Ghana. METHODS An observational study was undertaken of all patients undergoing cesarean delivery at Ridge Regional Hospital, Accra, before (pre-OR; August-September 2011) and after (post-OR; August-September 2012) introduction of an obstetric OR. The primary outcome was the DDI. RESULTS In total, 581 cesareans were performed in the pre-OR period and 574 in the post-OR period. Overall, the median DDI decreased from 259 min (interquartile range [IQR] 161-432) in the pre-OR period to 195 min (IQR 138-319) in the post-OR period (P<0.001). DDI was lower in the post-OR period than in the pre-OR period for both emergency (175 min [IQR 126-241] vs 220 min [IQR 146-315]; P<0.001) and elective (1828 min [IQR 1432-2985] vs 4291 min [IQR 2992-5862]; P<0.001) cesarean deliveries. Only one emergency cesarean-in the post-OR period-was conducted within the recommended 30-minute timeframe. CONCLUSION An obstetric OR lowered the DDI for cesarean delivery; however, a realistic timeframe for emergency cesareans in low-income countries remains to be determined.
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Affiliation(s)
- Onyi Onuoha
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rohit Ramaswamy
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Sung M Kim
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Medge D Owen
- Wake Forest School of Medicine, Winston-Salem, NC, USA.
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