The 30-Minute Decision-to-Incision Interval for Emergency Cesarean Delivery: Fact or Fiction?

The objective of this study was to evaluate the effect of the current guideline of 30-minute decision-to-incision interval (D-I) in emergent cesarean delivery (ECD) on neonatal and maternal outcomes. A retrospective chart review was conducted of pregnant women who underwent ECDs between January 1999 and December 2001. The overall median D-I was 20 minutes (range, 5 to 57 minutes). In 83 women (group I), D-I was ≤30 minutes, and in 28 women (group II), it exceeded 30 minutes. Group I had more neonates with cord pH <7.00, seizures, encephalopathy, and lower Apgar scores at 1 and 5 minutes than group II, but were not statistically significant. There was no significant difference in neonatal admission to the neonatal intensive care unit or length of stay between the two groups. Maternal complications were higher in group I, but not statistically significant. Although it was achieved in most of the ECDs, the guideline of 30-minute D-I does not seem to improve neonatal nor worsen maternal outcomes.

KEYWORDS

Decision-to-incision - emergency cesarean delivery - neonatal and maternal outcomes

REFERENCES

• 1 Hannah W. Indications for cesarean section: final statement of the panel of the National Consensus Conference on Aspects of Cesarean Birth.  CMAJ. 1986;  134 1348-1352
• 2 Royal College of Obstetricians and Gynaecologists .The National Sentinel Cesarean Section Audit Report. RCOG Clinical Effectiveness Support Unit. London; Royal College of Obstetricians and Gynaecologists 2001: 54-56
• 3 American Academy of Pediatrics and American College of Obstetricians and Gynecologists .Guidelines for Perinatal Care, 4th ed. Washington, DC; American Academy of Pediatrics and American College of Obstetricians and Gynecologists 1997
• 4 Royal College of Obstetricians and Gynaecologists and Royal College of Midwives .Developing standards. In: Towards Safer Childbirth London; Royal College of Obstetricians and Gynaecologists and Royal College of Midwives 1999: 17-18
• 5 Shiono P H, Fielden J G, McNellis D, Rhoads G G, Pearse W H. Recent trends in cesarean birth and trial of labor rates in the United States.  JAMA. 1987;  257 494-497
• 6 Lavery J P, Janssen J, Hutchinson L. Is the obstetric guideline of 30 minutes from decision to incision for Cesarean delivery clinically significant?.  J Health Risk Manage. 1999;  19 11-20
• 7 Schauberger C W, Rooney B L, Beguin E A, Schaper A M. Evaluating the thirty minutes interval in emergency cesarean sections.  J Am Coll Surg. 1994;  179 151-155
• 8 Chauhan S P, Roach H, Naef R W, Magann E F, Morrison J C, Martin Jr J N. Cesarean section for suspected fetal distress. Does the decision-incision time make a difference?.  J Reprod Med. 1997;  42 347-352
• 9 Delarue T, Maheo A, Souplet J P. Indications and contraindications of peridural anesthesia in obstetrics. Review of the literature.  Rev Fr Gynecol Obstet. 1988;  83 427-437
• 10 Hillemanns P, Hepp H, Rebhan H, Knitza R. Emergency cesarean section-organization and decision-delivery time.  Geburtshilfe Frauenheilkd. 1996;  56 423-430
• 11 MacKenzie I Z, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries.  BJOG. 2002;  109 498-504
• 12 Tuffnell D J, Wilkinson K, Beresford N. Interval between decision and delivery by caesarean section-are current standards achievable? Observational case series.  BMJ. 2001;  322 1330-1333
• 13 Quinn A J, Kilpatrick A. Emergency cesarean section during labour: response times and type of anaesthesia.  Eur J Obstet Gynecol Reprod Biol. 1994;  54 25-29
• 14 Helmy W H, Jolaoso A S, Ifaturoti O O, Afify S A, Jones M H. The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target?.  BJOG. 2002;  109 505-508