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Decision Delivery Interval in Emergency and Urgent Caesarean Sections: Need to Reconsider the Recommendations?

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Abstract

Introduction

The timeline between a decision made and delivery of the baby is termed decision delivery interval (DDI). According to current recommendations, an emergency caesarean section must be performed within 30 min of the decision. The present study was conducted with an objective to assess DDI in a busy obstetric unit in India and its impact on obstetric outcome.

Material and Method

A total of 480 women with indications of category I (emergency): Immediate threat to life of woman or foetus (n = 66), and category II (urgent): Maternal or foetal compromise but not immediately life-threatening (n = 414), were studied in the context of DDI and composite adverse perinatal outcomes including fresh stillbirth, 5-min Apgar score <7 and NICU admission.

Result

Recommended DDI of <30 min could be achieved in 30% cases of emergency CS only. Sixty-three per cent with prolapsed cord could be delivered within 30 min. The composite neonatal outcomes were not significantly increased up to DDI of 60 min for category I (emergency) (except in prolapsed cord) and up to 90 min in category II (urgent) caesarean sections.

Conclusion

Authors propose reconsideration of the present recommendations of DDI in categories I and II, while Crash CS (cord prolapse or catastrophic antepartum haemorrhage) should be a separate group with recommended DDI of 30 min. For the remaining cases in the present emergency CS group, the suggested DDI of 60 and, for urgent group, 90 min may be made following further studies to prevent this DDI yardstick from becoming a rod at our back.

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Authors and Affiliations

  1. Department of O&G, Pt. J N M Medical College & BRAM Hospital Raipur (C.G.), 27/272 New Shanti Nagar, Raipur, CG, 492001, India

    Nalini Mishra, Ruchi Gupta & Nomita Singh

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  1. Nalini Mishra
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  2. Ruchi Gupta
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  3. Nomita Singh
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Correspondence to Nalini Mishra.

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Conflict of interest

Authors declare that there is no conflict of interest.

Ethical approval

All procedures followed were in accordance with ethical standard of the responsible committee on human experiments (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5). This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Nalini Mishra is MD, DGO, DNB (O&G), MNAMS, FICOG and is currently working as Professor, Dept of O&G, Govt Med College, Chhattisgarh, India. Ruchi Gupta MD, Associate Professor, Dept of O&G, Govt Med College, Chhattisgarh, India. Nomita Singh MBBS, Resident Surgical Officer, Dept of O&G, Govt Med College, Chhattisgarh, India.

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Mishra, N., Gupta, R. & Singh, N. Decision Delivery Interval in Emergency and Urgent Caesarean Sections: Need to Reconsider the Recommendations?. J Obstet Gynecol India 68, 20–26 (2018). https://doi.org/10.1007/s13224-017-0991-6

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  • DOI: https://doi.org/10.1007/s13224-017-0991-6

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