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.

Introduction: Isobaric levobupivacaine is now being investigated in spinal anesthesia owing to its better safety profile; however, the studies are sparse which show clinical efficacy of intrathecal isobaric levobupivacaine alone in its ED95 dose (12.5-13.5mg) for cesarean sections (CS) and its comparison with most commonly used regime of hyperbaric bupivacaine (10mg). Objective and Methods: 100 parturients undergoing CS in spinal anesthesia were randomized in two equal groups to receive either 12.5mg isobaric levobupivacaine (group L) or 10mg hyperbaric bupivacaine (group B). Sensorymotor block characteristics (onset, extent, and duration), hemodynamic profile, adverse effects and success rate of the two drugs were compared. Results: All patients in both groups achieved target sensory level of T6 and Bromage score of 3 (complete motor block) hence no patient required anesthetic supplementation resulting in 100% success rate in both groups. Sensory onset (Time to T6) was significantly faster in group B (3.8±0.81 min) than in Group L (4.28±1.04 min) p = 0.011. Motor onset (Time to B3) was also significantly faster in Group B (3.04±0.69) than in group L (3.56±0.63), p = 0.0002. However this difference of < 1 min was clinically insignificant. Duration of analgesia, sensory blockade and motor blockade were significantly longer in group B than group L, p = 0.0001. Hemodynamically both groups were comparable. Conclusion: Isobaric levobupivacaine (12.5mg) can be used as an alternative to hyperbaric bupivacaine (10mg) in spinal anesthesia for cesarean section as it offers effective sensory motor blockade with clinically comparable onset time.