Category 1 cesarean section decision to delivery interval: the causes of delay and impact on neonatal outcomes

Abstract

Objectives: The introduction of cesarean section categorization and recommendations on decision to delivery interval was a major step forward towards standardizing clinical response to obstetric emergencies. The recommended decision to delivery interval (DDI) for category 1 cesarean sections is 30 minutes, however there is a balance to be struck to ensure that reducing fetal hypoxic risk is not at the expense of increasing maternal and fetal morbidity. The aim of the study was to review category 1 cesarean sections, focusing on reasons for delays and neonatal outcomes. Design: The study was conducted as a quality improvement initiative to review the performance of the institution in managing women delivered as category 1 cesarean section between January 2020 and August 2020. Methods: The data was extracted from the operating theatre log book and patient electronic records (Cerner system) and analyzed using SPSS statistics package. Results: There were 577 cases of category 1 Cesarean section undertaken during the study period. The recommended DDI of 30 minutes was achieved in 385/577 (67%) of cases but was exceeded in 192/577 (33%) of cases. The most common indication of category 1 cesarean section was fetal distress (58%). It was noted that significantly more women (88.8%) in the <30-minute group had the decision taken in the labor ward, which is in close proximity to the obstetric theatre. Significantly more women in the <30-minute group had epidural or general anesthesia. Significant delays in the preparation time, transfer time, anesthesia time and delivery time were noted in the >30-minute group. The neonates in the <30-minute group had significantly lower pH and base excess measurements at birth however fewer were admitted to the neonatal intensive care unit. Conclusion: This study has demonstrated that only two thirds of category 1 cesarean deliveries are performed within the 30-minute recommendation. The delays were evident at every stage of the process of performing the cesarean. There are some factors which are not modifiable such as non labor ward transfers. Continued monitoring of category 1 cesarean outcomes is recommended.

Evaluation of decision to delivery interval and its effect on feto‐maternal outcomes in Category‐I emergency cesarean section deliveries in Phuentsholing General Hospital, 2020: A retrospective cross‐sectional study

“…A similar finding was reported by Kitaw et al 10 study, where the DDI was achieved in 20.3% 10 . Other studies have reported better achievement of DDI within 30 min ranging from 60% to 71% 11–13 . One study reported 100% of Category‐I emergency cesarean sections were performed within 30 min of DDI 14 .…”

“… 10 Other studies have reported better achievement of DDI within 30 min ranging from 60% to 71%. 11 , 12 , 13 One study reported 100% of Category‐I emergency cesarean sections were performed within 30 min of DDI. 14 However, the majority of the published literature showed not able to meet the recommended DDI of 30 min.…”

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

“…Decision to delivery interval is a key indicator of quality of obstetric care and affects perinatal outcomes [ 7 , 8 ]. Decision to delivery interval is the duration from time when the decision to birth a baby by emergency cesarean section to the time the baby is birthed [ 9 , 10 ]. The world Health Organization (WHO) recommends a decision to delivery interval of 30 to 75 minutes depending on the context [ 11 ].…”

Decision To Delivery Time and Its Predictors Among Mothers Who Underwent Emergency Cesarean Delivery At Selected Hospitals of Northwest Ethiopia, 2023: Prospective Cohort Study

“…At the end of three months of follow-up, 62 (21.8%) women delivered within 30 min or less with a mean DDT of 48.9 min, which is nearly similar with other studies of 19.6%, 21.3% in Gondar Southern Ethiopia, and 20.3% in Bahir Dar. [14][15][16] This may be due to the similarity in the accessibility of logistics in hospitals, the practice and [17][18][19][20][21][22] This difference might be occurring due to various studies conducted in different with different set up of institutions and different sample sizes. The findings of this research were greater than those of studies conducted in Tanzania, Kenya, Benin teaching hospital, Nigeria, and Bahir Dar in 2021 which were 14.3%, 12%, 3%, 2.1%, and 5.7%, respectively.…”