Defining the decision‐to‐delivery interval at caesarean section: narrative literature review and proposal for standardisation

Abstract

The decision-to-delivery interval is a widely used term at non-elective caesarean section. While the definition may appear self-evident, there is no universally agreed consensus about when this period begins and ends. We reviewed the literature for original research utilising the terms 'decision-to-delivery', 'decision-to-incision' or 'incision-to-delivery' and examined definitions used for decision, delivery, incision, as well as any additional time intervals that were assessed. Our analysis demonstrated an inconsistent non-standardised approach to defining these intervals, which might have clinical practice and medicolegal ramifications. We propose that the decision-to-delivery interval should be defined as follows: the interval between the time at which the senior obstetrician makes the decision that a caesarean section is required and the time at which the fetus (or first fetus in the case of multiples) is delivered. The decision time should ideally be recorded contemporaneously in the medical notes or partogram.

Decision to delivery interval in cesarean delivery for suspected fetal distress: the risk factors and outcomes

“…The DDI was defined as the interval when the specialist gave the approval for CS until the delivery of the neonate. 8 Other intervals; from the decision to patient's arrival in the operation theatre (decision to theatre interval; DTI), from the arrival in the theatre to the start of surgery (theatre to incision interval; TII) and from incision to the delivery of the baby (IDI) were also recorded. Suspected fetal distress was defined as abnormal fetal heart pattern on cardiotocography (CTG) following the Society of Obstetricians and Gynecologists of Canada guideline on intrapartum fetal monitoring.…”

Emergencies in obstetric anaesthesia: a narrative review

“…However, there is significant heterogeneity in how decision‐to‐delivery intervals are defined and measured. One proposed definition is to mark the start time as when the senior obstetrician decides that surgery is required and the end time as the time when the fetus (or first in the case of multiples) is delivered [2]. Using standardised interprofessional communication of the decision for surgery can improve team response and minimise medicolegal risks.…”

Defining the Decision-to-Delivery Interval at Cesarean Section: Narrative Literature Review and Proposal for Standardization

“…Do we really need a publication on the definition of decision to delivery time? This might be your first thought, when you read the title of the manuscript by May et al1 Interestingly enough, the answer is a clear “yes!”. It is amazing to see seven different definitions of the timepoint “decision” and 4 different definitions of “incision.” At least “delivery” seems to be somewhat easier, although some record the moment of delivery of the fetus, others the moment of cord clamping.…”

“…As elaborated by May et al, 1 the decision to delivery time is a compound interval. It is inefficient if not impossible to improve decision to delivery time without identifying the single steps, that is transfer to the operating room, transfer to the operating table, anesthetic time, and abdominal skin preparation.…”

“…All references within each article were also investigated for inclusion based on similar search terms. Researchers examined each study for (1) the outcome measure (decision-to-delivery interval time), (2) the specific definition used by authors for "decision" or "incision," and (3) any other flagged events highlighted by authors within the decision-to-delivery procedural time.…”