Five-year impact of a new departmental protocol on emergency cesarean target times

Abstract

<p> <span style="font-size:10pt;">Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retrospective analysis of emergency cesareans from 2004 (introduction of the new SOP) to 2009 in a Swiss Level 3 perinatal center. Primary endpoints were the DDI, the pathology-to-decision interval (PDI), the 5 year learning curve, and neonatal and maternal outcome. Results: In the emergency cesarean group (175 women and 188 infants), mean DDI decreased over the observation period from 15 to 9 minutes (mean 10 minutes 41 seconds), and mean PDI from 11 to 6 minutes (mean 8 minutes). Not only did the DDI not exceed 15 minutes in over 90% of cases during the 5 years, but it fell consistently below 10 minutes in the latter stages of the learning curve. Only 2/188 infants had an umbilical artery pH < 7.00 and 19/188 had an Apgar score <5 at 5 minutes. Maternal morbidity comprised three cases of superficial wound infection. Conclusion: Logistic prerequisites comprise a surgical capability directly within the delivery suite, a standby surgical and anesthetic team, a crash call system, and clear duty allocation. International guideline target times are readily achievable at no additional significant fetal or maternal cost. <span> </span></span><span style="font-size:10pt;"></span> </p> <p> <span></span> </p

Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital

“…[ 3 6 13 14 ] To conform to the recent NICE 2011 guidelines, it is mandatory that obstetric units should conduct regular audits of their DDI. [ 8 9 10 ]…”

“…Recently Korda and Zimmermann,[ 8 ] analyzed a 5 years impact of a new departmental protocol on emergency CS target time, with respect to DDI (crash call to birth); pathology-to-decision interval (PDI) pathology to crash call, the 5-year learning curve, and perinatal outcomes in mother and neonate. The PDI was timed from the beginning of pathology to crash call (for e.g., beginning was timed manually from the electronic CTG; while vaginal bleeding was timed from midwife's call to the obstetrician).…”

“…Recently,[ 28 ] the effect of a simulation-based multidisciplinary team training proved that the proportion of emergency CS achieved within a 30 min time frame was higher after team training. [ 8 ]…”

“…[ 4 ] Various teaching and general hospitals worldwide have carried out audits on their response time for emergency cesarean sections (CSs) to assess if the proposed standards could be met in their institutions. [ 5 6 7 8 ] However, such audits from India are reported sporadically highlighting the reasons for delay in DDI, which are different from developed countries. [ 9 10 11 ]…”

Decision to delivery interval in emergency LSCS and its impact on fetal outcome

“…[9][10][11] NICE guidelines in 2011 mandates every obstetric units to conduct regular audits of their Decision to delivery interval. [12][13][14] Study was able to achieve since the audits were conducted regularly in the centre as per the proposed guidelines.…”