Is the obstetric guideline of 30 minutes from decision to incision for cesarean delivery clinically significant?

Abstract

A Cesarean delivery may be critical to the health and wellbeing of a newborn. The time required to extract an infant from a hostile in utero environment is a frequent issue in medical negligence cases. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics suggest a time guideline of 30 minutes from decision for Cesarean delivery to the beginning (incision) of the procedure. This time frame is based on survey data from hospitals throughout the United States and is not based on clinical outcomes or the pathophysiology of obstetric events. This review focuses on specific Cesarean indications as noted by the specialty groups and analyzes them from an outcome point of view. The authors conclude that specific high-risk factors do indeed warrant delivery in as expedient a fashion as possible; however, compliance with the 30-minute guideline does not necessarily lead to a difference in outcome as far as the neonate is concerned.

Impact of decision to delivery time of fetal mortality in canine caesarean section in a referral population

“…). It is known that a human fetus will undergo cardiac arrest after 185 min of in utero distress, but may develop neurological deficits after 60 min of fetal distress (Lavery ). The presence of an on‐site anaesthesia team contributed to a faster decision to delivery interval (DDI) in human studies (Thomas et al .…”

“…This 30-min guideline does not, however, correlate with outcome, rather an interval of 75-min is correlated with poorer survival in terms of fetal Apgar scores and survival (Thomas et al 2004). It is known that a human fetus will undergo cardiac arrest after 185 min of in utero distress, but may develop neurological deficits after 60 min of fetal distress (Lavery 1999). The presence of an on-site anaesthesia team contributed to a faster decision to delivery interval (DDI) in human studies (Thomas et al 2004;Huissoud et al 2010).…”

The 30-Minute Decision-to-Incision Interval for Emergency Cesarean Delivery: Fact or Fiction?

“…Only a few investigative efforts have been made to assess clinical outcome in the context of the 30-minute time frame. [6][7][8] Although the guidelines 3 acknowledge that ''not all indications for a cesarean delivery will require a 30-minute response time,'' this frame of reference often arises as a significant issue in obstetric litigation cases. 6 This study was conducted to identify whether this 30-minute interval has an impact on neonatal and maternal outcome in cases of ECD performed at a tertiary hospital with full in-house obstetrical, anesthesia, and pediatric staff and attending physicians 24 hours per day.…”

Labor & Delivery Operating Room Staffing and Operating Efficiency Using Queueing Theory

“…Our assumptions for 30 minutes decision-to-incision for unscheduled, non-emergent deliveries and 5 minutes for emergent deliveries, are based on general obstetric clinical performance to minimize risk for death or asphyxia in situations of prolonged fetal heart rate decelerations with or without preceding severe late or variable decelerations 12,13 . We acknowledge the controversy that surrounds these time interval metrics [14][15][16][17] .…”