Factors affecting “decision to delivery interval” in emergency caesarean sections in a tertiary care hospital: a cross sectional observational study
Keywords:
Caesarean section, Decision to delivery interval (DDI)Abstract
Background: The objective was to assess the waiting time and factors affecting the decision to delivery interval in an emergency caesarean section and to correlate it with neonatal and maternal outcomes.
Methods: This study was conducted in the Department of Obstetrics & Gynaecology at UCMS and GTB Hospital, Delhi which is a government supported tertiary care hospital located in East Delhi. Data of 275 emergency caesarean sections was collected and analyzed for decision to delivery interval (DDI) along with the causes of delay and maternal and fetal outcomes.
Results: The mean DDI was 183.24 minutes for all 275 cases and was 122 ± 89min for category I caesarean sections (crash caesareans). The major cause of delay was non availability of operation theatres due to long list of waiting caesareans sections. When the mean DDI exceeded 75 minutes, there was a 4.6 fold increase in the risk to the life of neonate while the maternal outcome was not significantly affected.
Conclusion: DDI of 30 minutes is difficult to achieve even for urgent caesarean sections in government based set up of a developing nation, therefore a more reasonable time frame of 60-75 min may be justified for emergency caesarean sections under similar set up.
Metrics
References
Wee MYK, Brown H, Reynolds F. The National Institute Of Clinical Excellence (NICE) guidelines for caesarean section: implications for the anaesthetist. IJA 2005; 14:147-58.
Derek JT, Kath W, Nicola B. Interval between decision and delivery- are current standards achievable? Observational case series. BMJ 2001; 322: 1330-33.
Jane T, Shantini P, David J. National cross section survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ 2004;328: 665-7.
MacKenzie IZ, Cooke I. Prospective 12 month study of 30 minute decision to delivery interval for emergency caesarean sections. BMJ 2001;322: 1334-5.
James D. Caesarean sections for fetal distress. BMJ 2001;322: 1316-7.
MacKenzie IZ, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries. BJOG 2002;109(5):498-504.
Sayegh I, Dupuis O, Clement HJ, Rudigoz RC Evaluating the decision--to--delivery interval in emergency caesarean sections. Eur J Obstet Gynecol Reprod Biol 2004;116(1):28-33.
Chauleur C, Collet F, Furtos C, Nourrissat A, Seffert P, Chauvin F. Identification of factors influencing the decision-to-delivery interval in emergency caesarean sections. Gynecol Obstet Invest 2009;68(4):248-54.
Chauhan SP, Roach H, Naef RW 2nd, Magann EF, Morrison JC, Martin JN Jr. Cesarean section for suspected fetal distress. Does the decision-incision time make a difference? J Reprod Med 1997;42(6):347-52.
Thomas J, Paranjothy S, James D National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ 2004;328(7441):665.
