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


  • Vidhu V. Nair Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita, Viswavidyapeetham University, Kochi, Kerala, India
  • Sobha S. Nair Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita, Viswavidyapeetham University, Kochi, Kerala, India
  • Prasanna Venugopalan Department of Obstetrics and Gynaecology, Travancore Medical College, Kollam, Kerala, India



Category I, Category II, Decision-delivery interval, Emergency LSCS, Fetal outcome, RCOG protocol


Background: Emergency LSCS can be categorized based on RCOG guidelines into category I and II which indicates maternal or fetal compromise. Here an urgent delivery and the DDI (decision to delivery interval) within 30 and 45 minutes respectively is needed.

Methods: This is a retrospective cross-sectional analysis conducted on a sample of 630 patients who underwent caesarean section over a year, from June 2016 to June 2017. The DDI were further classified into ≤30 and >30 minutes for category I, ≤45 and >45 minutes for category II LSCS. The primary objective is to determine whether DDI in Category I and II emergency LSCS has an impact on fetal outcome and secondary objective is to ensure that DDI is within the standard criterion as per RCOG protocol.

Results: Out of 630 samples of caesareans, it was found that 173 falls in Category I and 189 falls in Category II. Out of 87 (50.29%) patients delivered within 30 minutes in Category I, 29 babies required NICU admission. DDI was more than 30 minutes in 86 (49.71%) cases in Category I out of which 38 babies got admitted in NICU with low APGAR scores. Out of 176 (93.12%) patients who delivered within 45 minutes in Category II, 56 babies required NICU admission. DDI was more than 45 minutes in 13 (6.88%) cases in Category II and all these babies got admitted in NICU.

Conclusions: Decision -delivery interval has a significant impact on fetal outcome.

Author Biography

Sobha S. Nair, Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita, Viswavidyapeetham University, Kochi, Kerala, India




MacKenzie IZ, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section - Evidence from 415 deliveries. BJOG. 2002;109:498-504.

Lucas DN, Yentis SM, Kinsella SM. Urgency of caesarean section: a new classification. J R Soc Med. 2000;93:346-50.

Royal College of Obstetricians & Gynaecologists, the Royal College of Anaesthetists. Classification of urgency of caesarean section - a continuum of risk (Good Practice No. 11) Available at: Accessed on 19 May 2016.

National Institute for Health and Clinical Excellence. CG132 Cesarean Section. Clinical Guidelines for Emergency CS. Available from: http:// www. guidance. Last accessed on 2016 Jul 23.

The AAP Committee on Fetus and Newborn, ACOG Committee on Obstetric Practice. Guidelines for Perinatal Care. 7th ed. American Academy of Pediatricians; 2012:192.

World Health Organization. Appropriate technology for birth. Lancet. 1985;2:436-7.

Lagrew DC, Bush MC, Mckeown AM, Lagrew NG. Emergent (crash) cesarean delivery: indications and outcomes. Am J Obstet Gynecol. 2006;194:1638-43.

Tan WC, Tan LK, Tan HK, Tan AS. Audit of 'crash' emergency caesarean sections due to cord prolapse in terms of response time and perinatal outcome. Ann Acad Med Singapore. 2003;32:638-41.

Standards for Obstetric-Gynaecologic Services, 7th ed. Washington, DC; American College of Obstetricians and Gynaecologists. Committee on Professional Standards. 1989.

Indications for cesarean section: final statement of the panel of the National Consensus Conference on Aspects of Cesarean Birth. CMAJ. 1986;134:1348-52.

Royal College of Obstetricians and Gynaecologists. Report of a joint working group: organisational standards for maternity services. London: RCOG Press, 1995.

Korda V, Zimmermann R. Five-year impact of a new departmental protocol on emergency cesarean target times. Open J Obstet Gynecol. 2013;3:148-53.

Roy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D. Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Indian J Pediatr. 2008;75:1249-52.

Singh R, Deo S, Pradeep Y. The decision to delivery interval in emergency caesarean sections and its correlation with perinatal outcome: Evidence from 204 deliveries in a developing country. Trop Doct. 2012;42:67-9.

Benziv R, Ashwal E, Ezra H, Rabinerson D, Wiznitzer A, Ben-Haroush A. Decision to delivery interval in suspected placental abruption-association with pregnancy outcome. J Matern Fetal Neonatal Med. 2014;27:1680-3.

Schauberger CW, Rooney BL, Beguin EA, Schaper AM, Spindler J. Evaluating the thirty minute interval in emergency cesarean sections. J Am Coll Surg. 1994;179:151-5.

Helmy WH, Jolaoso AS, Ifaturoti OO, Afify SA, Jones MH. The decision-to-delivery interval for emergency caesarean section: Is 30 minutes a realistic target? BJOG. 2002;109:505-8.

Lim Y, Shah MK, Tan HM. Evaluation of surgical and anaesthesia response times for crash caesarean sections - An audit of a Singapore hospital. Ann Acad Med Singapore. 2005;34:606-10.

Yakasai IA, Ahmed ZD, Okonofua FE. Decision delivery interval in emergency cesarean section in tertiary centre in Northern Nigeria. Orient J Sci Res. 2012;1:16-23.

Ong BY, Cohen MM, Palahniuk RJ. Anesthesia for cesarean section - effects on neonates. Anesth Analg. 1989;68:270-5.

Leung TY, Lao TT. Timing of caesarean section according to urgency. Best Pract Res Clin Obstet Gynaecol. 2013;27:251-67.

Nair S, Mandang S, Siraj SH, Kwek K, Tan KH. A review of crash caesarean sections at KK Women's and Children's Hospital, Singapore in 2006. Singapore J Obstet Gynaecol. 2012;43:23-6.

Wee HY, Quek SC. Delivery by caesarean section. Effective system of mobilisation is used in Singapore. BMJ. 2001;323:931.

Korhonen J, Kariniemi V. Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scores. Acta Obstet Gynecol Scand. 1994;73:782-6.






Original Research Articles