Interval between decision and delivery by caesarean section—are current standards achievable? Observational case series

Abstract

Objectives: To audit interval from decision to delivery in urgent caesarean section to determine whether the current standard of 30 minutes is achievable routinely; to determine whether delay leads to an excess of admissions to special care. Design: Three audit cycles over four years followed by a continuous audit over 32 months. Setting: Large district general hospital delivering 5500 women each year. Participants: All women delivered by urgent caesarean section for abnormal fetal heart rate patterns, cord prolapse, failed instrumental delivery, or suspected placental abruption. Main outcome measures: Proportion of women delivered within 30 and 40 minutes of decision. Admission rates to special care by length of interval between decision and delivery. Results: In the continuous audit 478 of 721 (66.3%) women were delivered in 30 minutes and 637 (88.3%) within 40 minutes; 29 (4.0%) were undelivered at 50 minutes. If the woman was taken to theatre in 10 minutes, 409 of 500 (81.8%) were delivered in 30 minutes and 495 (97%) in 40 minutes. There was no significant difference in the proportion of babies born at 36 weeks or later who were admitted to special care, when analysed by interval from decision to delivery. 36/449 (8%) babies with an interval from decision to delivery of less than 30 minutes were admitted to special care and 3/23 (13%) with an interval of more than 50 minutes were admitted. Conclusions: The current recommendations for the interval between decision and delivery are not being achieved in routine practice. Failure to meet the recommendations does not seem to increase neonatal morbidity. Many national bodies recommend that when a decision is made to deliver a baby by caesarean section because of fetal distress, the baby should be delivered within 30 minutes There are no clear classifications of what is urgent nor any evidence that this standard is achievable in routine practice Delivery within 30 minutes is achievable in only two out of three cases; 88% will be delivered in 40 minutes; up to 4% of women will remain undelivered at 50 minutes Delay in delivery made no difference to the rate of admission to special care for babies over 36 weeks' gestation. © 2001, BMJ Publishing Group Ltd. All rights reserved.