Decision Delivery Interval in Emergency and Urgent Caesarean Sections: Need to Reconsider the Recommendations?

• DOI: 10.1007/s13224-017-0991-6
• Publication Date: 2017-04-13T12:15:01Z
• Authors: Nalini Mishra; Ruchi Gupta; Nomita Singh
• Keywords: Apgar score

The timeline between a decision made and delivery of the baby is termed decision delivery interval (DDI). According to current recommendations, an emergency caesarean section must be performed within 30 min of the decision. The present study was conducted with an objective to assess DDI in a busy obstetric unit in India and its impact on obstetric outcome.A total of 480 women with indications of category I (emergency): Immediate threat to life of woman or foetus (n = 66), and category II (urgent): Maternal or foetal compromise but not immediately life-threatening (n = 414), were studied in the context of DDI and composite adverse perinatal outcomes including fresh stillbirth, 5-min Apgar score <7 and NICU admission.Recommended DDI of <30 min could be achieved in 30% cases of emergency CS only. Sixty-three per cent with prolapsed cord could be delivered within 30 min. The composite neonatal outcomes were not significantly increased up to DDI of 60 min for category I (emergency) (except in prolapsed cord) and up to 90 min in category II (urgent) caesarean sections.Authors propose reconsideration of the present recommendations of DDI in categories I and II, while Crash CS (cord prolapse or catastrophic antepartum haemorrhage) should be a separate group with recommended DDI of 30 min. For the remaining cases in the present emergency CS group, the suggested DDI of 60 and, for urgent group, 90 min may be made following further studies to prevent this DDI yardstick from becoming a rod at our back.