Background In 2010, the RCOG suggested that urgency of caesarean section (CS) represents a continuum of risk rather than discrete categories1 prompting NICE to review its recommendations on decision-to-delivery intervals (DDIs) for unplanned CS.2 As such, category 1 and 2 CS should be performed as quickly as possible, with a category 2 being performed within 75 minutes. Less emphasis was placed on the previous “benchmark” of 30 minutes for all emergency CS.3
Study objective To assess whether the DDI for unplanned CS affected fetal outcome.
Methods A retrospective analysis of all unplanned CS during a 6month period (February-August 2012) in the Horton General Hospital, Banbury. We looked for any correlation between DDIs and outcome – cord blood gases (cord pH <7.05 arterial or <7.1 venous), APGAR scores (<7 at 5minutes) and term admissions to SCBU.
Results and discussion 4 (57%) grade 1 CS had a DDI of less than and 3 (43%) of more than 30minutes (range 17-45). There was one case of acidosis where the DDI was 25 minutes. 35 (78%) grade 2 CS had a DDI of less and 10 (12%) of more than 75 minutes (range 37-125). One baby from the group DDI<75 minutes was acidotic with low APGARs and another required admission to SCBU compared to none from the group DDI>75 minutes. 71 grade 3 CS were performed with one case of acidosis (DDI 67 minutes). We postulate that this suggests no correlation between DDI and fetal outcome, supporting the concept of a continuum of risk whereby a DDI should be individualised for each case.
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