A Cross Sectional Study to Evaluate Decision to Delivery Interval in Emergency Caeserian Section at a Tertiary Care Hospital

Background:One of the main factors affecting maternal morbidity and mortality is the decision to delivery interval (DDI) that is, the time taken from the decision to take the patient up for caesarean section to the delivery of the fetus. Method:This is a retrospective observational study conducted over a period of twelve months where 370 patients were studied. Results:No delay was seen in 49.2% cases whereas most delay was noted after decision by obstetricians to transfer patient to OT(22.2%). Conclusion:In order to get favourable maternal and fetal outcome decision to delivery interval should be within 30 minutes and this can be made possible if factors like results of blood investigations and cross matching of blood can be made available on time.

A time-motion study on the operating room processes among pregnant COVID-19 patients undergoing cesarean section in a tertiary government hospital

@#Objective. This study aims to determine time and motion in the operating room in emergent, urgent and scheduled cesarean section surgeries among pregnant COVID-19 patients. Methodology. A time and motion performance evaluation study was done by computing the following parameters: pre-induction time, pre-incision time, opening time, closing time, for both decision-to-delivery interval (DDI) and overall operative time. Results. During the study period, emergent DDI average was 2 hours and 38 minutes, emergent overall operative time was 1 hour and 31 minutes, urgent DDI average was 3 hours and 51 minutes, and urgent overall operative time of 1 hour and 57 minutes. However, in both urgent and emergent cases, the recommended DDI of 30 minutes, and the average duration of 44.3 minutes for CS were not feasible. Conclusion. The COVID-19 pandemic has negatively affected the provision of surgical obstetric care and OR utilization. Due to the new safety protocol for healthcare workers and patients, there was a significant delay in DDI and overall operative time. The causes were preparation, anesthesia factors or obstetrician factors. Identifying modifiable obstacles may improve the DDI, overall operative time, and the quality of maternal and child birth care during this pandemic.

An audit of the decision to delivery interval in emergency caesarean section and its effect on neonatal outcome

Background: Emergency caesarean section (CS) is divided into four categories based on the degree of urgency by RCOG and NICE guidelines. It is recommended that the decision to delivery interval (DDI) in emergency CS should be within 30 minutes in category 1 and within 75 minutes in category 2. Our Primary objective was to study the incidence and indications of emergency CS and audit the DDI in emergency CS at tertiary care hospital. Our secondary objective was to study the effect of DDI on neonatal outcome.Methods: Descriptive study was carried out among 409 women who underwent emergency CS from August 2018 to December 2018 at St. John's medical college hospital, Bangalore. Relevant data was collected by chart review. Emergency CS were categorised according to RCOG guidelines based on the degree of urgency and further classified based on DDI as <30 minutes, 30-75 minutes and >75 minutes.Results: We had 409 cases of emergency CS. Category 1 had 113 (27.63%) cases, category 2 had 126 (30.81%) cases and category 3 had 170 (41.56%) cases. DDI of <30 minutes was achieved in 19.5% in category 1, DDI of <75 minutes was achieved in 93.65% in category 2. Fetal distress was the leading cause of emergency CS in category 1 and 2. There was a high incidence of low APGAR in babies delivered in <30 minutes and lower APGAR was significantly associated with <30 minutes of DDI (p<0.0001).Conclusions: Fetal distress was the leading cause of emergency CS. DDI interval of <30 minutes was not always associated with good neonatal outcome; Category of CS has a significant effect on neonatal outcome.

Decision-to-delivery intervals and total duration of surgery for Caesarean sections in a tertiary general hospital

<p><b>INTRODUCTION</b>This study aimed to determine the decision-to-delivery intervals (DDIs), total duration of surgery and factors influencing these for Caesarean sections (CSs).</p><p><b>METHODS</b>A retrospective study was conducted of all CSs performed from August 2013 to June 2014 at a single tertiary general hospital. Data collected included maternal demographics, indications for CS, category of urgency, DDI, total duration of surgery, grade of first surgeon and number of previous CSs.</p><p><b>RESULTS</b>In total, 488 CSs (Category 1: n = 28; Category 2: n = 137; Category 3: n = 184; Category 4: n = 139) were studied. Overall mean duration of surgery was 41.7 minutes. Mean DDI was 23.9 minutes and 64.5 minutes for Category 1 and Category 2 CSs, respectively. For Category 1 CSs, deliveries during office hours had a significantly shorter DDI than deliveries out of office hours (p < 0.05). For Category 2 CSs, deliveries during office hours had a significantly longer DDI (p < 0.05). Total duration of surgery for senior surgeons was significantly shorter than for trainee surgeons (p < 0.05). Women with no previous CSs had a significantly shorter duration of surgery than those who had one or more (p < 0.05).</p><p><b>CONCLUSION</b>The majority of the deliveries were within the recommended DDI corresponding to the degree of urgency of CS. The influence of time of day on DDI might be due to challenges of time taken to transfer patients to operating theatres. Total duration of surgery was influenced by surgical experience, history of previous CS and individual surgical styles and preferences.</p>

The Relationship between Decision-to-Delivery Interval in Emergency Caesarean Sections and Neonatal Outcome / 实用妇产科杂志

Objectlve:To assess the influential factors of decision-to-delivery inteval (DDI) in caesarean section, and its influence on neonatal outcomes.Methods:472 caesarean sections were divided into two groups according to Lucas's classification :the emergency caesarean sections as group 1 (291) ; and the e-lective caesarean sections as group 2 (181).It was divided into DDI ≤30 min group and DDI > 30 mir group in group 1.A retrospective study was performed in DDI, influential factors of DDI, neonatal Apgar score and umbilical arterial blood gas.Results: ①The mean DDI was 35.5±11.6 min in group 1,in wgich DDI≤30 min was 210 cases (72.2%) and 49.3 ±22.8 min in group 2, in which DDI≤30 min was 86 cases (47.5%).②IN group 1,umbilical artery pH and Apgar core at 1 min after birth could be improved sigbificantly in the cases of DDI ≤ 30 min (P<0.05) , but no correlation was found between the DDI and Apgar scrore at 5 min ,as compared with DDI ＞30MIN CASES(p＞0.05).③It was mainly influenced by time taken to get the patient into operation room in DDI >30 min (56 cases, 69.1 %).Concluslons :The recommended DDI ≤30 min is not routinely achieved even in emergency caesarean sections.Shortening DDI as far as pos-sible might improve the neonatal outcome.