Decision-to-delivery interval: Is 30 min the magic time? What is the evidence? Does it work?

Emergency caesarean section is required when delivery can reduce the risk to the life of the mother or foetus. When a caesarean section is indicated for foetal compromise, a decision-to-delivery interval of 30 min (or less) has been suggested as the ideal time frame within which an obstetric team should achieve delivery. In theory, a short decision-to-delivery interval may minimise intra-uterine hypoxia and improve neonatal outcome. Current medical evidence does not support this time frame. There are certain indications for caesarean section that necessitate a much shorter decision-to-delivery interval, but evidence suggests that the majority of neonates may be safely delivered within a longer interval of time. Current tools available for the diagnosis of foetal distress are imperfect, and the concept of foetal distress is poorly defined. Future research should focus on finding accurate means of diagnosing foetal distress in labouring women and establishing universally agreed evidence-based decision-to-delivery targets without compromising maternal or foetal safety.

Anaesthesia for minor procedures in children with malignant disease.

Minor invasive procedures in children with leukaemia can be very distressing for patients, parents and staff. In Nottingham a combined clinic has been established with an anaesthetist as an integral member of the team. General anaesthesia, usually by inhalation, is frequently employed. From May 1980 to September 1984, 515 anaesthetics were given to 97 patients. Records are kept to allow analysis of the clinic's function. With close personal contact, induction of anaesthesia becomes increasingly a matter of cooperation between patient and anaesthetist, removing much of the fear of these procedures. The development of this service is described and the reasons for its success are discussed.