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

doi:10.1136/bmj.322.7298.1330

BMJ 2001;322:1330-1333 ( 2 June )

Papers

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

Editorial by James Papers p 1334

Derek J Tuffnell, consultant, Kath Wilkinson, clinical governance support officer, Nicola Beresford, senior house officer.

Maternity Unit, Bradford NHS Trust, Bradford BD9 6RJ

Correspondence to: D J Tuffnell derek.tuffnell{at}bradfordhospitals.nhs.uk

Objectives: To audit interval from decision to deliveryin urgent caesarean section to determine whether the current standardof 30 minutes is achievable routinely; to determine whether delayleads to an excess of admissions to specialcare.
Design: Three audit cycles over four years followedby a continuous audit over 32months.
Setting: Large district general hospital delivering5500 women eachyear.
Participants: All women delivered by urgent caesarean sectionfor abnormal fetal heart rate patterns, cord prolapse, failedinstrumental delivery, or suspected placentalabruption.
Main outcome measures: Proportion of women delivered within 30 and40 minutes of decision. Admission rates to special care by lengthof interval between decision anddelivery.
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 takento theatre in 10 minutes, 409 of 500 (81.8%) were delivered in30 minutes and 495 (97%) in 40 minutes. There was no significantdifference in the proportion of babies born at 36 weeks or laterwho were admitted to special care, when analysed by interval fromdecision to delivery. 36/449 (8%) babies with an interval fromdecision to delivery of less than 30 minutes were admitted tospecial care and 3/23 (13%) with an interval of more than 50 minuteswereadmitted.
Conclusions: The current recommendations for the intervalbetween decision and delivery are not being achieved in routinepractice. Failure to meet the recommendations does not seem toincrease neonatalmorbidity.

What is already known on this topic
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

What this study adds
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

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