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

Area of Science:

• Obstetrics and Gynecology
• Neonatal Care
• Healthcare Auditing

Background:

• Current obstetric guidelines recommend an interval of 30 minutes from decision to delivery for urgent caesarean sections.
• Achieving this standard in routine practice is crucial for optimizing neonatal outcomes.
• Auditing this interval is essential to assess adherence and identify areas for improvement.

Purpose of the Study:

• To audit the decision-to-delivery interval in urgent caesarean sections.
• To determine if the 30-minute standard is routinely achievable.
• To investigate if delays in delivery are associated with increased admissions to special care.

Main Methods:

• A multi-cycle audit was conducted over four years, followed by a continuous audit for 32 months.
• Data were collected from women undergoing urgent caesarean sections for various obstetric emergencies.
• Key outcome measures included the proportion of deliveries within 30 and 40 minutes and special care admission rates.

Main Results:

• In continuous audit, 66.3% of women were delivered within 30 minutes and 88.3% within 40 minutes.
• When theatre access was within 10 minutes, delivery rates within 30 and 40 minutes improved significantly.
• No significant difference in special care admissions was observed based on the decision-to-delivery interval.

Conclusions:

• The established 30-minute standard for urgent caesarean sections is not consistently met in current clinical practice.
• Despite not meeting the recommended interval, there is no evidence of increased neonatal morbidity.
• Further efforts may be needed to improve adherence to guidelines, but current practice does not appear to negatively impact neonatal outcomes.