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The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target?
W H Helmy1, A S Jolaoso, O O Ifaturoti
1Department of Obstetrics, Gravesend and North Kent Hospital, UK.
Objective:
To evaluate whether a 30-minute decision-to-delivery interval is a realistic target for emergency caesarean section.
Design:
An audit of all emergency caesarean sections over five separate periods.
Setting:
A district general hospital.
Participants:
Five groups of women (343 women) with an indication for emergency caesarean section.
Methods:
Following an initial survey, a structured time sheet was introduced, followed by four other surveys to complete the audit cycle.
Main Outcome Measure:
The proportion of caesarean sections where the decision-to-delivery interval was achieved within 30 minutes. The reasons for delay.
Results:
In the first survey of 73 emergency caesarean sections, the time to deliver the infant exceeded 30 minutes in 47 women (64%). The main sources of delay were transferring the women to the operating theatre and starting the anaesthetic. After the introduction of a structured time sheet, there was an improvement with each survey, but the target of 30 minutes was reached in only 71% of caesarean sections in the final survey.
Conclusions:
The introduction of a time sheet can improve the decision-to-delivery interval for emergency caesarean section; however, a universal standard of 100% in 30 minutes is unrealistic.