Emergency caesarean section: influences on the decision-to-delivery interval

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Healthcare Management

Background:

• RCOG/NICE guidelines mandate delivery within 30 minutes for fetal compromise during labor.
• Timely emergency caesarean delivery is critical for fetal well-being.

Purpose of the Study:

• To identify factors influencing decision-to-delivery (DD) intervals for emergency caesarean sections.
• To assess the impact of midwifery staffing and anesthesia type on DD times.

Main Methods:

• Prospective data collection over 12 months for grade 1 and 2 emergency caesareans.
• Analysis of decision-to-delivery intervals in relation to patient-to-midwife ratios and anesthesia type.

Main Results:

• A higher ratio of laboring women to midwives significantly prolonged DD intervals (P < 0.001).
• Prolonged transfer times to the operating theatre were the primary cause of extended DD intervals.
• General anesthesia reduced DD intervals for grade 1 caesareans (P < 0.001) and was more common during day shifts (P < 0.009).

Conclusions:

• Midwifery staffing levels are a key determinant of DD intervals for urgent caesarean sections.
• The choice of anesthesia impacts delivery times, with general anesthesia being faster for urgent cases.
• Optimizing staffing and anesthesia protocols can improve timely delivery for fetal compromise.