Labor room setting compared with the operating room for simulated perimortem cesarean delivery: a randomized
Steve Lipman1, Kay Daniels, Sheila E Cohen
1From the Departments of Anesthesia and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California.
Obstetrics and Gynecology
|October 22, 2011
Summary
Perimortem cesarean delivery during simulated maternal arrest is significantly faster in the labor room compared to the operating room. Performing this emergency procedure in the labor room improves resuscitation times and is recommended.
Area of Science:
- Obstetrics and Gynecology
- Emergency Medicine
- Neonatal Resuscitation
Background:
- Perimortem cesarean delivery is a critical intervention during maternal cardiopulmonary arrest.
- Timely delivery is crucial for maternal and fetal outcomes.
- Current practices often involve transport to the operating room, potentially delaying delivery.
Purpose of the Study:
- To compare the efficiency of perimortem cesarean delivery in the labor room versus the operating room during simulated maternal arrests.
- To test the hypothesis that operating room transport delays critical resuscitation milestones.
Main Methods:
- A randomized simulation study involving 15 multidisciplinary teams.
- Teams performed perimortem cesarean delivery on a manikin in either the labor room or operating room.
- Primary outcome was time to incision; secondary outcomes included milestone achievement and task completion.
Main Results:
- Median time to incision was significantly shorter in the labor room (4:25) compared to the operating room (7:53).
- Fifty-seven percent of labor room teams achieved delivery within 5 minutes, versus 14% in the operating room.
- Key resuscitation tasks, including neonatal team contact and defibrillator placement, were faster in the labor room.
Conclusions:
- Perimortem cesarean delivery in the labor room is substantially faster than in the operating room.
- Achieving delivery within 5 minutes is challenging even under optimal simulated conditions.
- Findings support performing perimortem cesarean delivery in the labor room to minimize delays during actual maternal arrests.