Decision-to-delivery interval in emergency cesarean deliveries: real-world data from a tertiary obstetric care center...

International guidelines recommend decision-to-delivery intervals (DDIs) of ≤30 minutes (min) for emergency cesarean deliveries (ECDs), whereas the German Society recommends ≤20 min. However, the feasibility and relevance of these thresholds vary across and within healthcare systems. This study assessed the association between DDI and perinatal outcomes in ECDs performed during and outside regular working hours at a tertiary obstetric care center in Turkey.

This single-center, retrospective study included 835 ECDs with complete medical records out of 11,014 deliveries conducted between January 2021 and December 2024 at the Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, Istanbul, Turkey. Cases were categorized according to timing (working vs. outside working hours) and DDI duration (≤15, 16-30, 31-45, 46-60, and ≥61 min). Demographic data and perinatal outcomes were analyzed across these groups. Subgroup analyses were also performed according to gestational age at birth and type of anesthesia.

The overall mean DDI was 24.4 ± 12.0 min, with a median of 22 (8-68) min. 76.2% of ECDs had a DDI ≤30 min. Mean DDI was similar between working hours (24.2 min) and outside working hours (24.4 min) (p = 0.892). While the median 1- and 5-minute Apgar scores were comparable between groups (p = 0.236 and p = 0.645, respectively), neonatal intensive care unit (NICU) admission was higher during working hours (p = 0.021). The lowest Apgar scores were observed in the ≤15-minute DDI group, particularly in term pregnancies, whereas no consistent association was seen in preterm cases. In early preterm deliveries and cases under general anesthesia, prolonged DDI was associated with intrapartum fetal death. In multivariable analysis, gestational age was the only independent predictor of NICU admission, while in a Firth-penalized model, gestational age and general anesthesia were independently associated with a 5-minute Apgar score <7; DDI was not independently associated with adverse neonatal outcomes in either model.

In this tertiary obstetric care center, the recommended 30-minute DDI target was achieved in the majority of ECDs. Although lower Apgar scores were observed in cases with the shortest DDIs, prolonged DDI was not independently associated with adverse neonatal outcomes after adjustment for potential confounders. Gestational age was the main determinant of neonatal outcome, whereas DDI showed no independent effect. Nevertheless, early preterm deliveries and cases performed under general anesthesia may represent high-risk subgroups in which prolonged DDI is associated with adverse fetal outcomes.