Emergency caesarean section during labour: response times and type of anaesthesia

Eighteen percent of 212 consecutive emergency caesarean sections at term were classified as truly 'urgent' (requiring delivery within 20 min). The interpretation of the intrapartum cardiotocographs was generally accurate, although after an independent review of the tracings six cases classified originally as 'urgent' had Krebs scores > 4. Among the 'urgent' cases the median total time interval from decision to operate to delivery of the baby was 25 min (IQR between 20 and 33). One-third of the 'urgent' cases had total time intervals exceeding 30 min and the longest delay was 56 min. Acidotic FBS results and antepartum haemorrhage produced most rapid responses. Nine percent of the babies required SCBU admission. Seven percent of the patients in the study had general anaesthetics for their operations. Although the achievement of a total time interval delay of between 20 and 30 min was possible with regional anaesthetic techniques, a general anaesthetic was needed to obtain a time interval of less than 20 min. In conclusion, regional anaesthetic techniques can provide response times which are acceptable for the majority of 'urgent' caesarean sections with the administration of a general anaesthetic occasionally justified in the fetal interest.