Maternal and Fetal Outcomes in Extremely Urgent Caesarean Delivery in Relation to the Decision-to-delivery Interval Abstract

Kei-Man CHOW, Shui-Lam MAK

Objectives:
To evaluate whether there were any differences in the maternal and fetal outcomes for extremely urgent Caesarean deliveries having shorter decision-to-delivery interval (DDI) versus those with longer DDI (i.e. >20 minutes), and to explore the reasons for longer DDI.

Methods:
Retrospective data were retrieved between 1 January 2011 and 30 June 2013 from all women with singleton pregnancies delivering at >24 weeks of gestation by extremely urgent Caesarean sections for fetal distress. Data including the causes of fetal distress, DDI and the breakdown, perinatal outcomes (Apgar scores, cord blood pH, need for neonatal intensive care unit admission) and maternal outcomes (operative complications, wound infection, need for intensive care unit admission) were collected.

Results:
Of 171 extremely urgent Caesarean deliveries, 159 (93%) and 100 (58%) were delivered within 30 and 20 minutes after decision, respectively. Compared with the group with DDI of ≤20 minutes, the antenatal characteristics, gestational age, and birth weight were not significantly different in those with DDI of >20 minutes. No significant differences in the maternal outcomes of fever, endometritis, wound infection, bladder injury, hysterectomy, and the need for special postoperative care were found between these two groups. Besides, the mean cord blood pH was significantly lower in those with DDI of ≤20 minutes (7.19 ± 0.14 vs. 7.23 ± 0.09, p=0.04), however, no significant differences in the Apgar scores at 5 minutes as well as the need for admission to neonatal intensive care unit were noted between these two groups. No hypoxic ischaemic encephalopathy was found in those with DDI of >20 minutes. When compared with those with DDI of ≤20 minutes, more time was required in the preparation and transfer of patient to the operating theatre (15.9 vs. 7.9 mins, p<0.001), induction of anaesthesia (6.9 vs. 6.0 mins, p=0.01), and from skin incision to delivery of the baby (3.4 vs. 2.7 mins, p=0.01) for those with DDI of >20 minutes.

Conclusion:
The cord blood pH was lower in the group with DDI of ≤20 minutes than that with DDI of >20 minutes. The reason for delayed DDI was mainly related to the longer time required for preparation and transfer of patient to the operating theatre.

Hong Kong J Gynaecol Obstet Midwifery 2015; 15(1):16–22

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