Target decision to delivery intervals for emergency caesarean section based on neonatal outcomes and three year follow-up

Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):276-81. doi: 10.1016/j.ejogrb.2011.07.044. Epub 2011 Aug 11.


Objective: To investigate current target decision to delivery intervals (DDIs) for 'emergency' caesarean section.

Study design: Prospective observational cohort study in a teaching hospital providing district and tertiary maternity services delivering 6000 babies per annum.

Results: 68% Category 1 deliveries were achieved within 30min and 66% Category 2 within 75min (26% for antepartum Category 2 deliveries). Category 1 deliveries were quicker using general rather than regional anaesthesia (21 vs. 29min, odds ratio [OR] for delivery <30min 4.2, 95%CI 1.3-14.2). 8% Category 1 and 4% Category 2 neonates were acidotic or asphyxiated. The risk of acidosis was not reduced by delivery within 30min for Category 1 (OR 0.56; 0.11-2.81), or within 75min for Category 2 (OR 2.72; 0.6-25.1). Three babies were registered with developmental impairment by three years of age; none were Category 1 deliveries.

Conclusions: Our data suggest that clinical triage is effective, with the more compromised fetus delivered more rapidly using general anaesthesia. For Category 1 deliveries a 30min target DDI is appropriate, although those born after longer DDI did not show developmental impairment. For Category 2 caesarean sections performed for acute fetal distress or concerns, failed instrumental delivery, failure to progress or placental bleeding, a 75min DDI may be an appropriate target but did not protect against acidosis, asphyxia or developmental impairment. Longer DDIs did not result in unfavourable outcomes for other Category 2 indications.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidosis / congenital
  • Acidosis / etiology
  • Acidosis / prevention & control
  • Anesthesia, Obstetrical / adverse effects
  • Apgar Score
  • Asphyxia Neonatorum / etiology
  • Asphyxia Neonatorum / prevention & control
  • Cesarean Section* / adverse effects
  • Child Development* / drug effects
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hospitals, Teaching
  • Humans
  • Infant, Newborn
  • Male
  • Pregnancy
  • Pregnancy Complications / classification*
  • Pregnancy Complications / physiopathology
  • Pregnancy Complications / surgery*
  • Pregnancy Outcome
  • Prospective Studies
  • Time Factors
  • Triage / methods*
  • United Kingdom / epidemiology