Cohort study of the decision to delivery interval and neonatal outcome for emergency operative vaginal delivery

Abstract

The purpose of this study was to assess whether a target decision to delivery interval (DDI) is appropriate for 'emergency' operative vaginal delivery and whether this would reduce adverse neonatal outcomes. We performed a retrospective cohort study of 1021 singleton term babies who experienced operative delivery for 'fetal distress' in the second stage of labor between 1998 and 2003 in Dundee, Scotland. The mean DDI in a labor room was 14.5 minutes (SD 9.5) compared to 30.0 minutes (SD 14.6) in an operating room. Shorter DDIs were associated with use of local rather than regional or general anesthesia. There were no significant differences in rates of low Apgar score (< 7 at 5 min) OR 0.99 (95% CI 0.27, 3.71), fetal acidosis (pH < 7.10) OR 1.24 (0.78, 1.99), neonatal resuscitation OR 1.00 (95% CI 0.65, 1.53), or admission to NICU OR 0.53 (95% CI 0.27, 1.03) for babies delivered within 15 minutes compared to greater than 15 minutes. The outcomes were similar for a 30-minute threshold. The DDIs for forceps and vacuum deliveries were similar as were neonatal outcomes. A DDI of 15 minutes is an achievable target for operative vaginal delivery in a labor room with 30 minutes for delivery in an operating room; however, setting arbitrary limits is unlikely in itself to prevent adverse neonatal outcomes.