Decision to incision: time to reconsider

Abstract

The fifth edition of Standards for Obstetrics and Gynecology published in 1982 stated that, “An obstetric service that generally cares for high-risk patients should be staffed and equipped to handle emergencies and to be able to begin cesarean delivery within 15 minutes.” However, in 1987, Shiono et al reported that in a survey of 538 hospitals almost all hospitals had the ability to perform an emergency cesarean section within 30 minutes; and therefore the 15-minute rule was changed in 1988 to a 30-minute rule in the sixth edition of the American College of Obstetricians and Gynecologists (ACOG) Standards for Obstetric Services as well in the second edition of the Guidelines for Perinatal Care. Since then, labor and delivery units all across the United States have been held to this 30-minute time interval, referred to as the decision to incision rule, although there are virtually no evidence-based medical studies supporting such a rule. As happened in 1988, it is time for revision once again.