Decision-to-delivery Interval Research Articles

Impact of ‘decision-to-delivery’ interval on maternal and perinatal outcomes: a retrospective study of emergency caesarean section from 2017 to 2021 at a secondary health facility in Nigeria

BackgroundThe decision-to-delivery interval (DDI) for a caesarean section is among the factors that reflect the quality of care a pregnant woman receives and the impact on maternal and foetal outcomes and should not exceed 30 min especially for Category 1 National Institute for Health and Care Excellence (NICE) guidelines. Herein, we evaluated the effect of decision-to-delivery interval on the maternal and perinatal outcomes among emergency caesarean deliveries at a secondary health facility in north-central Nigeria.MethodsWe conducted a four-year retrospective descriptive analysis of all emergency caesarean sections at a secondary health facility in north-central Nigeria. We included pregnant mothers who had emergency caesarean delivery at the study site from February 10, 2017, to February 9, 2021.ResultsOut of 582 who underwent an emergency caesarean section, 550 (94.5%) had a delayed decision-to-delivery interval. The factors associated with delayed decision-to-delivery interval included educational levels (both parents), maternal occupation, and booking status. The delayed decision-to-delivery interval was associated with an increase in perinatal deaths with an odds ratio (OR) of 6.9 (95% CI, 3.166 to 15.040), and increased odds of Special Care Baby Unit (SCBU) admissions (OR 9.8, 95% CI 2.417 to 39.333). Among the maternal outcomes, delayed decision-to-delivery interval was associated with increased odds of sepsis (OR 4.2, 95% CI 1.960 to 8.933), hypotension (OR 3.8, 95% 1.626 TO 9.035), and cardiac arrest (OR 19.5, 95% CI 4.634 to 82.059).ConclusionThis study shows a very low optimum DDI, which was associated with educational levels, maternal occupation, and booking status. The delayed DDI increased the odds of perinatal deaths, SCBU admission, and maternal-related complications.

Cesarean birth decision-to-delivery interval in sub-Saharan Africa: A systematic review and meta-analysis

Background: Globally, in 2017, 810 women died daily from pregnancy- or childbirth-related preventable complications. Of these deaths, 94% occurred in resource-poor countries, with the highest maternal and perinatal mortality occurring in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis of studies on the decision-to-delivery interval (DDI) from the SSA to determine the mean DDI, establish the maternal and neonatal outcomes reported, and evaluate the obstacles to achieving the gold standard DDI of ≤30 minutes. Methods: We performed a systematic literature review and meta-analysis of eligible studies between January 1995 and December 2022, in seven databases and grey literature. Studies of any design were included if they reported obstetric emergencies delivered by cesarean birth and had information on the DDI. Three independent reviewers applied eligibility criteria, assessed the risk of bias, and extracted data. The authors performed meta-analysis of mean DDI on studies with adequate data. Results: Thirty-nine studies with 41 datasets (12,835 participants), qualified for inclusion. In these studies, only 6.34% of cesarean deliveries were performed in under 30 minutes. A meta-analysis of 27 datasets found an overall DDI mean of 2.81 hours (168.8 minutes, 95%CI 151.5 to 186.2)). The pooled perinatal and maternal case fatality rates for the included studies were 61.2 in 1000 and 444.1 in 100,000 CDs, respectively. Conclusion: This review and meta-analysis found unacceptably high mean DDI, and perinatal and maternal mortality following cesarean delivery in SSA.

Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis

ObjectiveAn emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes.MethodThis was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured.ResultsOf the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed.ConclusionCompared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.

Effect of in situ simulation training for emergency caesarean section on maternal and infant outcomes

BackgroundEmergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas.MethodsData on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation.ResultsPrimary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P < 0.05).ConclusionsThe DDI for emergency caesarean section procedures can be significantly shortened, and neonatal Apgar scores at 1 min improved by implementing in situ simulation training for emergency caesarean section in obstetric rapid response teams. In situ simulation training is an effective tool for training in emergency caesarean section procedures and is worth promoting.

Decision to delivery interval, maternal and fetal outcomes in emergency caesarean sections in a tertiary teaching hospital, Dar es salaam, Tanzania.

Emergency caesarean section (CS) answers the question on how soon the procedure should be performed. Maternal and fetal outcomes deteriorate when decision to delivery interval (DDI) exceeds 75 min. This study aimed at determining the DDI, Maternal and fetal outcomes in CS categories at Muhimbili National Hospital (MNH). A descriptive cross-sectional study involving 427 emergency CS at MNH was conducted from September to November, 2017. Data was extracted and analysed using SPSS version 23.0 where frequency, means, chi-square test and DDI were calculated to determine its association with categories of CS. The mean DDI for category one, two and three CS were 126.73, 133.57 and 160.08 min respectively. Only two (0.5%) and 54 (12.6%) of category one and two emergency CS met the recommended DDI of 30 and 75 min respectively. Maternal and fetal adverse outcome were increasing with increase in DDI. There was no significant association between DDI and adverse maternal outcome (OR: 1.2; 95% CI 0.49-2.83) and fetal outcome (OR: 1.7; 95% CI 0.91-3.38). The proportions of adverse maternal and fetal outcome were high when DDI was ≥ 75 min. Improving triage of the patients according to their urgency is crucial in reducing prolonged DDI.

Decision to Delivery Interval of Emergency Caesarean Sections: Evaluating Adherence to Timeframe and its Impact on Feto-Maternal Outcomes

Objective: To evaluate the decision to delivery interval (DDI) of category-1 and category-2 emergency caesarean section (ECS) and its effect on neonatal and maternal outcomes.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at Combine Military Hospital (CMH), Kharian, Pakistan from February 2022 to February 2023.Methods: Data from 332 patients who underwent emergency caesarean section (ECS) at a tertiary care hospital were collected on a structured proforma and analyzed. Feto-maternal outcomes were dependent, and time to decision to delivery interval were independent variables.Results: Out of 332 ECS, 126 were Category 1, and 206 were category 2. The percentages of emergency caesarean section (ECS) done within the recommended DDI were 39.5% for category 1 and 20.5% for category 2. The median (IQR) of DDI was 45 (37–54) min and 90 (75–98) min for category 1 and category 2. Eclampsia, fetal distress and failed progress of labor were the most typical indications. In both types, there was no statistically significant poor neonatal outcome related to APGAR at 1 min and 5 min. Delays were associated with more cases of post-operative fever 74 (36) and 22(13.3) in category 2 than in category 1 ECS.Conclusion: Our study found delays in the decision-to-delivery interval (DDI) for both category 1 and category 2 emergency Caesarean sections. However, no statistically significant association was found between neonatal and maternal outcomes.&#x0D; How to cite this: Parveen S, Waqar S. Decision to Delivery Interval of Emergency Caesarean Sections: Evaluating Adherence to Timeframe and its Impact on Feto-Maternal Outcomes. Life and Science. 2023; 4(4): 445-451. doi: http://doi.org/10.37185/LnS.1.1.424

Decision-to-Delivery Interval and Obstetric Outcomes of Emergency Caesarean Sections in a Nigerian Teaching Hospital

Background: Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objective: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients’ relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p&lt;0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI &gt; 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foeto-maternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutes as a benchmark.

The application of rapid response team in category 1 emergency caesarean section teaching for OBGYN residents in the delivery room.

Category 1 cesarean section (CS) can be a life-saving procedure when there is immediate threat to the life of the woman or fetus. However, category 1 CS is a challenge for obstetrics and gynecology residents, and it is necessary to establish an effective and straightforward teaching strategy. This study aimed to evaluate the efficiency of rapid response team (RRT) on category 1 CS teaching for obstetrics and gynecology residents in the delivery room. A total of 142 residents who underwent standardized residency training programs in the delivery room were divided into a RRT teaching group and a traditional response (TR) teaching group. In the RRT teaching group, Category 1 emergency CS teaching was started and explored by rapid response team. The training included both theoretical and practical components. After the training, decision-to-delivery interval (DDI), neonatal Apgar score, operation time and rate of postpartum hemorrhage were compared. A questionnaire on the subjective assessment of various aspects of the program was conducted at the end of the training period. The DDI in minutes in the RRT teaching group (n = 72) was significantly shorter than that of the TR teaching group (n = 70) (11.83 ± 4.16 vs 13.56 ± 5.47, P = .0364). The score of satisfaction from residents in the RRT teaching group was significantly higher than that of the TR group [7 (6, 9) vs 9 (7, 10), P = .0154]. Compared with the TR teaching group, more residents thought their clinical skills have been improved (94.29% vs 100%, P = .0396) and willing to recommend their training method to others (91.43% vs 100%, P = .0399) in the RRT teaching group. However, no significant differences were observed in the incidence of postpartum hemorrhage between the 2 groups. RRT teaching is beneficial in the standardized training and teaching of residents in the delivery room. It improves the DDI of category 1 emergency cesarean section and the degree of satisfaction.

Evaluation of Decision-to-Delivery Interval and Its Effect on Maternal and Neonatal Outcomes in Category-1 and Category-2 Emergency Caesarean Section Deliveries: A Systematic Review

Emergency cesarean section is a surgery delivery through the abdomen that must be carried out immediately within a decision-to-delivery interval (DDI) &lt;30 minutes because it threatens the maternal and neonatal. This study prevents prolonged DDI response time for emergency cesarean section categories 1 and 2. This study aims to determine the causes of prolonged DDI for maternal and neonatal outcomes so that hospital management becomes standardized with the standard of care for emergency cesarean sections and the quality of care for patients increases. A literature search was conducted through four databases, SpringerLink, ScienceDirect, Google Scholar, and PubMed, using keywords that matched the clinical questions. Article selection was carried out based on exclusion and inclusion criteria. The selected literature was reviewed and assessed for validity, importance, and applicability based on the Oxford Center of Evidence-Based Medicine guidelines. Nineteen (19) studies examined category 1 or category 2 emergency cesarean sections from publications from 2018 to 2022. Of the 19 studies, only 3 achieved a response time of 30 minutes for emergency cesarean section category 1 and 75 minutes for category 2. However, 17 studies explained that DDI did not affect maternal and neonatal outcomes. Factors that influence not achieving the DDI target are the unavailability of operating rooms, anesthesiologists, pediatricians, and insufficient nurses. On the other hand, lack of special training, no standard emergency cesarean section service, and limited places and facilities impact maternal and neonatal outcomes.

Evaluation of decision to delivery interval and its effect on feto-maternal outcomes in Category-I emergency cesarean section deliveries in Phuentsholing General Hospital, 2020: A retrospective cross-sectional study.

When there is an immediate threat to maternal or fetal life, it is recommended to deliver within 30 min of the decision to have favorable perinatal outcomes. However, there is no data on the delivery intervals for Category-I emergency cesarean section in Bhutan. The study evaluated the decision todelivery interval (DDI)and its effect on perinatal and maternal outcomes in Category-I emergency cesarean section. A retrospective cross-sectional study was conducted at the Phuentsholing General Hospital, Bhutan, from January 1, 2020to December 31, 2020. Mothers who underwent Category-I emergency cesarean section were included. The demographic variables, patient transfer time, anesthesia time, operation time, DDI, and maternal and perinatal outcomes were recorded in a standard proforma. The data were analyzed using SPSS version 23. Of 78 Category-I emergency cesarean sections, only 23 (29.5%) of the cases were able to perform within 30 min of the DDI. The median (interquartile range) DDIwas 37 (30-44) min. More time was taken by anesthetists to administer anesthesia (20 [15-8] min). Fetal distress (40, 51.3%) was the commonest indication. The longest DDI was around 39 min for prolonged labor, and the shortest was 26 min for failed instrumental delivery. Over half of the newborns delivered more than 30 min of DDI had low APGAR scores (25, 32.1%) at 1 min and meconium was present (23, 29.5%). Intensive care was required in 11 (14.1%), of which there was 1 (1.3%) neonatal death. The Category-I emergency cesarean sections performed within recommended DDI of 30 min were much less. The main delay was due to the longer time taken for the patient transfer and time taken by the anesthetists to administer anesthesia. Perinatal outcomes were favorable when the deliveries were conducted within 30 min of DDI.

Crash Caesarean Delivery: How to Optimise Decision-to-Delivery Interval by Initiating a Novel Code? A Clinical Audit.

Many resource-constrained centres fail to meet the international standard of 30min of decision-to-delivery interval (DDI) of Category-1 crash caesarean deliveries. However, specific scenarios like acute foetal bradycardia and antepartum haemorrhage necessitate even faster interventions. A multidisciplinary team developed a "CODE-10 Crash Caesarean" rapid response protocol to limit DDI to 15min. A multidisciplinary committee analysed a retrospective clinical audit of maternal-foetal outcomes over 15months (August 2020-November 2021), and expert recommendations were sought. The median DDI of twenty-five patients who underwent a "CODE-10 Crash Caesarean delivery" was 13 ± 6min, with 92% (23/25) of DDIs falling below 15min. Seven neonates required intensive care for more than 24h with no maternal or neonatal mortality. DDIs during office and non-office hours were not significantly different (12.5 ± 6min vs 13 ± 5min, p = 0.911). Transport delays caused the two instances of DDI > 15min. The novel "CODE-10 Crash Caesarean" protocol may be feasible for adoption in a similar tertiary-care setting with appropriate planning and training.

Application of the Plan-Do-Check-Act Cycle in Shortening the Decision to Delivery Interval Time.

ObjectiveTo discuss the application value of the plan–do–check–act (PDCA) cycle in shortening the decision to delivery interval (DDI) time.MethodsA total of 106 DDI cases from the Ningbo Women and Children’s Hospital (China) from January 2019 to December 2020 were selected as the subjects of this study. The causes for the prolongation of DDI were analyzed and protocols were developed. Through continuous summaries and improvement, a standardized process was established to direct clinical application, ie, the PDCA cycle.ResultsThe DDI was shortened from 14.26 min in 2019 to 12.18 min in 2020 and the neonatal asphyxia rate significantly decreased from 34.69% in 2019 to 12.50% in 2020 (P < 0.05).ConclusionThe PDCA cycle management mode effectively shortened the DDI time and reduced the neonatal asphyxia rate, without increasing adverse maternal outcomes.

The evaluation of decision-to-delivery interval in category-1 emergency cesarean section: a report of six cases

BackgroundIn category-1 emergency cesarean section, decision-to-delivery interval (DDI) is an important indicator for evaluating the quality of maternity care. I thus evaluated DDI and neonatal outcome in category-1 emergency cesarean section in our institution.Case presentationI collected data from the six patients undergoing category-1 emergency cesarean section performed between October 1, 2019, and December 31, 2021. The average age and gestational age were 32 years old (range, 21–42) and 34 weeks (range, 26–40), respectively. Three patients suffered from abruptio placenta and the others fetal distress. All the surgeries were performed under general anesthesia, and the average DDI was 21 min (range, 10–29). The morality was 25% in neonates whose gestational ages of >35 weeks, and that was 67% in neonates whose gestational ages of <27 weeks.ConclusionsDDI was achieved within 30 min in all the patients, and the mortality of neonate might depend on gestational age.

A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section

The achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section (CS) is relatively low in developing countries. This study was aimed to compare DDI in emergency CS before and after the implementation of a specific care process improvement protocol, called ‘code blue’. A total of 300 women underwent emergency CS were included; 150 consecutive cases before (during 2015–2016) and the other 150 consecutive cases after (during 2017–2018) ‘code blue’ implementation. Timing of decision-to-delivery process was compared. The results showed that median DDI was significantly shorter after ‘code blue’ implementation (22 vs. 52.5 minutes, p<.001). DDI of ≤30 minutes was achieved in 80% of the women under ‘code blue’ compared to 8% before implementation (p<.001). Significant improvements were observed regardless of decision time. Pregnancy and neonatal outcomes were comparable between the two periods. The implementation of ‘code blue’ protocol for emergency CS results in significantly shorter DDI and other time intervals. Impact Statement What is already known on this subject? Achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section is relatively low in developing countries. Various setting-specific care improvement processes have been reported to shorten DDI. What do the results of this study add? A multidisciplinary care improvement process (‘code blue’) that developed according to specific evidence and based on a hospital’s context can significantly shorten DDI as well as other time intervals in women requiring emergency CS. What are the implications of these findings for clinical practice and/or further research? The ‘code blue’ protocol could be used as a model for other hospitals and health care settings to develop their own specific quality improvement process in order to shorten DDI for emergency CS. Collaboration and communication between all staff members could help in better identification of significant barriers as well as development of appropriate solutions. Further studies are also needed to determine whether the shortened DDI could improve neonatal outcomes.

An audit of the effect of case selection on compliance with a 30-minute audit standard for decision-to-delivery interval at category 1 caesarean section

BackgroundOur hospital has an audit standard that ≥90% of women having category 1 (emergency) caesarean section should have a decision-to-delivery interval (DDI) ≤30 min. This audit aimed to identify potential influences of case selection on compliance. MethodsA prospective audit of category 1 caesarean section recorded urgency at time of decision for surgery and any urgency changes, as well as whether caesarean section followed failed operative vaginal delivery in the operating theatre. ResultsAmong 405 women, 158 women had failed operative vaginal delivery in the operating theatre followed by caesarean section, 247 had the delivery decision made in the labour room, 43 had a change in urgency. Depending on case inclusion, the proportion of women with DDI room, and 43 >30 min ranged between 8.3% (30/362; no urgency change, failed operative vaginal delivery included) and 21.9% (54/247; change in urgency, failed operative vaginal delivery excluded). The proportion of women with a DDI >30 min was 18.5% (42/227) if the decision for category 1 caesarean section was made in the labour delivery room (excluding cases of failed operative vaginal delivery). ConclusionsCompliance with an audit standard for (DDI) at category 1 caesarean section is markedly influenced by the inclusion criteria. For comparability with other publications, it is suggested urgency should be reported as that applied at the point of decision for caesarean section, however, category 1 caesarean section cases following failed operative vaginal delivery in the operating theatre should be identified and reported separately.

Category 1 cesarean section decision to delivery interval: the causes of delay and impact on neonatal outcomes

Objectives: The introduction of cesarean section categorization and recommendations on decision to delivery interval was a major step forward towards standardizing clinical response to obstetric emergencies. The recommended decision to delivery interval (DDI) for category 1 cesarean sections is 30 minutes, however there is a balance to be struck to ensure that reducing fetal hypoxic risk is not at the expense of increasing maternal and fetal morbidity. The aim of the study was to review category 1 cesarean sections, focusing on reasons for delays and neonatal outcomes. Design: The study was conducted as a quality improvement initiative to review the performance of the institution in managing women delivered as category 1 cesarean section between January 2020 and August 2020. Methods: The data was extracted from the operating theatre log book and patient electronic records (Cerner system) and analyzed using SPSS statistics package. Results: There were 577 cases of category 1 Cesarean section undertaken during the study period. The recommended DDI of 30 minutes was achieved in 385/577 (67%) of cases but was exceeded in 192/577 (33%) of cases. The most common indication of category 1 cesarean section was fetal distress (58%). It was noted that significantly more women (88.8%) in the &lt;30-minute group had the decision taken in the labor ward, which is in close proximity to the obstetric theatre. Significantly more women in the &lt;30-minute group had epidural or general anesthesia. Significant delays in the preparation time, transfer time, anesthesia time and delivery time were noted in the &gt;30-minute group. The neonates in the &lt;30-minute group had significantly lower pH and base excess measurements at birth however fewer were admitted to the neonatal intensive care unit. Conclusion: This study has demonstrated that only two thirds of category 1 cesarean deliveries are performed within the 30-minute recommendation. The delays were evident at every stage of the process of performing the cesarean. There are some factors which are not modifiable such as non labor ward transfers. Continued monitoring of category 1 cesarean outcomes is recommended.

A Cross Sectional Study to Evaluate Decision to Delivery Interval in Emergency Caeserian Section at a Tertiary Care Hospital

Background: One of the main factors affecting maternal morbidity and mortality is the decision to delivery interval (DDI) that is, the time taken from the decision to take the patient up for caesarean section to the delivery of the fetus. Method: This is a retrospective observational study conducted over a period of twelve months where 370 patients were studied. Results: No delay was seen in 49.2% cases whereas most delay was noted after decision by obstetricians to transfer patient to OT (22.2%). Conclusion: In order to get favourable maternal and fetal outcome decision to delivery interval should be within 30 minutes and this can be made possible if factors like results of blood investigations and cross matching of blood can be made available on time.

Impact of simulation training on decision to delivery interval in cord prolapse

BackgroundUmbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality...

O.5 COVID-19, category 1 caesarean sections, decision-to- delivery intervals and neonatal outcomes

Introduction: During the COVID-19 pandemic, we highlighted a significant 50% reduction in general anaesthetic (GA) rates for caesarean section (CS).1 NICE guidance standard recommends a decision-to-delivery interval (DDI) <30 min for category (cat) 1 CS.1 We investigated whether the increased use of regional anaesthesia (RA) for cat 1 CS during the pandemic influenced DDI and neonatal outcomes.

P.40 An audit of anaesthetic practice and associated neonatal outcomes for category 1 caesarean sections during the initial wave of the COVID-19 pandemic

Introduction: At the onset of the global pandemic of COVID- 19, significant changes were necessary to ensure the safe practice of obstetric anaesthesia. We carried out a retrospective comparative survey over the time period 1 April to 15 May 2020 and compared it to the same time period from 2019 in our tertiary centre (6800 deliveries/annum; caesarean section (CS) rate of 34%). Our primary objective was to audit the change in anaesthetic practice and its impact on the decision to delivery interval (DDI) and neonatal outcomes for category 1 CS.