Decision-to-delivery Interval Research Articles

A Time-Motion Study on the Operating Room Processes among Pregnant COVID-19 Patients Undergoing Cesarean Section in a Tertiary Government Hospital

Objective. This study aims to determine time and motion in the operating room in emergent, urgent and scheduled cesarean section surgeries among pregnant COVID-19 patients.
 Methodology. A time and motion performance evaluation study was done by computing the following parameters: pre-induction time, pre-incision time, opening time, closing time, for both decision-to-delivery interval (DDI) and overall operative time.
 Results. During the study period, emergent DDI average was 2 hours and 38 minutes, emergent overall operative time was 1 hour and 31minutes, urgent DDI average was 3 hours and 51 minutes, and urgent overall operative time of 1 hour and 57 minutes. However, in both urgent and emergent cases, the recommended DDI of 30 minutes, and the average duration of 44.3 minutes for CS were not feasible.
 Conclusion. The COVID-19 pandemic has negatively affected the provision of surgical obstetric care and OR utilization. Due to the new safety protocol for healthcare workers and patients, there was a significant delay in DDI and overall operative time. The causes were preparation, anesthesia factors or obstetrician factors. Identifying modifiable obstacles may improve the DDI, overall operative time, and the quality of maternal and child birth care during this pandemic.

Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020.

PurposeAlthough its fetal outcomes and practicality are unclear time interval between decision-to-delivery ≤30 minutes in emergency caesarean section (CS) is the internationally accepted standard of practice. This study aimed to determine whether a decision to delivery interval (DDI) of approximately 30 minutes was achieved in daily practice, its fetal outcomes, and associated factors among emergency caesarean section delivery at South Gondar Zone Hospitals, Northwest Ethiopia.Patients and MethodsRetrospective cross-sectional study was carried out from August 1–30/2020 among emergency caesarean sections. Information was collected from the birth register book and individual files of standardized facility booking forms. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. A bivariable and multivariable logistic regression analysis was conducted and a significant association was recorded at p<0.05.ResultsOnly 17.5% of parturients attained a decision-to-delivery interval ≤30 minutes. The average median of decision to delivery interval was 54 minutes with interquartile range (IQR) of 48–80 minutes. Time taken to collect material with Adjusted odds ratio (AOR=10.3, 95% CI 5.87–45.7), time of decision (AOR=0.32, 95% CI, 0.15–0.67), and time taken from decision to delivery to delivery of anesthesia (AOR=4.74, 95% CI, 1.30–17.3) were the predictors of prolonged delivery time interval. Significant fetal adverse outcomes were not observed in a decision to delivery interval higher than 30 minutes.ConclusionIn most cases, delivery was not completed within the prescribed ≤30-minutes interval, particularly in developing countries with infrastructural challenges, however, fetal outcomes were not directly correlated. Despite lack of substantial linkage between the delivery time declaration and fetal events, an unreasonable gap from the decision-making to birth of the child is not appropriate and should be discouraged.

Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study.

Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD. A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant. The overall mean DDI was 233.99±132.61 minutes (range 44-725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes. Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI.

Association and Determinants of Decision-Delivery Interval of Emergency Caesarean Sections and Perinatal Outcome in a Tertiary Institution

Introduction: A Decision to Delivery Interval (DDI) of 30 minutes for emergency caesarean section has been widely recommended but there is little evidence to support it. This target may not be practicable in a busy maternity unity and therefore, the anticipated beneficial effect on neonatal outcome requires re-evaluation. Aim: To determine the association between decision-delivery interval and perinatal outcome of emergency caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a period of four years. Materials and Methods: This was a retrospective observational study of the cases in emergency caesarean sections performed at the Department of Obstetrics and Gynaecology, AEFUTHA from 1st January 2012 to 1st January 2016. Hospital records of the women with singleton pregnancy at term who delivered through emergency caesarean sections were retrieved. Data extracted include socio-demographic and obstetric characteristics, duration between decision for caesarean section and intervention, indications for the caesarean section, reasons for delay in DDI, association between booking status and DDI and association of DDI and foetal outcome, APGAR score at 1st and 5th minutes and admission to NICU. Data were analysed with IBM statistics version 20. The p-value &lt;0.05 were regarded as statistically significant. Results: A total of 638 emergency caesarean sections involving singleton pregnancies at term, 522 (81.8%) of which had complete records and were analysed. The mean age of participants was 27.8±5.1 years, 89.3% were para 1-4 and 55.0% were unbooked. Only 6 (1.1%) of the emergency caesarean sections were performed within the recommended 30 minutes of DDI. The mean DDI was 189±124 minutes with range of 25 minutes to 1220 minutes. Two cases performed within 25 minutes were cases of foetal distress and cord prolapse while only a case of reduced foetal movement was delayed to 1220 minutes. The most common indications for emergency caesarean section were cephalopelvic disproportion 129 (24.7%) and foetal distress 65 (12.5%). The major cause of delay was delay in cross-matching of blood for surgery 136 (26.1%) while delay in giving informed consent contributed 67 (12.8%). There was no correlation between DDI of 75 minutes or above and the 1st minute APGAR score (AOR=2.48, CI=0.86-7.16, p-value=0.09), 5th minute APGAR score (AOR=3.08, CI=1.55-6.11, p-value=0.09), foetal outcome (AOR=0.82, CI=017-3.79, p-value=0.08) and admission to Newborn Intensive Care Unit (NICU) (AOR=2.08, CI=0.77-5.56, p-value=0.14). Conclusion: This study showed that there was no correlation between DDI&gt;75 minutes and poor perinatal outcome. Efforts should be made to strengthen the health system and improve the quality of care in order to keep DDI within this time limit for improved perinatal health outcome and indices.

Does the mode of anesthesia affect the feto-maternal outcome in category-1 caesarean section? A prospective non-randomized study comparing spinal versus general anesthesia

ABSTRACT Background: There are some advantages and drawbacks of both spinal (SA) and general anaesthesia (GA) used for caesarean section (CS) and there is no fully perfect process. Although GA is still the first choice for category‑1 emergency CS because of time constraints, but this technique poses several problems. This study was planned to compare maternal and fetal results in women undergoing emergent CS with spinal or general anesthesia. Materials and Methods: This study took place at Benha University Hospital during the period from August 2020 to February 2021. It included 74 patients who had emergency CS and were subdivided into 2 groups according to the appropriate clinical indications. Patient features, CS indication, decision-to-delivery interval (DDI), uterine incision-to delivery (UIDT), cord blood pH, Apgar scores, length of hospital stay (LOS) and maternal morbidity have been noted. Results: 74 patients were included in the analysis of total 77 patients underwent category 1 CS. The DDI and UIDT were not significantly different. One and 5-min Apgar scores were significantly higher in SA group compared to GA group. The umbilical cord blood pH showed no difference. No differences were noted between both groups regarding neonatal and maternal morbidity postoperative. Conclusion: GA may be considered the fastest anaesthesia procedure in emergency situations, as it eliminates the risk of a failed regional block. In the meantime, the danger to mother or fetus is higher. Thus, we recommend regional anesthesia wherever possible due to better outcome regarding APGAR score and LOS.

Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria \u2013 a retrospective analysis

BackgroundTo evaluate the perinatal status of neonates delivered by assisted vaginal delivery (AVD) versus second-stage caesarean birth (CS).MethodsA 5-year retrospective study was conducted in a tertiary hospital. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics.ResultsA total of 559 births met the inclusion criteria; AVD (211; 37.7%) and second-stage CS (348; 62.3%). Over 80% of the women were aged 20–34 years: 185 (87.7%) for the AVD group, and 301 (86.5%) for the second-stage CS group. More than half of the women were parous: 106 (50.2%) for the AVD group, and 184 (52.9%) for the second-stage CS group. The commonest indication for intervention in both groups is delayed second stage: 178 (84.4%) in the AVD group, and 239 (68.9%) in the second-stage CS group. There was a statistically significant difference in decision to delivery interval (DDI) between both groups: 197 (93.4%) women in the AVD group had DDI of less than 30 min and 21 women (6.0%) in the CS group had a DDI of less than 30 min (p < 0.001). During the DDI, there were 3 (1.4%) intra-uterine foetal deaths (IUFD) in the AVD and 19 (5.5%) in the CS group (p = 0.023). After adjusting for co-variates, there were statistically significant differences between the AVD and CS groups in the foetal death during DDI (p = 0.029) and perinatal deaths (p = 0.040); but no statistically significant differences in severe perinatal outcomes (p = 0.811), APGAR scores at 5th minutes (p = 0.355), and admission into the NICU (p = 0.946). After adjusting for co-variates, use of AVD was significantly associated with the level of experience of the care provider, with resident (junior) doctors less likely to opt for AVD than CS (aOR = 0.45, 95% CI: 0.29–0.70).ConclusionSecond-stage CS when compared with AVD was not associated with improved perinatal outcomes. AVD is a practical option for reducing the rising Caesarean delivery rates without compromising the clinical status of the newborn.

Impact of decision to delivery time of fetal mortality in canine caesarean section in a referral population.

In human medicine, there is a recommended decision to delivery interval (DDI), which allows for the optimization of protocols and systematic review of hospital success. In veterinary medicine, no such guideline has been established or investigated. The purpose of this study was to investigate the relationship between the interval from the decision to perform a caesarean section and the delivery of the neonates and fetal mortality at the time of surgery. One hundred and fifty canine caesarean sections were evaluated retrospectively. Caesarean cases were dichotomized to those that had at least one perinatal death and cases where all puppies survived. Factors that increased the likelihood of at least one perinatal death at caesarean section were: cases that presented as an emergency caesarean section, the dam presenting with a fetus in the vaginal canal, the dam not having a history of previous caesareans sections, and being multiparous. Even though there was no association of DDI with likelihood of having perinatal death, timing related factors that increased the likelihood of having at least one perinatal death at caesarean section were: cases where total anaesthesia time was longer than 2 h; time from induction to start of surgery was longer than 45 min and surgical time longer than 75 min. In conclusion, time is a factor in the success of canine caesarean sections and further research is needed to better define the optimal decision to delivery time in canine caesarean sections in order to optimize fetal survival and hospital protocol success rates.

Simulation Training Is Useful for Shortening the Decision-to-Delivery Interval in Cases of Emergent Cesarean Section

(Abstracted from J Matern Fetal Neonatal Med 2018;31(23):3128–3132) In the setting of obstetric emergencies for pregnant women or their fetuses, prompt delivery should be performed. While no clear absolute time threshold has been demonstrated to be a specific standard of care, many guidelines have recommended that the decision-to-delivery interval (DDI) be kept to less than 30 minutes when emergent cesarean section (ECS) is performed.

Urgency of Caesarean Section, Grading, Alarm Chain and Intrauterine Resuscitation: A Survey of Scandinavian Practice

(Acta Anaesthesiol Scand. 2018;62(2):167–176) In urgent cesarean sections (CS), time to delivery is essential for maternal and fetal outcomes. Therefore, a 4-point classification system (Lucas classification) to recognize the urgency of CS is often used to streamline communication. However, nationwide guidelines for urgent CS vary across Scandinavia, and data regarding intrauterine resuscitation, organizational factors, and auditable decision-to-delivery intervals (DDI) have not been investigated in Scandinavian countries. The authors of the present study surveyed Scandinavian anesthesiologists practicing obstetric anesthesia, to establish a consensus on current clinical practice guidelines for emergency CS.

Influence of anaesthetic technique on maternal and foetal outcome in category 1 caesarean sections - A prospective single-centre observational study.

Background and Aims:In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome.Methods:Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score <7, umbilical cord blood pH <7.2, neonatal intensive care unit admission or death) was created for adverse neonatal outcome. Logistic regression was done to assess the influence of confounding factors on the occurrence of adverse neonatal outcome.Results:Of 123 patients who underwent category 1 cesarean section, 114 patients were included for analysis. The DDI and UIDT were comparable. One and 5-min Apgar scores were significantly lower in the group general anaesthesia (GA) than in the group spinal anaesthesia (SA). The umbilical cord blood pH was comparable (7.21 ± 0.15 vs 7.25 ± 0.11 in groups GA and SA, respectively). Neonatal intensive care admission and maternal outcome were comparable in both the groups. Subgroup analysis of patients with foetal heart rate of less than 100 showed that group GA had significantly lower 1-min Apgar scores and umbilical cord blood pH and significantly more neonatal admission and mortality. Binominal logistic regression showed that group GA (odds ratio 2.9, 95% confidence intervals 1.27-6.41) and gestational age were independently associated with adverse neonatal outcome.Conclusion:GA for category 1 CS was associated with increased incidence of adverse neonatal outcome.

Determinants of Decision to Delivery Interval (DDI) in Emergency Caesarean Sections in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Nigeria

Background: Emergency caesarean sections are invaluable when vaginal delivery is either impossible or possess risk to the life of mother and or the foetus. Patients however still encounter delays after the decision has been made, despite recommended time frame. Objective: This is to identify the common indications for emergency caesarean section, factors responsible for delays after decision has been made and the short-term effect on the mother and neonate. Materials and methods: This was a retrospective study in which case records of patients who had emergency caesarean section were retrieved. Information about sociodemographic characteristics, booking status, parity, indication for surgery, decision time, incision time and short term feto-maternal outcomes were collected with the aid of structured proforma. Data was analyzed with Stata: Release 13 statistical software. Results: The mean age of participants was 28.9 ± 5.1 years, 51.3% were booked, primary caesarean section rate was 84.0%. The commonest indication was cephalo-pelvic disproportion (40.5%). The mean DDI was 145.3 ± 69.2 min. Patients’ factor was the leading cause of delay due to lack of funds and non-provision of surgical materials (53.5%). Leading hospital factors were non-availability of blood and blood products (32.8%) and power outage (28.0%). Five min APGAR score was normal in 92.3% of the neonates and 0.5% had severe asphyxia. Conclusion: This study shows that there are still avoidable delays in emergency caesarean section. Although there were no immediate neonatal complications, improving health care delivery so as to eliminate the identified causes would go a long way in reducing these delays.

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift.

Background: One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or "top-up" of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden. Methods: A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday - Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were used. Results: In total, 135 ECS were analysed: 92% of the cases were delivered within 30 minutes and mean DDI for all cases was 17.3±8.1 minutes. GA shortened the DDI by 10 and 13 minutes compared to SPA and tEDA (p<0.0005). DDI for SPA and tEDA did not differ. There was no difference in DDI regarding time of day or weekday. Apgar <7 at 5' was more commonly seen in ECS having GA (11 out of 64) compared to SPA (2/30) and tEDA (1/41) (p<0.05). Conclusion: GA shortens the DDI for ECS, but the use of SPA as well as tEDA with opioid supplementation maintains a short DDI and should be considered when time allows. Top-up epidural did not prolong the DDI compared to SPA. The day of week or time of ECS had no influence on the anaesthesia service as measured by the DDI.

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift

Background: One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or “top-up” of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden. Methods: A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday – Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were used. Results: In total, 135 ECS were analysed: 92% of the cases were delivered within 30 minutes and mean DDI for all cases was 17.3±8.1 minutes. GA shortened the DDI by 10 and 13 minutes compared to SPA and tEDA (p<0.0005). DDI for SPA and tEDA did not differ. There was no difference in DDI regarding time of day or weekday. Apgar <7 at 5’ was more commonly seen in ECS having GA (11 out of 64) compared to SPA (2/30) and tEDA (1/41) (p<0.05). Conclusion: GA shortens the DDI for ECS, but the use of SPA as well as tEDA with opioid supplementation maintains a short DDI and should be considered when time allows. Top-up epidural did not prolong the DDI compared to SPA. The day of week or time of ECS had no influence on the anaesthesia service as measured by the DDI.

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift

Background: One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or "top-up" of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden. Methods: A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday - Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were used. Results: In total, 135 ECS were analysed: 92% of the cases were delivered within 30 minutes and mean DDI for all cases was 17.3±8.1 minutes. GA shortened the DDI by 10 and 13 minutes compared to SPA and tEDA (p<0.0005). DDI for SPA and tEDA did not differ. There was no difference in DDI regarding time of day or weekday. Apgar <7 at 5' was more commonly seen in ECS having GA (11 out of 64) compared to SPA (2/30) and tEDA (1/41) (p<0.05). Conclusion: GA shortens the DDI for ECS, but the use of SPA as well as tEDA with opioid supplementation maintains a short DDI and should be considered when time allows. Top-up epidural did not prolong the DDI compared to SPA. The day of week or time of ECS had no influence on the anaesthesia service as measured by the DDI.

Peut-on diminuer le délai décision-extraction des césariennes en urgence en optimisant l’architecture des locaux ?

ObjectiveTo study the influence of architectural premises’ improvements on decision-to-delivery interval (DDI) in case of emergency cesarean sections. MethodsA retrospective observational Before-After study conducted in a type III maternity, first from 2004 to 2009 (Period 1, P1) then after moving our unit to new premises from 2009 to 2013 (P2). DDI, maternal and neonatal outcomes of every emergency cesarean section were studied. ResultsThe mean DDI of extremely urgent cesarean significantly decreased from 21.3±10.3minutes during P1 (n=294) to 14.9±7.14minutes during P2 (n=165). During P2 there was an increase in the proportion of extreme emergency cesarean sections done in less than 30minutes (85.1% versus 93.5%, P=0.003) as according to the ACOG recommendations, and also an increase of DDI of less than 15minutes (25.8% versus 61.1%, P<0.001). Also during P2 if there was a reduction of umbilical cord pHs, which were correlated to DDI, we observed a reduction of neonatal hospitalizations (42.2% versus 35.7%, P<0.001). Apgar score was correlated to umbilical cord pH and birth weight, but not to DDI. ConclusionThe space optimization has allowed our level III maternity to improve the rate of extreme emergency cesarean sections performed with DDI of less than 30 and even 15minutes, according to international recommendations. These results were obtained by reducing the transfer time to the operating room. Despite a positive correlation between DDI and umbilical cord pH, there was an improvement in neonatal outcomes associated with a decrease of neonatal hospitalizations.

Decision-to-Delivery Time and Perinatal Complications in Emergency Cesarean Section.

A decision-to-delivery interval (DDI) of no more than 20 minutes has long been considered a requirement for cesarean sections, even though there have hardly been any studies on this topic. We retrospectively investigated data relevant to DDI for emergency cesarean sections performed for the most common indications, namely, suspected and documented fetal asphyxia. We analyzed data on emergency in-hospital cesarean sections in the period 2008-2015. Low 5- and 10-minute Apgar scores (a scheme with points awarded for breathing, heart rate, muscle tone, skin coloration, and the elicitability of reflexes) were the primary endpoints; acid-base status in arterial cord blood and in-hospital neonatal death were the secondary endpoints. The raw analysis was supplemented by an analysis adjusted for various factors including gestational age, maternal age, and obstetrical presentation. Data from 39 291 neonates were included. The DDI was up to 10 minutes in 64.6% of cases, from 11 to 20 minutes in 34.3%, and over 20 minutes in 1.1%. Low Apgar scores were less common in children whose emergency cesarean sections were performed within 10 minutes or within 20 minutes. For example, the adjusted odds ratio for a 10-minute Apgar score below 4 was 0.49 (95% confidence interval [0.25; 0.96] when a DDI of more than 20 minutes was used as the reference criterion. This is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so.

Simulation training is useful for shortening the decision-to-delivery interval in cases of emergent cesarean section

Objective: We examined the effect of simulation training for medical staff on the decision-to-delivery interval (DDI) in cases of emergent cesarean delivery and the effect of a shortened DDI on maternal and neonatal outcomes.Material and methods: Our hospital is a tertiary perinatal center. As the simulation training was performed in March 2014, the study population was divided into two groups: pretraining group (November 2011–March 2014, 29 months: n = 15) and post-training group (April 2014–August 2016, 29 months: n = 35).Results: The DDI was significantly shorter in the post-training group than in the pretraining group (p = .009). In particular, the decision-to-entering the operating room interval was significantly shorter in the post-training group than in the pretraining group (p = .003). The umbilical artery pH was significantly better in post-training group than in the pretraining group (p = .019). Furthermore, the umbilical artery pH was significantly improved by simulation training only in “irreversible” cases (p = .012).Conclusions: The DDI was significantly shortened by introducing simulation training. We also demonstrated a beneficial effect of the simulation training on the umbilical artery pH, especially in “irreversible” cases, without increasing the rate of maternal adverse outcome.

Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section?

Maternal obesity can cause problems with anesthesia and surgery which may be reflected in emergency cesarean sections (CS) as an increased decision-to-delivery interval (DDI). To study the association of elevated maternal BMI with DDI and the failure of regional anesthesia. Eight hundred and forty-two consecutive emergency CSs during a period of 1 year in a tertiary hospital were studied retrospectively. DDIs were analyzed in Crash and < 30-min urgency categories (n = 528), while the time required to establish regional anesthesia and its success were analyzed for all emergency CS cases. The urgency distribution of the CSs was 11%, 52%, and 37% in Crash, < 30-min, and > 30-min urgency categories respectively. Increased BMI was associated with longer DDI time in the < 30-min urgency category (33(13-176) vs. 38(18-118) min; P < 0.05 for BMI < 30 and > 35 group respectively). Regional anesthesia failures (new regional anesthesia, conversion to general anesthesia, or complaint of pain during surgery) took place in 3.7%, 6.8%, and 8.5% in the BMI < 30, 30-35, and > 35 groups respectively (P = 0.021). Epidural top-up resulted in shorter DDI and time delay between arrival at the operating room and skin incision across all urgency and BMI groups than combined spinal epidural (CSE) anesthesia. Higher BMI was associated with longer DDI and more regional anesthesia failures. Epidural top-up was faster than CSE for establishing CS anesthesia.

Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital.

Background and Aims:The American College of Obstetricians and Gynecologists (ACOG) committee on professional standards and the National Institute of Clinical Excellence (NICE) guidelines suggest that decision-to-delivery interval (DDI) and emergency cesarean section (CS) should not be more than 30 min, and a delay of more than75 min in the presence of maternal or fetal compromise can lead to poor outcome. This prospective 1-year study was conducted on emergency CS in a tertiary care hospital to evaluate the DDI, factors affecting it and to analyze their effects on maternal and neonatal outcome.Material and Methods:A structured proforma was used to analyze the data from all women undergoing emergency CS, during a 1-year period, included in Category 1 and 2 of NICE guidelines for CS.Results:A total of 453 emergency CSs were evaluated, with a mean DDI of 36.3 ± 17.2 min for Category 1 CS and 38.1 ± 17.7 min for Category 2 CS (P > 0.05). Only 42.4% emergency CSs confirmed to the 30 min DDI while 57.6% had a DDI of more than 30 min. Reasons of delay were identified as a delay in shifting the patient to operation theater (22.1%), anesthesia factors (18.1%), and lack of resources or manpower (16.1%). Maternal complications occurred in 15 (3.3%) patients with 3 (0.7%) nonsurvivors having a DDI of 91.0 ± 97.0 min as compared to survivors with a DDI of 36.8 ± 15.7 min, P = 0.001. There was no significant association between DDI and occurrence of neonatal complications.Conclusion:Failure to meet the current recommendations was associated with adverse maternal outcomes, but not with adverse neonatal outcome.

Risk Factors, Maternal and Neonatal Outcome in Umbilical Cord Prolapse in South Indian Population

ABSTRACT Objective To assess associated risk factors, maternal and neonatal outcome of pregnancies complicated by umbilical cord prolapse in South Indian population. Study design It was a descriptive study. Risk factors, maternal and neonatal outcome were noted down retrospectively from case records of mothers affected by umbilical cord prolapse from April 2014 to March 2016. Results There were 39 cases of umbilical cord prolapse in 2 years. The incidence of umbilical cord prolapse in our hospital was 0.1%. Most of the women were ≤ 25 years of age (72%). Primis were 56%. Most common presentation in umbilical cord prolapse was cephalic presentation (64%). Among the affected individuals, 82% had term gestation, 79% had higher presenting part, and 87% had spontaneous rupture of membranes. Babies were delivered by lower segment cesarean section (LSCS) in 95% and birth weight was ≥2.5 kg in 67% of cases with umbilical cord prolapse. Decision to delivery interval (DDI) was ≤30 minutes in 84% of cases. APGAR score was ≥7 at 1 minute in 65% and ≥7 at 5 minutes in 83% of cases. There were 15 neonatal intensive care unit (NICU) admissions and 2 stillbirths. Most common gender was male (75%). Conclusion In our study, maternal risk factors were different from traditional risk factors in relation to age, parity, period of gestation, presentation, and birth weight. But, station of presenting part, early dilatation of cervix at diagnosis, and male gender predominance were similar to traditional risk factors. Neonatal outcome was good in our study with no birth injuries. All cases should be monitored properly to reduce the occurrence of umbilical cord prolapse even in low-risk population. Early detection and intervention is required for good neonatal outcome. Umbilical cord prolapse should be managed by an expert obstetrician. How to cite this article Hembram M, Sagili H. Risk Factors, Maternal and Neonatal Outcome in Umbilical Cord Prolapse in South Indian Population. J South Asian Feder Obst Gynae 2017;9(4):323-326.