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

ObjectiveTo investigate current target decision to delivery intervals (DDIs) for 'emergency' caesarean section.Study designProspective observational cohort study in a teaching hospital providing district and tertiary maternity services delivering 6000 babies per annum.Results68% Category 1 deliveries were achieved within 30 min and 66% Category 2 within 75 min (26% for antepartum Category 2 deliveries). Category 1 deliveries were quicker using general rather than regional anaesthesia (21 vs. 29 min, odds ratio [OR] for delivery <30 min 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 30 min for Category 1 (OR 0.56; 0.11-2.81), or within 75 min 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.ConclusionsOur data suggest that clinical triage is effective, with the more compromised fetus delivered more rapidly using general anaesthesia. For Category 1 deliveries a 30 min 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 75 min 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.