title: Decision-to-delivery interval for emergency caesareans in the Aurore perinatal network.
abstract: OBJECTIVE
  To determine the interval between decision and delivery (DDI) for urgent and very urgent caesarean deliveries within a perinatal network, to compare the results according to maternity ward level and organisation, and to assess the impact of DDI on neonatal outcome.
  
  
  METHODS
  Prospective observational study in the 31 maternity units of the Aurore perinatal network (17 Level I, 12 Level II, and two Level III). The obstetric team defined the degree of urgency for the caesareans, measured the DDI, and reported neonatal outcome.
  
  
  RESULTS
  The study includes 666 unplanned caesarean sections. The median DDI for emergency caesareans (n=365) was 48 min for Level I units, 40 min for Level II, and 22 min for Level III (P<0.05). For the very urgent caesareans (n=82), the median DDI was respectively 35, 24, and 13 min (P<0.05) and the percentage with a DDI<or=30 min were 45%, 62%, and 100% (P<0.05). The proportion of DDI<or=30 min was 0% in maternity units where obstetricians and anaesthetists were not always onsite, 67% when only the anaesthetist was always present (P<0.05) and 88% for units where both were always present. The neonate's condition did not differ significantly according to DDI.
  
  
  CONCLUSIONS
  DDI varies very substantially according to the level and organisation of the maternity units in the Aurore network. It was not significantly correlated with neonatal outcome in our population.
authors.affiliation: Hospices Civils de Lyon Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France. cyril.huissoud@chu-lyon.fr
authors.forename: Cyril
authors.initials: C
authors.lastname: Huissoud
authors.forename: Corinne
authors.initials: C
authors.lastname: Dupont
authors.forename: Florence
authors.initials: F
authors.lastname: Canoui-Poitrine
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.forename: Gil
authors.initials: G
authors.lastname: Dubernard
authors.forename: René-Charles
authors.initials: RC
authors.lastname: Rudigoz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods; D004630:Emergencies; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis; D005602:France / Q000453:epidemiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D013997:Time Factors