Decision-to-delivery interval for emergency caesareans in the Aurore perinatal network.
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.
Huissoud
Cyril
C
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
Dupont
Corinne
C
Canoui-Poitrine
Florence
F
Touzet
Sandrine
S
Dubernard
Gil
G
Rudigoz
René-Charles
RC
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