title: Target decision to delivery intervals for emergency caesarean section based on neonatal outcomes and three year follow-up.
abstract: OBJECTIVE
  To investigate current target decision to delivery intervals (DDIs) for 'emergency' caesarean section.
  
  
  METHODS
  Prospective observational cohort study in a teaching hospital providing district and tertiary maternity services delivering 6000 babies per annum.
  
  
  RESULTS
  68% Category 1 deliveries were achieved within 30min and 66% Category 2 within 75min (26% for antepartum Category 2 deliveries). Category 1 deliveries were quicker using general rather than regional anaesthesia (21 vs. 29min, odds ratio [OR] for delivery <30min 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 30min for Category 1 (OR 0.56; 0.11-2.81), or within 75min 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.
  
  
  CONCLUSIONS
  Our data suggest that clinical triage is effective, with the more compromised fetus delivered more rapidly using general anaesthesia. For Category 1 deliveries a 30min 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 75min 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.
authors.affiliation: Department of Obstetrics and Gynaecology, North Devon District Hospital, Barnstaple, Devon, UK. greg.pearson@doctors.org.uk
authors.forename: Greg A
authors.initials: GA
authors.lastname: Pearson
authors.forename: Brenda
authors.initials: B
authors.lastname: Kelly
authors.forename: Robin
authors.initials: R
authors.lastname: Russell
authors.forename: Susan
authors.initials: S
authors.lastname: Dutton
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.forename: Ian Z
authors.initials: IZ
authors.lastname: MacKenzie
mesh_terms: D000138:Acidosis / Q000151:congenital / Q000209:etiology / Q000517:prevention & control; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000209:etiology / Q000517:prevention & control; D002585:Cesarean Section / Q000009:adverse effects; D002657:Child Development / Q000187:drug effects; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification* / Q000503:physiopathology / Q000601:surgery*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D014218:Triage / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology