title: The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome.
abstract: OBJECTIVE
  To study the effect of a departmental program designed to shorten the decision-to-delivery interval (DDI) for emergency cesarean section (ECS) for nonreassuring fetal heart rate (NRFHR) on maternal and neonatal outcome.
  
  
  METHODS
  A protocol for managing ECS that included documenting precise time-intervals, identification of delaying obstacles and debriefing of each case, was implemented from March 2011. All women who delivered by ECS for NRFHR, as the only indication were included. Detailed information regarding DDI, maternal intraoperative and postoperative complications, and neonatal early outcomes were compared before (period-P1) (-27 months) and after (period 2) (+27 months) program implementation.
  
  
  RESULTS
  During 54 months of study, 593 ECS DDI were included. Mean DDI decreased at period 2 (12.3 ± 3.8 min, n = 301) compared with period 1 (21.7 ± 9.1 min, n = 292), P < .001. Rate of cord pH ≤7.1 and 5 min Apgar score ≤7 decreased at period 2 compared with period 1, P = .016 and P = .031, respectively. Worse composite neonatal outcome decreased at period 2 compared with period 1, 15.6% vs 32.2%, respectively, P ≥ .001. Composite maternal outcome did not differ between the groups. Worse neonatal outcome was dependent on time period (period 1), odds ratio, 2.12; 95% confidence interval, 1.27-3.55; P = .004 and on gestational age at delivery, odds ratio, 0.68; 95% confidence interval, 0.62-0.76; P < .001.
  
  
  CONCLUSIONS
  Introduction of a management protocol to shorten DDI in ECS for NRFHR was associated with improved early neonatal outcome without change in maternal complications.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Weiner
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Nataly
authors.initials: N
authors.lastname: Fainstein
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tikva, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Ben-Haroush
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Oscar
authors.initials: O
authors.lastname: Sadan
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Golan
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Kovo
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003657:Decision Making; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D015397:Program Evaluation; D013997:Time Factors
keywords: decision-to-delivery interval; emergent cesarean section; nonreassuring fetal heart rate