title: Decision-to-delivery interval in pregnant women with intrapartum non-reassuring fetal heart rate patterns.
abstract: OBJECTIVE
  It has been proposed that delivery should be accomplished within 30 minutes after diagnosis of fetal distress. The objective of this study was to determine the decision-to-delivery interval (DDI) in emergency caesarean delivery for non-reassuring fetal heart rate (FHR).
  
  
  METHODS
  A total of 272 term, singleton pregnant women who underwent an emergency caesarean section for non-reassuring FHR were included. Patient characteristics and clinical data were reviewed. The timing of the decision-to-delivery process was reviewed.
  
  
  RESULTS
  The mean age was 28.7 years; the mean gestational age at delivery was 38.4 weeks; and 93.7% were in FHR category 2. The decision for emergency caesarean delivery was made during normal office hours in 31.6%. Median time for decision-to-operating room, decision-to-incision and decision-to-delivery was 42.3, 48.5 and 56 minutes, respectively. Only 6.6% of women had a DDI of <30 minutes, whereas 30.5% had a DDI of >75 minutes. Significantly shorter intervals were observed for every endpoint among patients in FHR category 3, and they were significantly more likely to deliver within 30 minutes than were those in FHR category 2 (41.2% vs. 4.3%, P < 0.001). Similar results were observed for cases that occurred during normal and after hours. Neonatal outcomes were comparable among different DDI categories.
  
  
  CONCLUSIONS
  Only 6.6% of women with non-reassuring FHR achieved the 30-minute goal for caesarean delivery (median 56 minutes). Better performance was observed among patients in FHR category 3 regardless of diagnosis time, with 41.2% of these patients having a DDI of <30 minutes.
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Dittakarn
authors: http://orcid.org/0000-0002-5901-5923
authors: D
authors: Boriboonhirunsarn
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Kanokwaroon
authors: K
authors: Watananirun
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Nalat
authors: N
authors: Sompagdee
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D003657:Decision Making; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D008485:Medical Audit; D011247:Pregnancy; D013785:Thailand; D055815:Young Adult
keywords: clinical audit; clinical guidelines; clinical safety