Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study.
OBJECTIVE
A decision-to-delivery interval (DDI) of 30 min for category-one caesarean section (CS) deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one ('crash') CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS.


METHODS
This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05.


RESULTS
The mean (standard deviation) DDI was 9.4 (3.2) min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9%) of women had general anaesthesia (GA) for category-one CS. Of those who had an epidural catheter already in situ (34.4%), 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA).


CONCLUSIONS
Our 'crash' CS protocol achieved 100% of deliveries within 30 min. The majority (88.9%) of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA.
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
Clare Newton
CN
Dunn
Sing Health Anaesthesiology Residency Programme, Singapore Health Services, Singapore.
Qianpian
Q
Zhang
International Bacclaureate Diploma Programme, Anglo-Chinese School (Independent), Singapore.
Josh Tjunrong
JT
Sia
Centre for Quantitative Medicine, Duke NUS Graduate Medical School, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore.
Pryseley Nkouibert
PN
Assam
Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore.
Shephali
S
Tagore
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Anaesthesiology Program, Duke-NUS Graduate Medical School, Singapore.
Ban Leong
BL
Sng
Caesarean section; emergencies; general anaesthesia; local anaesthesia