[Can we do a cesarean section in less than 30min in unsuitable premises in order to follow the recommendations of the ACOG?]

Abstract

Objectives: This study aims to assess in clinical practice the "decision-to-delivery" interval for an emergency cesarean section depending on the type of care.

Materials and methods: This is a retrospective study conducted at the maternity of the CHU of Caen Level III between 2004 and 2009. The comprehensive collection of data totals 294 emergency cesarean sections. The main indications were found to be: bradycardia, cord prolapse, uterine rupture, eclampsia, failure of vacuum extraction on fetal heart rate abnormality during expulsion, the suspicion of placental abruption and hemorrhage in placenta previa. Recorded activities day and night were individualized and the maternal and fetal complications related to the emergency.

Results: The mean "decision-to-delivery" interval is of 21.3±10.3minutes with 80.2% of cesarean sections within 30minutes (CE30) and 25.8% in less than 15minutes. Concerning the activity period, the average time at night is 22.5±10.3minutes with 20.7% <15minutes and 77.2% <30minutes and in the daytime, the average time is 20.1±10.1minutes with 31.2% <15minutes and 83.3% <30minutes. The laying of spinal anesthesia in the operating room significantly delays the time of extraction (54.9% vs. 91, 8% CE30, P<0.001), but the epidural before the cesarean section and general anesthesia is faster with 91.9% vs. 78.9% (P=0.002) and 91.8% vs. 81.6% (P=0.022) respectively CE30. We deplored 9 deaths of newborns. These nine deaths represent 3.2% of emergency caesarean sections with an average time of 20.7±14.7minutes.

Conclusion: The time is influenced by the transition to the operating room, the type of anesthesia and lack of information clearly stated to the team. The fetal prognosis is not limited to the "decision-to-delivery" interval but it remains essential in situations of emergency. The 15 or 30minutes interval is discussed in the literature. Obviously, the delay must be appreciated based on certain parameters (medical personnel, architecture) and each Alpha must adapt their practice to the physical working environment to meet the recommended objectives. However, the introduction of a protocol for extreme emergencies would allow for optimal responsiveness of all the teams involved and should result in a compliance period of 30minutes. Teamwork and adherence to procedures can improve these results.