Research Article
Volume 10 Issue 5 - 2021
Category 1 Caesarean Section Decision to Delivery Interval: The Causes of Delay and Impact on Neonatal Outcomes
Mariam Kunjachen Maducolil1*, Shameena Ajmal1, Enas Abdulrahim Ibrahim Alzebdeh1, Abubaker YH Abdel Rahim1, Enaam Mohammed Ali Rudwan1, Smitha Joel1, Huda Abdullah Hussain Saleh1, Stephen W Lindow2 and Thomas A Farrell1
1Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
2Coombe Women and Infants University Hospital, Dublin, Ireland
*Corresponding Author: Mariam Kunjachen Maducolil, Associate Consultant, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
Received: March 16, 2021; Published: April 22, 2021




Abstract

Introduction: The introduction of cesarean section categorization and recommendations on decision to delivery interval was a major step forward towards standardizing clinical response to obstetric emergencies. The recommended decision to delivery interval (DDI) for category 1 cesarean sections is 30 minutes, however there is a balance to be struck to ensure that reducing fetal hypoxic risk is not at the expense of increasing maternal and fetal morbidity.

Aim of the Study: The aim of the study was to review category 1 cesarean sections, focusing on reasons for delays and neonatal outcomes.

Design: The study was conducted as a quality improvement initiative to review the performance of the institution in managing women delivered as category 1 cesarean section between January 2020 and August 2020.

Methods: The data was extracted from the operating theatre log book and patient electronic records (Cerner system) and analyzed using SPSS statistics package.

Results: There were 577 cases of category 1 Cesarean section undertaken during the study period. The recommended DDI of 30 minutes was achieved in 385/577 (67%) of cases but was exceeded in 192/577 (33%) of cases. The most common indication of category 1 cesarean section was fetal distress (58%).

It was noted that significantly more women (88.8%) in the < 30-minute group had the decision taken in the labor ward, which is in close proximity to the obstetric theatre. Significantly more women in the < 30-minute group had epidural or general anesthesia. Significant delays in the preparation time, transfer time, anesthesia time and delivery time were noted in the > 30-minute group. The neonates in the < 30-minute group had significantly lower pH and base excess measurements at birth however fewer were admitted to the neonatal intensive care unit.

Conclusion: This study has demonstrated that only two thirds of category 1 cesarean deliveries are performed within the 30-minute recommendation. The delays were evident at every stage of the process of performing the cesarean.

There are some factors which are not modifiable such as non- labor ward transfers. Continued monitoring of category 1 cesarean outcomes is recommended.

 

Keywords: Category 1 Cesarean Section; Delays; Neonatal Outcome; Decision to Delivery Interval; Quality Improvement

References

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Citation: Mariam Kunjachen Maducolil., et al. “Category 1 Caesarean Section Decision to Delivery Interval: The Causes of Delay and Impact on Neonatal Outcomes”. EC Gynaecology 10.5 (2020): 84-92.

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