Abstract
Objective
To assess the frequency of emergency cesarean deliveries with decision-to-delivery
intervals (DDIs) of less than 30 minutes after implementation of a code blue protocol
following National Institute of Child Health and Human Development (NICHD) category
III fetal heart rate (FHR) tracings. The secondary aim was to compare differences
in pregnancy outcomes for deliveries completed before and after the 30-minute threshold.
Methods
All women undergoing a code blue emergency cesarean delivery between July 2015 and
December 2021 were included. Information from electronic medical records, including
baseline demographics, clinical characteristics, and pregnancy outcomes were retrospectively
reviewed.
Results
Among 254 code blue cesarean deliveries, 246 (96.9%) had a DDI of ≤30 minutes. The
median DDI was 17 (14.3–20.0) minutes. No significant differences in adverse maternal
and neonatal outcomes were detected between deliveries with DDIs greater than and
less than 30 minutes. The incidence of stillbirth was higher in the >30 minute-DDI
group than in the ≤30 minute-DDI group (12.5% vs. 2%; P = 0.176).
Conclusions
After implementation of a code blue protocol for emergency cesarean delivery, a DDI
within 30 minutes was achieved in 97% of cases with category III FHR tracings. The
incidence of stillbirth was dramatically higher in the >30 minutes-DDI group. We encourage
all obstetric units to consider every factor that could reduce the DDI by developing
specific, local protocols.
Résumé
Objectif
Évaluer la fréquence des césariennes d’urgence avec un délai décision-accouchement
(DDA) de moins de 30 minutes après l’adoption d’un protocole code bleu en cas de tracé
de fréquence cardiaque fœtale (FCF) de catégorie III d’après le National Institute
of Child Health and Human Development (NICHD). L’objectif secondaire était de comparer
les différences dans les issues de grossesse entre les accouchements ayant eu lieu
avant et après le seuil de 30 minutes.
Méthodologie
Toutes les femmes ayant subi une césarienne d’urgence avec code bleu dans la période
de juillet 2015 à décembre 2021 ont été incluses. Un examen rétrospectif a été effectué
à partir des renseignements extraits des dossiers médicaux électroniques, y compris
les données démographiques de base, les caractéristiques cliniques et les issues de
grossesse.
Résultats
Des 254 césariennes avec code bleu, 246 (96,9 %) ont eu un DDA de 30 minutes ou moins.
Le DDA médian était de 17 minutes (14,3–20,0). Aucune différence significative n’a
été observée en ce qui concerne les issues maternelles et néonatales entre les accouchements
où le DDA était supérieur ou inférieur à 30 minutes. L’incidence des mortinaissances
était plus élevée dans le groupe DDA de plus de 30 minutes que dans le groupe DDA
de 30 minutes ou moins (12,5 % p/r 2 %; p = 0,176).
Conclusions
Après la mise en œuvre d’un protocole code bleu pour césarienne d’urgence, il a été
possible d’obtenir un DDA de 30 minutes ou moins dans 97 % des cas de tracé de FCF
de catégorie III. L’incidence des mortinaissances était considérablement plus élevée
dans le groupe DDA de plus de 30 minutes. Nous encourageons toutes les unités d’obstétrique
à considérer tous les facteurs qui pourraient réduire le DDA en élaborant des protocoles
locaux spécifiques à leur contexte.
Keywords
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Article info
Publication history
Published online: September 09, 2022
Accepted:
September 2,
2022
Received:
July 5,
2022
Footnotes
Disclosures: This study was supported by a grant from the Siriraj Research Development Fund (managed by Routine to Research: R2R; grant no. R016435032).
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
