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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- FIGO consensus guidelines on intrapartum fetal monitoring: physiology of fetal oxygenation and the main goals of intrapartum fetal monitoring.Int J Gynaecol Obstet. 2015; 131: 5-8
- FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography.Int J Gynaecol Obstet. 2015; 131: 13-24
- Intrapartum fetal monitoring.Am Fam Physician. 2009; 80: 1388-1396
- Practice bulletin no. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles.Obstet Gynecol. 2009; 114: 192-202
- The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines.Obstet Gynecol. 2008; 112: 661-666
- Guidelines for perinatal care.5th ed. American Academy of Pediatrics, Elk Grove Village (IL)2002
- Practice bulletin no. 116: management of intrapartum fetal heart rate tracings.Obstet Gynecol. 2010; 116: 1232-1240
- The Royal College of Obstetricians and Gynaecologists and the Royal College of Anaesthetists. Setting standards to improve women’s health. Classification of urgency caesarean section. A continuum of risk.(Available at:)
- Caesarean section: clinical guidelines [CG132].(Available at:)
- Decision to delivery interval: a retrospective study of 1,000 emergency caesarean sections.J Obstet Gynaecol. 2006; 26: 307-310
- Decision-to-delivery interval in emergency caesarean delivery in tertiary care hospital in Thailand.Obstet Gynecol Sci. 2018; 61: 48-55
- Decision-to-incision times and maternal and infant outcomes.Obstet Gynecol. 2006; 108: 6-11
- Decision-to-delivery interval in pregnant women with intrapartum non-reassuring fetal heart rate patterns.J Eval Clin Pract. 2016; 22: 998-1002
- Committee opinion no. 644: the Apgar score.Obstet Gynecol. 2015; 126: e52-e55
- Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy.Obstet Gynecol. 2014; 123: 896-901
- A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section.J Obstet Gynaecol. 2022; 42: 999-1003
- French organizational guidelines for obstetrics anaesthesia.Anesth Reanim. 2016; 2: 206-212
- Multidisciplinary team training reduces the decision-to-delivery interval for emergency Caesarean section.Acta Anaesthesiol Scand. 2015; 59: 1287-1295
- The effect of a program to shorten the decision-to-delivery interval for emergent caesarean section on maternal and neonatal outcome.Am J Obstet Gynecol. 2014; 210 (224 e1–6)
- Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France.Anaesth Crit Care Pain Med. 2019; 38: 623-630
- The association of decision-to-incision time for caesarean delivery with maternal and neonatal outcomes.Am J Perinatol. 2018; 35: 247-253
- Decision-to-incision time and neonatal outcomes: a systematic review and meta-analysis.Obstet Gynecol. 2014; 123: 536-548
- Decision - delivery interval and perinatal outcome in emergency caesarean sections.J Obstet Gynaecol. 2005; 25: 342-346
- Crash emergency caesarean section: decision-to-delivery interval under 30 min and its effect on Apgar and umbilical artery pH.Arch Gynecol Obstet. 2005; 273: 161-165
- Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency caesareans.J Perinatol. 2005; 25: 229-235
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.
