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Decision-to-Delivery Interval After Implementation of a Specific Protocol for Emergency Cesarean Delivery Because of Category III Fetal Heart Rate Tracings

Published:September 09, 2022DOI:https://doi.org/10.1016/j.jogc.2022.09.001

      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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