Decision-to-delivery interval for emergency caesareans in the Aurore perinatal network

Abstract 

Objectives

To determine the interval between decision and delivery (DDI) for urgent and very urgent caesarean deliveries within a perinatal network, to compare the results according to maternity ward level and organisation, and to assess the impact of DDI on neonatal outcome.

Study design

Prospective observational study in the 31 maternity units of the Aurore perinatal network (17 Level I, 12 Level II, and two Level III). The obstetric team defined the degree of urgency for the caesareans, measured the DDI, and reported neonatal outcome.

Results

The study includes 666 unplanned caesarean sections. The median DDI for emergency caesareans (n=365) was 48min for Level I units, 40min for Level II, and 22min for Level III (P<0.05). For the very urgent caesareans (n=82), the median DDI was respectively 35, 24, and 13min (P<0.05) and the percentage with a DDI≤30min were 45%, 62%, and 100% (P<0.05). The proportion of DDI≤30min was 0% in maternity units where obstetricians and anaesthetists were not always onsite, 67% when only the anaesthetist was always present (P<0.05) and 88% for units where both were always present. The neonate's condition did not differ significantly according to DDI.

Conclusions

DDI varies very substantially according to the level and organisation of the maternity units in the Aurore network. It was not significantly correlated with neonatal outcome in our population.

Keywords: Caesarean, Emergency, Decision-to-delivery interval, Perinatal network