Does the decision-to-delivery interval have an effect on fetal outcome in unplanned caesarean sections?
<h3>Background</h3> In 2010, the RCOG suggested that urgency of caesarean section (CS) represents a continuum of risk rather than discrete categories1 prompting NICE to review its recommendations on decision-to-delivery intervals (DDIs) for unplanned CS.2 As such, category 1 and 2 CS should be performed as quickly as possible, with a category 2 being performed within 75 minutes. Less emphasis was placed on the previous “benchmark” of 30 minutes for all emergency CS.3 <h3>Study objective</h3> To assess whether the DDI for unplanned CS affected fetal outcome. <h3>Methods</h3> A retrospective analysis of all unplanned CS during a 6month period (February-August 2012) in the Horton General Hospital, Banbury. We looked for any correlation between DDIs and outcome – cord blood gases (cord pH &lt;7.05 arterial or &lt;7.1 venous), APGAR scores (&lt;7 at 5minutes) and term admissions to SCBU. <h3>Results and discussion</h3> 4 (57%) grade 1 CS had a DDI of less than and 3 (43%) of more than 30minutes (range 17-45). There was one case of acidosis where the DDI was 25 minutes. 35 (78%) grade 2 CS had a DDI of less and 10 (12%) of more than 75 minutes (range 37-125). One baby from the group DDI&lt;75 minutes was acidotic with low APGARs and another required admission to SCBU compared to none from the group DDI&gt;75 minutes. 71 grade 3 CS were performed with one case of acidosis (DDI 67 minutes). We postulate that this suggests no correlation between DDI and fetal outcome, supporting the concept of a continuum of risk whereby a DDI should be individualised for each case.