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Five-year impact of a new departmental protocol on emergency cesarean target times


Korda, Visnja; Zimmermann, Roland (2013). Five-year impact of a new departmental protocol on emergency cesarean target times. Open Journal of Obstetrics and Gynecology, 03(01):148-153.

Abstract

Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retrospective analysis of emergency ce- sareans from 2004 (introduction of the new SOP) to 2009 in a Swiss Level 3 perinatal center. Primary endpoints were the DDI, the pathology-to-decision interval (PDI), the 5-year learning curve, and neona- tal and maternal outcome. Results: In the emergency cesarean group (175 women and 188 infants), mean DDI decreased over the observation period from 15 to 9 minutes (mean 10 minutes 41 seconds), and mean PDI from 11 to 6 minutes (mean 8 minutes). Not only did the DDI not exceed 15 minutes in over 90% of cases during the 5 years, but it fell consistently below 10 minutes in the latter stages of the learning curve. Only 2/188 infants had an umbilical artery pH < 7.00 and 19/188 had an Apgar score < 5 at 5 minutes. Ma- ternal morbidity comprised three cases of superficial wound infection. Conclusion: Logistic prerequisites comprise a surgical capability directly within the de- livery suite, a standby surgical and anesthetic team, a crash call system, and clear duty allocation. Interna- tional guideline target times are readily achievable at no additional significant fetal or maternal cost.

Abstract

Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retrospective analysis of emergency ce- sareans from 2004 (introduction of the new SOP) to 2009 in a Swiss Level 3 perinatal center. Primary endpoints were the DDI, the pathology-to-decision interval (PDI), the 5-year learning curve, and neona- tal and maternal outcome. Results: In the emergency cesarean group (175 women and 188 infants), mean DDI decreased over the observation period from 15 to 9 minutes (mean 10 minutes 41 seconds), and mean PDI from 11 to 6 minutes (mean 8 minutes). Not only did the DDI not exceed 15 minutes in over 90% of cases during the 5 years, but it fell consistently below 10 minutes in the latter stages of the learning curve. Only 2/188 infants had an umbilical artery pH < 7.00 and 19/188 had an Apgar score < 5 at 5 minutes. Ma- ternal morbidity comprised three cases of superficial wound infection. Conclusion: Logistic prerequisites comprise a surgical capability directly within the de- livery suite, a standby surgical and anesthetic team, a crash call system, and clear duty allocation. Interna- tional guideline target times are readily achievable at no additional significant fetal or maternal cost.

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Additional indexing

Item Type:Journal Article, not refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Obstetrics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:03 Feb 2014 10:18
Last Modified:05 Apr 2016 17:26
Publisher:Scientific Research Publishing
ISSN:2160-8792
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.4236/ojog.2013.31A028

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