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

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 cesareans 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 neonatal 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. Maternal morbidity comprised three cases of superficial wound infection. Conclusion: Logistic prerequisites comprise a surgical capability directly within the delivery suite, a standby surgical and anesthetic team, a crash call system, and clear duty allocation. International guideline target times are readily achievable at no additional significant fetal or maternal cost.