The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target?

OBJECTIVE

To evaluate whether a 30-minute decision-to-delivery interval is a realistic target for emergency caesarean section.

DESIGN

An audit of all emergency caesarean sections over five separate periods.

SETTING

A district general hospital.

PARTICIPANTS

Five groups of women (343 women) with an indication for emergency caesarean section.

METHODS

Following an initial survey, a structured time sheet was introduced, followed by four other surveys to complete the audit cycle.

MAIN OUTCOME MEASURE: The proportion of caesarean sections where the decision-to-delivery interval was achieved within 30 minutes. The reasons for delay.

RESULTS

In the first survey of 73 emergency caesarean sections, the time to deliver the infant exceeded 30 minutes in 47 women (64%). The main sources of delay were transferring the women to the operating theatre and starting the anaesthetic. After the introduction of a structured time sheet, there was an improvement with each survey, but the target of 30 minutes was reached in only 71% of caesarean sections in the final survey.

CONCLUSIONS

The introduction of a time sheet can improve the decision-to-delivery interval for emergency caesarean section; however, a universal standard of 100% in 30 minutes is unrealistic.