OJOG  Vol.3 No.1 A , February 2013
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.


Cite this paper
Korda, V. and Zimmermann, R. (2013) Five-year impact of a new departmental protocol on emergency cesarean target times. Open Journal of Obstetrics and Gynecology, 3, 148-153. doi: 10.4236/ojog.2013.31A028.
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