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Majority of CS deliveries within recommended DDI

Stephen Padilla
19 Jul 2017
Crash Caesarean Section for Fetal Distress

Most of the category 1 and category 2 caesarean section (CS) deliveries at a single tertiary hospital in Singapore are within the recommended decision-to-delivery intervals (DDIs) corresponding to the degree of urgency of CS, according to a recent study. Challenges with respect to the time taken to transfer patients to operating theatres may have brought about the influence of time of day on DDI.

“Total duration of surgery was influenced by surgical experience and history of previous CSs,” researchers said. “Individual surgical styles and preferences also influenced the total duration of surgery, as evidenced by the wide variation among surgeons of similar seniority.”

A total of 488 CSs were investigated (category 1: n=28; category 2: n=137; category 3: n=184; category 4: n=139), with an overall mean surgery duration of 41.7 minutes. [Singapore Med J 2017;58:332-337]

Category 1 and category 2 CSs had a mean DDI of 23.9 and 64.5 minutes, respectively. DDI was significantly shorter for deliveries during office hours than deliveries out of office hours in category 1 CSs (p<0.05). On the other hand, DDI was significantly longer for deliveries during office hours in category 2 CSs (p<0.05).

“Our audit showed that for category 1 CSs, the mean DDI was 23.9 minutes and 82.1 percent deliveries were done within the recommended time period of 30 minutes. For category 2 CSs, the mean DDI was 64.5 minutes and 86.9 percent deliveries were performed within the recommended time period of 75 minutes. When combined for both categories, the mean DDI was 57.6 minutes,” researchers noted.

These findings were similar with those of Tolcher et al, who conducted a review and meta-analysis of 34 studies. They found that 79.0 percent of category 1 deliveries and 36.0 percent of category 2 deliveries were achieved within 30 minutes. In addition, the mean decision-to-incision or delivery recorded in 27 studies were 21.2 minutes, 42.6 minutes and 32.4 minutes for categories 1, 2, and combined 1 and 2 CSs, respectively. [Obstet Gynecol 2014;123:536-48]

Senior surgeons, compared with trainee surgeons, had a significantly shorter total duration of surgery (p<0.05). Moreover, women with no previous CSs had a significantly shorter duration of surgery than those who had one or more (p<0.05).

“In our study, CSs that exceeded the recommended timings were due to delays in transferring the patient to the operating theatre. This is because our centre is a multidisciplinary centre with heavy demand for operating theatres and anaesthetic manpower,” researchers explained.

“To reduce DDI times at our hospital, we have implemented a strict emergency CS protocol. In addition, improvements have been made to the layout of the labour ward (ie, removal of a wall and addition of a door) to allow direct access to the operating theatre,” they added.

The authors performed a retrospective study of all CSs conducted from August 2013 to June 2014 at a single tertiary general hospital. They collected data on maternal demographics, indications for CS, category of urgency, DDI, total duration of surgery, grade of first surgeon and number of previous CSs.

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