Decision-to-Delivery Time and Perinatal Complications in Emergency Cesarean Section
| Autor: | Björn Misselwitz, Stephan Schmidt, Frank Louwen, Stefanie Schill, Friedrich Wolff, Christof Veit, Günther Heller, Erik Bauer, Teresa Thomas |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Time Factors Decision Making 03 medical and health sciences 0302 clinical medicine Pregnancy Heart rate medicine Humans 030212 general & internal medicine Retrospective Studies Asphyxia Neonatorum 030219 obstetrics & reproductive medicine Cesarean Section Obstetrics business.industry Infant Newborn Pregnancy Outcome Gestational age Retrospective cohort study General Medicine Odds ratio medicine.disease Confidence interval Apgar Score Original Article Female Apgar score Emergencies Presentation (obstetrics) business |
| Zdroj: | Deutsches Ärzteblatt international. |
| ISSN: | 1866-0452 |
| DOI: | 10.3238/arztebl.2017.0589 |
| Popis: | Background A decision-to-delivery interval (DDI) of no more than 20 minutes has long been considered a requirement for cesarean sections, even though there have hardly been any studies on this topic. We retrospectively investigated data relevant to DDI for emergency cesarean sections performed for the most common indications, namely, suspected and documented fetal asphyxia. Methods We analyzed data on emergency in-hospital cesarean sections in the period 2008-2015. Low 5- and 10-minute Apgar scores (a scheme with points awarded for breathing, heart rate, muscle tone, skin coloration, and the elicitability of reflexes) were the primary endpoints; acid-base status in arterial cord blood and in-hospital neonatal death were the secondary endpoints. The raw analysis was supplemented by an analysis adjusted for various factors including gestational age, maternal age, and obstetrical presentation. Results Data from 39 291 neonates were included. The DDI was up to 10 minutes in 64.6% of cases, from 11 to 20 minutes in 34.3%, and over 20 minutes in 1.1%. Low Apgar scores were less common in children whose emergency cesarean sections were performed within 10 minutes or within 20 minutes. For example, the adjusted odds ratio for a 10-minute Apgar score below 4 was 0.49 (95% confidence interval [0.25; 0.96] when a DDI of more than 20 minutes was used as the reference criterion. Conclusion This is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so. |
| Databáze: | OpenAIRE |
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