Maternal and neonatal morbidity of emergency caesarean sections with a decision-to-delivery interval under 30 minutes: evidence from 10 years.

PURPOSE: The purpose was to investigate the decision-to-delivery interval for emergency caesarean section and to compare the perioperative maternal and neonatal morbidity to that of intrapartum non-emergent caesarean section.

MATERIALS AND METHODS: A cohort study was designed evaluating 109 women undergoing 'crash' emergency caesarean section and 109 controls from 1988 to 1997 in a University hospital. All emergency caesarean sections were performed in the delivery room. Controls were matched by gestational age. Retrospective collection of data relating to indication, maternal and neonatal outcome of both groups was conducted. Time intervals between decision to deliver and actual delivery were collected for all emergency deliveries.

RESULTS: The emergency caesarean section cohort represented a high risk group with a mean gestational age of 34.8 weeks and a high number of patients with preterm labour (29.3%). All 109 emergency caesarean sections were achieved within a decision-to-delivery time of 30 min. Severe maternal haemorrhage was significantly higher mainly because of underlying obstetrical complications such as placenta praevia, placental abruption, and others resulting in a blood transfusion rate of 10.1%. Procedure related and infectious maternal morbidity, however, was not significantly increased. All women undergoing the emergency procedure received perioperative antibioprophylaxis. Mean umbilical arterial blood pH and Apgar scores were significantly lower in infants delivered by emergency caesarean section but there was no difference in the admission to the NICU.

CONCLUSIONS: Emergency caesarean section performed in the delivery room may result in a decision-to-delivery time of less than 30 min without detrimental perioperative effects on mother or infant.