Am J Perinatol 2009; 26(3): 221-226
DOI: 10.1055/s-0028-1103033
© Thieme Medical Publishers

Emergency Cesarean Section and the 30-Minute Rule: Definitions

Charles W. Schauberger1 , Suneet P. Chauhan2
  • 1Gundersen Lutheran Medical Center, La Crosse, Wisconsin
  • 2Aurora Women's Pavilion, West Allis, Wisconsin
Further Information

Publication History

Publication Date:
21 November 2008 (online)

ABSTRACT

We explored the role that lack of a standard definition and heterogeneity in patient selection criteria in the literature might have on the apparent inability to routinely begin an emergency cesarean section in less than 30 minutes. A review of the literature on emergency cesarean delivery was performed. Although there are some similarities in definitions and the criteria used for patient selection in multiple studies, the variability in the definitions could be responsible for some of the apparent timeliness performance deficiency in the literature. A standard definition and directions for future research are suggested.

REFERENCES

  • 1 Chauhan S P, Magann E F, Scott J R, Scardo J A, Hendrix N W, Martin J N. Cesarean delivery for fetal distress: rate and risk factors.  Obstet Gynecol Surv. 2003;  58 337-350
  • 2 Bors-Koefoed R, Zylstra S, Resseguie L J, Ricci B A, Kelly E E, Mondor M C. Statistical models of outcome in malpractice lawsuits involving death or neurologically impaired infants.  J Matern Fetal Med. 1998;  7 124-131
  • 3 Myers R E. Two patterns of perinatal brain damage and their conditions of occurrence.  Am J Obstet Gynecol. 1972;  112 246-276
  • 4 Adamsons K, Myers R E. Late decelerations and brain tolerance of the fetal monkey to intrapartum asphyxia.  Am J Obstet Gynecol. 1977;  128 893-900
  • 5 Shiono P H, Fielden J G, McNellis D, Rhoads G G, Pearse W H. Recent trends in cesarean birth and trial of labor rates in the United States.  JAMA. 1987;  257 494-497
  • 6 ACOG-AAP .Guidelines for Perinatal Care, 2nd ed. 1988: 71
  • 7 Royal College of Obstetricians and Gynaecologists .Report of a joint working group: organizational standards for maternity services. London; RCOG Press 1995
  • 8 ACOG-AAP .Guidelines for Perinatal Care, 6th ed. 2007: 159
  • 9 Bloom S L, Leveno K J, Spong C Y et al.. Decision-to-incision times and maternal and infant outcomes.  Obstet Gynecol. 2006;  108 6-11
  • 10 Hendrix N W, Chauhan S P. Cesarean delivery for nonreassuring fetal heart rate tracing.  Obstet Gynecol Clin North Am. 2005;  32 273-286
  • 11 Holcroft C J, Graham E M, Aina-Mumuney A, Rai K K, Henderson J L, Penning D H. Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans.  J Perinatol. 2005;  25 229-235
  • 12 Schauberger C W, Rooney B L, Beguin E A, Schaper A M, Spindler J. Evaluating the thirty minute interval in emergency cesarean sections.  J Am Coll Surg. 1994;  179 151-155
  • 13 Chauhan S P, Roach H, Naef R W, Magann E F, Morrison J C, Martin J N. Cesarean section for suspected fetal distress.  J Reprod Med. 1997;  42 347-352
  • 14 Lucas D N, Yentis S M, Kinsella S M et al.. Urgency of caesarean section: a new classification.  J R Soc Med. 2000;  93 346-350
  • 15 Helmy W H, Jolaoso A S, Ifaturoti O O, Afify S A, Jones M H. The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target?.  BJOG. 2002;  109 505-508
  • 16 Thomas J, Paranjothy S, James D. National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section.  BMJ. 2004;  328 665-668
  • 17 Sayegh I, Dupuis O, Clement H J, Rudigoz R C. Evaluating the decision-to-delivery interval in emergency caesarean sections.  Eur J Obstet Gynecol Reprod Biol. 2004;  116 28-33
  • 18 Lurie S, Sulema V, Kohen-Sacher B, Sadan O, Glezerman M. The decision to delivery interval in emergency and non-urgent cesarean sections.  Eur J Obstet Gynecol Reprod Biol. 2004;  113 182-185
  • 19 Spencer M K, MacLennan A H. How long does it take to deliver a baby by emergency caesarean section?.  Aust N Z J Obstet Gynaecol. 2001;  41 7-11
  • 20 Tuffnell D J, Wilkinson K, Beresford N. Interval between decision and delivery by caesarean section—are current standards achievable?.  BMJ. 2001;  322 1330-1333
  • 21 MacKenzie I Z, Cooke I. Prospective 12 month study of 30 minute decision to delivery intervals for “emergency” caesarean section.  BMJ. 2001;  322 1334-1335
  • 22 Onah H E, Ibeziako N, Umezulike A C, Effetie E R, Ogbuokiri C M. Decision-delivery interval and perinatal outcome in emergency caesarean sections.  J Obstet Gynaecol. 2005;  25 342-346
  • 23 Lim Y, Shah M K, Tan H M. Evaluation of surgical and anaesthesia response times for crash caesarean sections—an audit of a Singapore hospital.  Ann Acad Med Singapore. 2005;  34 606-610
  • 24 Kolas T, Hofoss D, Oian P. Predictions for the decision-to-delivery interval for emergency cesarean sections in Norway.  Acta Obstet Gynecol Scand. 2006;  85 561-566
  • 25 Bruce D, Stone S, Harding K. Evaluation of emergency caesarean sections—completion of the audit cycle in a Central London teaching hospital.  J Obstet Gynaecol. 2002;  22 273-278
  • 26 Livermore L J, Cochrane R M. Decision to delivery interval: a retrospective study of 1,000 emergency caesarean sections.  J Obstet Gynaecol. 2006;  26 307-310
  • 27 Mooney S E, Ogrinc G, Steadman W. Improving emergency caesarean delivery response times at a rural community hospital.  Qual Saf Health Care. 2007;  16 60-66
  • 28 Hillemanns P, Hasbargen U, Strauss A, Schulze A, Genzel-Boroviczeny O, Hepp H. Maternal and neonatal morbidity of emergency caesarean sections with a decision-to-delivery interval under 30 minutes: evidence from 10 years.  Arch Gynecol Obstet. 2003;  268 136-141
  • 29 Choate J W, Lund C J. Emergency cesarean section. An analysis of maternal and fetal results in 177 operations.  Am J Obstet Gynecol. 1968;  100 703-715
  • 30 Dunphy B C, Robinson J N, Sheil O M, Nicholls J SD, Gillmer M DG. Caesarean section for fetal distress, the interval from decision to delivery, and the relative risk of poor neonatal condition.  J Obstet Gynaecol. 1991;  11 241-244
  • 31 Quinn A J, Kilpatrick A. Emergency caesarean section during labour: response times and type of anaesthesia.  Eur J Obstet Gynecol Reprod Biol. 1994;  54 25-29
  • 32 Korhonen J, Kariniemi V. Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scores.  Acta Obstet Gynecol Scand. 1994;  73 782-786
  • 33 Lavery J P, Janssen J, Hutchinson L. Is the obstetric guideline of 30 minutes from decision to incision for cesarean delivery clinically significant?.  J Healthc Risk Manag. 1999;  19 11-20
  • 34 MacKenzie I Z, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries.  BJOG. 2002;  109 498-504
  • 35 Tan W C, Tan L K, Tan H K, Tan A SA. Audit of “crash” emergency caesarean sections due to cord prolapse in terms of response time and perinatal outcome.  Ann Acad Med Singapore. 2003;  32 638-641
  • 36 Nasrallah F K, Harirah H M, Vadhera R, Jain V, Franklin L T, Hankins G DV. The 30-minute decision-to-incision interval for emergency cesarean delivery: fact or fiction?.  Am J Perinatol. 2004;  21 63-68
  • 37 Kwek K, Yeap M L, Tan K H, Tee J CS, Yeo G SH. Crash caesarean section—decision-to-delivery interval.  Acta Obstet Gynecol Scand. 2005;  84 914-915
  • 38 Elvedi-Gasparovic V, Klepac-Pulanic T, Peter B. Maternal and fetal outcome in elective versus emergency caesarean section in a developing country.  Coll Antropol. 2006;  30 113-118
  • 39 Lagrew D C, Bush M C, McKeown A M, Lagrew N G. Emergent (crash) cesarean delivery: indications and outcomes.  Am J Obstet Gynecol. 2006;  194 1638-1643
  • 40 Langley G J, Nolan K M, Nolan T W, Norman C L, Provost L P. The Improvement Guide. San Francisco; Jossey-Bass 1996
  • 41 Ransom S B, Joshi M S, Nash D B. The Healthcare Quality Book. Chicago; Health Administration Press 2005
  • 42 Nielsen P E, Goldman M B, Mann S et al.. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial.  Obstet Gynecol. 2007;  109 48-55

Charles W SchaubergerM.D. M.S. 

1900 South Avenue, Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

Email: cwschaub@gundluth.org

    >