The study was aimed at looking at the decision to delivery times of category 1 ,2 and 3 caesarean sections

1. Decision to delivery interval in
emergency caesarean Section
February 2018
Bushra Saeed SPR
Obstetrics and Gynaecology Department
Princess Alexandra Hospital
Harlow, Essex, United Kingdom
1

2.  A monthly audit looking at the decision to delivery
times of category 1 ,2 and 3 caesarean sections
2
Introduction

3.  Based on original National Sentinel Caesarean Section
Audit, RCOG 2001
 Auditable standards recommended:
 Urgency
 Indication
 Condition of FHR
 Result of FBS
 ‘Decision to delivery time’ interval,
 ICU/NICU/SCBU admission
 Apgar scores
3
Introduction (2)

4.  A retrospective case note review of all Cat 1, 2, 3
EMCS that were performed in the Unit between 1st
and 28th Feb ‘18
 Data was collected from:
1. Completed audit proforma
2. COSMIC Electronic record
3. The Birth Register
4
Methodology

5. 5
National maternal statistics in
England: 2013-2014
2011-12 2012-13 2013-14
Caesarean Rate 25.0% 25.5% 26.2%
Elective 10.2% 10.7% 13.2%
Emergency 14.8% 14.8% 13.0%
Instrumental
Delivery Rate
12.9% 12.8% 12.9%
Forceps 6.6% 6.8% n/a
Ventouse 6.3% 6.0% n/a
Induction Rate 22.1% 23.3% 25.0%

6. Method of delivery Number %
SVD 372,836 59.4
Instrumental 79,806 12.7
LSCS 174,720 27.8
6
National Statistics-Delivery Episodes
from HES, 2016-17

7. Method of delivery Number
Total number of
deliveries
( LW 236 +BU 44) 280
EMCS 51
ELCS 46
7
PAH Deliveries during February
2018

8. 8
PAH EMCS - Dec
No.
Cat 1 11
Cat 2 31
Cat 3 9
TOTAL 51

9.  Immediate threat to the life of the mother or fetus
 Needs to de done within 30 minutes from decision
 Examples: - Prolonged fetal bradycardia,
- Cord prolapse
- Uterine rupture
- APH/abruption
- Pathological CTG
9
Category 1

10.  Maternal or fetal compromise that is not
immediately life-threatening
 Needs to done within 75 minutes from
decision to avoid any deterioration of maternal
or fetal condition
 Examples:
- Suspicious CTG with slow
progress in labour
- Failure to progress in labour
10
Category 2

11.  Represents the mother who needs early delivery but there is no
maternal or fetal compromise
 Ideally <24 hours
 Example: - Previous c/section or breech
presentation in labour but
planned for elective caesarean
section
- Failed IOL
11
Category 3

12. Time interval in mins12
Time to Cat 1 sections
Numberofsections
0
1
2
3
4
5
6
7
≤6 <30

13. 13
Indication of Cat 1 sections
Number of sections
 Unsuccessful Forceps 6
 Placental abruption 1
 Abnormal CTG 1
 Fetal Bradycardia 1
 Station -2 at Full dilatation 1

14. Time interval in mins14
Time to Cat 2 sections
0
5
10
15
20
25
<75 <200
Numberofsections

15.  Failure to progress 17
 Suspicious CTG 4
 Undiagnosed Breech in labour 1
 Booked ELCS , Contracting 2
 Severe PET 1
 Twins + Breech+SROM 1
 Scar tenderness in VBAC 1
 Declined Instrument at full dilatation 1
 Brow Presentation 1
 Not Documented 2
15
Indication of Cat 2

16. Time interval in hrs16
Time to Cat 3 sections
0
1
2
3
4
5
6
<10 <24
Numberofsections

17.  Failed IOL 3
 Breech & SROM 1
 Booked ELCS & Contracting 2
 IUGR + Abnormal doppler 3
17
Indications of Cat 3

18. Compliance %
Cat 1 (≤30 mins) 100
Cat 2 (≤75 mins) 70.9
Cat 3 (≤24 hrs) 100
18
Dec % Compliance with standard

19.  Majority of caesarean sections are done within
recommended time frames
 Need to gather more information - reasons for time delay
Majority of proformas not filled, most filled in incorrectly
 Needs to use updated proformas and include indication for
caesarean section
19
Conclusions

20. 20