This study assessed the decision to delivery interval (DDI) for emergency and non-urgent cesarean sections at King Abdulaziz University Hospital in Saudi Arabia. The study analyzed 213 cesarean sections from January to June 2008. The median DDI was 62.5 minutes for non-urgent sections and 41 minutes for emergency sections, below the recommended 30 minutes. For emergency sections, 30.6% had a DDI under 30 minutes. No correlation was found between DDI and infant Apgar scores. The study concludes that achieving the 30 minute standard for emergency sections remains important to reduce maternal anxiety, though may not impact infant outcomes.
Clinical and Commercial Experience With CoolSculpting (Aesthetic Journal of S...Laura Pietrzak
Article published in the Aesthetic Journal of Surgery title, "Clinical and Commercial Experience With CoolSculpting". Features work by Laura Pietrzak using the CoolSculpting device.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Clinical and Commercial Experience With CoolSculpting (Aesthetic Journal of S...Laura Pietrzak
Article published in the Aesthetic Journal of Surgery title, "Clinical and Commercial Experience With CoolSculpting". Features work by Laura Pietrzak using the CoolSculpting device.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Laura Pietrzak CoolSculpting Treatment Technique - New YorkLaura Pietrzak
Laura Pietrzak has performed more CoolScultping aesthetic treatments than anyone else in the world. This presentation to the American Society of Aesthetic Plastic Surgeons describes her CoolSculpting patient success stories which led to her development of the new Treatment to Transformation protocol for CoolSculpting globally.
Current Role of Surgery in Endometriosis; Indications and ProgressCrimsonpublisherssmoaj
Endometriosis is a chronic debilitating disease , which affects women of reproductive age group, although medical therapy may be helpful in managing pain associated with Endometriosis or infertility, surgery becomes an integral part of managing this disease .Although initially surgery was limited to l aporotomy associated with ovarian cystectomy and/or TAH with BSO. Laporoscopy gradually replaced that. Though diagnostic laparoscopy is used for confirmation of endometriosis by histological examination, it is not acceptable that Laporoscopy be done in multiple steps, initially to diagnose and later for treatment. Recently a lot of advancement has come in the imaging techniques by which one can combine planning of surgery based on the imaging classification. Deep endometriosis involving bowel, genitourinary tract can be dealt by careful dissection in controlled trained hands, in a well equipped set up to achieve the optimum results .Endometriosis associated infertility may or may not warrant surgery as with multiple studies operation on ovarian endometriomas might land up in reducing ovarian reserve - while doing straight IVF may result in better pregnancy rates ,getting good oocyte retrieval in contrast to poor ovarian reserve resulting from damage to ovarian morphology. Use of laser for ovarian cystectomy helps in getting better outcomes than simple drainage and coagulation procedures. Robotic surgery is the latest addition, which aids in better dissection and management but its problem is its cost, not accessible to many patients and not many trained personnel available.
The Impact of Massed versus Spaced Instruction on Learning of Procedural Skil...Farooq Khan
Authors:
F.A. Khan, MDCM, C. Patocka, MDCM, F. Bhanji, MD, MSc, I. Bank, MDCM, FRCPC, FAAP, A. Dubrovsky, MDCM, MSc, FRCPC, D. Brody, MD, FRCPC;
McGill Emergency Medicine Residency Program
Introduction:
Survival from cardiac arrest has been linked to the quality of resuscitation care. Unfortunately, health care providers frequently underperform in these critical scenarios, with a well-documented deterioration in skills following an advanced life support course. Improving initial training and preventing decay in knowledge and skills are a priority in resuscitation education. The purpose of this study was to determine if a resuscitation course taught in a spaced format compared to the usual “massed” instruction results in improved procedural skills.
Methods:
We delivered a case-based pediatric resuscitation course to two cohorts of medical students: one in a spaced format (four 75-minute weekly sessions) and the other in a massed format (a single 5-hour session). Four weeks following course completion, blinded observers assessed each learner at various skills stations. Primary outcomes were performance on bag-valve-mask ventilation (BVMV), intraosseous (IO) insertion, and chest compressions using expert-developed checklists. Secondary outcomes included performance of “key components” of the above skills.
Results:
Forty-five of 48 students completed the study protocol (23 spaced and 22 massed). Students in the spaced cohort scored higher overall for BVMV (6.9 ± 1.4 v. 5.8 ± 1.9, p < 0.04), without significant differences in scores for IO insertion (3.9 ± 1 v. 3.7 ± 1.2, p = 0.575) and chest compressions (10.9 ± 2.7 v. 10.1 ± 2.4, p = 0.342). They were also more likely to administer oxygen during BVMV (OR 47.2, 95% CI 5.2- 423, p < 0.001), adhere to a target ventilation rate (OR 4.9, 95% CI 1.1- 21.2, p < 0.03), use a stool when appropriate for chest compressions (OR 8.3, 95% CI 1.2-59, p < 0.03), and landmark correctly for IO insertion (OR 5.4, 95% CI 1.3-24.3, p < 0.02). The intervention group also had a significantly shorter mean time to IO insertion (30.2 ± 34 seconds v. 62.1 ± 30 seconds, p = 0.002).
Conclusion:
Infrequent yet critically important procedures learned in a spaced format may result in better skill retention and more efficient task completion when compared to traditional massed training.
In June 2013, a medical student research project was conducted which looked to characterize how long patients waited in line before being registered and triaged. This study took place at Royal University Hospital and St. Paul’s Hospital. This project inspired RPIW #51, which was aimed at reducing patient lead time at the emergency department in SPH. RPIW #51 successfully reduced the lead time from patients entering the ED to being assigned a bed by 50%. Audience members will learn how a research project translated into an RPIW that greatly improved multiple aspects of the patient experience in St. Paul’s ED.
Information about Fast Track Surgery by Dr. Dhaval Mangukiya
Details of Fast Track Surgery, ERAS, Sir David Cuthbertson, Procedure-Specific fast-track surgery results, Colorectal surgery, Esophageal Resection, Pancreatic Surgery, Liver Surgery, Cochrane Database of Systematic Reveiws, Primary outcomes, Secondary outcomes, and Results
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Laura Pietrzak CoolSculpting Treatment Technique - New YorkLaura Pietrzak
Laura Pietrzak has performed more CoolScultping aesthetic treatments than anyone else in the world. This presentation to the American Society of Aesthetic Plastic Surgeons describes her CoolSculpting patient success stories which led to her development of the new Treatment to Transformation protocol for CoolSculpting globally.
Current Role of Surgery in Endometriosis; Indications and ProgressCrimsonpublisherssmoaj
Endometriosis is a chronic debilitating disease , which affects women of reproductive age group, although medical therapy may be helpful in managing pain associated with Endometriosis or infertility, surgery becomes an integral part of managing this disease .Although initially surgery was limited to l aporotomy associated with ovarian cystectomy and/or TAH with BSO. Laporoscopy gradually replaced that. Though diagnostic laparoscopy is used for confirmation of endometriosis by histological examination, it is not acceptable that Laporoscopy be done in multiple steps, initially to diagnose and later for treatment. Recently a lot of advancement has come in the imaging techniques by which one can combine planning of surgery based on the imaging classification. Deep endometriosis involving bowel, genitourinary tract can be dealt by careful dissection in controlled trained hands, in a well equipped set up to achieve the optimum results .Endometriosis associated infertility may or may not warrant surgery as with multiple studies operation on ovarian endometriomas might land up in reducing ovarian reserve - while doing straight IVF may result in better pregnancy rates ,getting good oocyte retrieval in contrast to poor ovarian reserve resulting from damage to ovarian morphology. Use of laser for ovarian cystectomy helps in getting better outcomes than simple drainage and coagulation procedures. Robotic surgery is the latest addition, which aids in better dissection and management but its problem is its cost, not accessible to many patients and not many trained personnel available.
The Impact of Massed versus Spaced Instruction on Learning of Procedural Skil...Farooq Khan
Authors:
F.A. Khan, MDCM, C. Patocka, MDCM, F. Bhanji, MD, MSc, I. Bank, MDCM, FRCPC, FAAP, A. Dubrovsky, MDCM, MSc, FRCPC, D. Brody, MD, FRCPC;
McGill Emergency Medicine Residency Program
Introduction:
Survival from cardiac arrest has been linked to the quality of resuscitation care. Unfortunately, health care providers frequently underperform in these critical scenarios, with a well-documented deterioration in skills following an advanced life support course. Improving initial training and preventing decay in knowledge and skills are a priority in resuscitation education. The purpose of this study was to determine if a resuscitation course taught in a spaced format compared to the usual “massed” instruction results in improved procedural skills.
Methods:
We delivered a case-based pediatric resuscitation course to two cohorts of medical students: one in a spaced format (four 75-minute weekly sessions) and the other in a massed format (a single 5-hour session). Four weeks following course completion, blinded observers assessed each learner at various skills stations. Primary outcomes were performance on bag-valve-mask ventilation (BVMV), intraosseous (IO) insertion, and chest compressions using expert-developed checklists. Secondary outcomes included performance of “key components” of the above skills.
Results:
Forty-five of 48 students completed the study protocol (23 spaced and 22 massed). Students in the spaced cohort scored higher overall for BVMV (6.9 ± 1.4 v. 5.8 ± 1.9, p < 0.04), without significant differences in scores for IO insertion (3.9 ± 1 v. 3.7 ± 1.2, p = 0.575) and chest compressions (10.9 ± 2.7 v. 10.1 ± 2.4, p = 0.342). They were also more likely to administer oxygen during BVMV (OR 47.2, 95% CI 5.2- 423, p < 0.001), adhere to a target ventilation rate (OR 4.9, 95% CI 1.1- 21.2, p < 0.03), use a stool when appropriate for chest compressions (OR 8.3, 95% CI 1.2-59, p < 0.03), and landmark correctly for IO insertion (OR 5.4, 95% CI 1.3-24.3, p < 0.02). The intervention group also had a significantly shorter mean time to IO insertion (30.2 ± 34 seconds v. 62.1 ± 30 seconds, p = 0.002).
Conclusion:
Infrequent yet critically important procedures learned in a spaced format may result in better skill retention and more efficient task completion when compared to traditional massed training.
In June 2013, a medical student research project was conducted which looked to characterize how long patients waited in line before being registered and triaged. This study took place at Royal University Hospital and St. Paul’s Hospital. This project inspired RPIW #51, which was aimed at reducing patient lead time at the emergency department in SPH. RPIW #51 successfully reduced the lead time from patients entering the ED to being assigned a bed by 50%. Audience members will learn how a research project translated into an RPIW that greatly improved multiple aspects of the patient experience in St. Paul’s ED.
Information about Fast Track Surgery by Dr. Dhaval Mangukiya
Details of Fast Track Surgery, ERAS, Sir David Cuthbertson, Procedure-Specific fast-track surgery results, Colorectal surgery, Esophageal Resection, Pancreatic Surgery, Liver Surgery, Cochrane Database of Systematic Reveiws, Primary outcomes, Secondary outcomes, and Results
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
A Prospective Study of Evaluation of Operative Duration as a Predictor of Mortality in Pediatric Emergency Surgery: Concept of 100 Minutes Laparotomy in Resource-limited Setting
The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas (eCPR and post-resuscitation care) are being covered in detail at separate talks at this meeting. This presentation will focus on updating the audience on the more continuous approach to evidence evaluation, and the key recent publications that have made us at least re-evaluate our practices in BLS (including ventilation), ALS (including anti-arrhythmics) and peri-resuscitation care.
Contents lists available at ScienceDirectApplied Nursing RAlleneMcclendon878
Contents lists available at ScienceDirect
Applied Nursing Research
journal homepage: www.elsevier.com/locate/apnr
Original article
Optimize patient outcomes among females undergoing gynecological
surgery: A randomized controlled trial
Kari Johnson (PhD, RN, ACNS-BC, Hartford Scholar)⁎, Sherry Razo (M.A.-L., BSN, RN, NEA-BC),
Jeannie Smith (BSN, CMSRN), Alex Cain (RN), Kathi Soper (BSN, RN-BC)
Honor Health Thompson Peak Medical Center, 7400 E. Thompson Peak Parkway, Scottsdale, AZ 85255, United States
A R T I C L E I N F O
Keywords:
Gynecological surgery
Enhanced Recovery After Surgery (ERAS)
Hysterectomy
Bundle components
Institute of Healthcare Improvement
Length of stay
30 day readmission
Patient satisfaction
Randomized controlled trial
A B S T R A C T
Background: Optimizing early education in gynecological procedures utilizing an Enhanced Recovery after
Surgery (ERAS) program and a bundle concept may optimize patient outcomes after surgery.
Purpose: Evaluate whether an ERAS bundle compared to standard education can affect length of stay, 30 day
readmission, and patient satisfaction among patients undergoing gynecologic surgery.
Design: Prospective, comparative, randomized design
Setting: 28 bed Medical Surgical Unit
Sample/Intervention: 50 patients undergoing hysterectomy, 25 who received post-operative evidence based
bundle/standard education, and 25 who received standard education packet. Bundle components included 1)
early mobilization, 2) early transition to oral pain medication, 3) early feeding, and 4) chewing gum. A follow-up
phone call was made in two to three days following discharge for both groups utilizing teach-back.
Results: 84% (n = 21) patients in the bundle group were discharged in one day. There were no 30 day read-
missions for both groups. Twenty two (88%) participants met the bundle components 100% of the time. For the
indicator “walking helped with recovery” 100% (n = 25) responded “very good to excellent” for bundle group
and 96% (n = 24) responded “very good to excellent” for standard group. Twenty three (92%) of the bundle
group felt that that overall nursing care received was very good to excellent and 24 (96%) of the general group
felt that overall nursing care received was very good to excellent.
Conclusion: Optimizing peri-operative education using a bundle approach to provide evidence based interven-
tions can minimize risk and enhance early recovery for females undergoing gynecological surgery.
1. Introduction
A hysterectomy is a common gynecological surgical procedure with
minimally invasive methods including vaginal or laparoscopic proce-
dures. Studies have shown that preoperative patient education can
improve patient outcomes after surgery, including reduced length of
hospital stay, decreased post-operative complications, and increased
patient satisfaction with the surgical experience (Modesitt et al., 2016;
Steiner & Strand, 2017; Wijk, Franzen, Ljungqvist, & Nilsson, 2014).
Enhanced recovery p ...
Dexamethasone in Prevention of Respiratory Morbidity in Elective Caesarean S...احمد عبدالراضى
Dexamethasone in Prevention of Respiratory Morbidity in
Elective Caesarean Section in Term Fetus
Qena University Hospital Experience
By
Ahmed Abdel-Rady Ali
(M.B, B.Ch.)
Resident physician in obstetrics and gynecology
Qena University Hospital
South Valley University
Outpatient surgery benefits patients and surgeons alike, as it is convenient, safe and cost-effective. We sought to assess the safety and feasibility of daycare thyroid surgery in a stand-alone Daycare Surgery Center in South India.
The ideal intraoperative time for laparoscopic gas.pptxmohammadOmari19
The ideal time for laparoscopic surgery in patients with obesity and Bbariatric Ssurgery Obesity Surgery and interventions worldwide and delivering surgical services in the operative teaching medical topics and education services and information about the wound healing
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after ab...Takehiko Ito
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after abdominal surgery: A questionnaire survey. The 1st International Nursing Research Conference of World Academy of Nursing Science, Kobe: Program & Abstracts, 235.
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
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weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Similar to The decision to delivery interval in emergency and non (20)
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Discover Palmer, Puerto Rico, through an immersive cultural tour that unveils its rich history and vibrant traditions. Experience lively festivals, savor authentic cuisine, and explore local markets. Visit historical landmarks, museums, and stunning colonial architecture. Engage with friendly locals, enjoy live music, and hike scenic nature trails, all while participating in cultural workshops and discovering unique artisan crafts.
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The decision to delivery interval in emergency and non
1. JKAU: Med. Sci., Vol. 18 No. 2, pp: 47-54 (2011 A.D. / 1432 A.H.)
DOI: 10.4197/Med. 18-2.4
_________________________________
Correspondence & reprint request to: Dr. Khalid H. Sait
P.O. Box 80215, Jeddah 21589, Saudi Arabia
Accepted for publication: 04 January 2011. Received: 10 June 2010.
47
The Decision to Delivery Interval in Emergency and Non-
Urgent Caesarean Sections at King Abdulaziz University
Hospital
Khalid H. Sait, MBChB, FRCSC
Department of Obstetrics & Gynecology, Faculty of Medicine
King Abdulaziz University Hospital Jeddah, Saudi Arabia
khalidsait@yahoo.com
Abstract. The aim of this study is to assess the decision to delivery interval in
our obstetric unit in comparison to current recommendations. A retrospective
study included an analysis of consecutive non-elective caesarean sections
performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia
from January to June 2008. The decision to delivery interval was compared
between emergency and non urgent caesarean sections. During the study
period, 213 non-elective caesarean sections were performed, 164 were
classified as non urgent caesarean (Group 1) and 49 as emergency caesarean
(Group 2). The median and inter-quartile ranges in the decision to delivery
interval were 62.5 min (45-80) and 41 min (27-68) in Group 1 and 2,
respectively (p < 0.001). In the Group 1, 10.3% delivered within 30 min
compared to 30.6 % in the Group 2 (p < 0.05). No correlation was found
between the decision to delivery interval and the Apgar score at 1 minor 5
min in both groups. It’s believed that all centers should set a standard of
decision to delivery interval of 30 min. that needs to be achieved in order to
reduce maternal anxiety and physician's liability.
Keywords: Caesarean sections, Decision to delivery interval.
Introduction
The American College of Obstetricians and Gynecologists (ACOG)
recommend that the decision to delivery interval (DDI) for emergency
2. K.H. Sait48
caesarean section (C/S) should not exceed 30 min[1]
. However, this
recommendation does not appear to be sustained by evidence based
data[2-6]
, and is probably drawn from medico-legal grounds. In practice,
the DDI is mainly influenced by the facilities and staff availability[7]
.
Primarily, our study was performed to assess how close our obstetric
unit was to achieving the target of 30 min in emergency caesarean
sections. Secondly, the requisite to evaluate the DDI in non-urgent
caesarean sections performed during labor. Finally, the necessity to
appraise the influence of DDI on fetal outcome reflected by 1 and 5 min
Apgar score.
Materials and Methods
This retrospective study included an analysis of consecutive non-
elective caesarean sections performed at King Abdulaziz University
Hospital in Jeddah, Saudi Arabia from January to June 2008. The
delivery ward is fully equipped with maternal and fetal monitoring
facilities. Two operating theaters (emergency operating room) are located
within the delivery ward and are few meters from the nurses’ station. All
non elective caesarean sections are performed in the emergency operating
room within the delivery ward.
An emergency C/S was defined as one, which required prompt
delivery to reduce the risk to the pregnant women or their infants. The
pre-operative diagnoses included fetal distress, substantially heavy
vaginal bleeding in suspected placental abruption, heavily bleeding
placenta previa, or suspected ruptured uterus and a prolapsed umbilical
cord. A non-urgent C/S was defined as one performed during labor for
other indication (Table 1). The DDI was defined as the time between the
decision to perform the C/S and the delivery of the infant. The operation
was performed either under general or spinal anesthesia, depending on
the urgency.
Statistical Analysis
Statistical analysis was performed by “student's” t-test, Pearson's chi-
square (X²) test and Spearman's correlation analysis (r). As indicated, the
distribution of difference in time of delivery was tested for normality
using the Kolmogorov-Smirnov (K-S) test and was found to be Non-
3. The Decision to Delivery Interval in Emergency and Non-Urgent Cesarean Sections at KAUH 49
parametric. Mann-Whitney u-test was used for Non-parametric data
significance set at p < 0.05.
Table 1. Indication for non elective caesarean section (January – June 2008).
Group 1 (n = 164)
Non urgent Caesarean
Group 2 (n = 49)
Emergency Caesarean
Indications No (%) Indications
Breech in labor 35 (21.3%) Fetal distress
Previous one CS. refuse VBAC 5 (3.04%) Cord prolapsed
Severe pre-eclampsia 16 (9.75%) Severe Ante partum hemorrhage
Failure to progress 23 (14%) Rupture uterus
Failure VBAC 18 (10.9%)
Multiple pregnancy in labor 12 (7.3%)
Mild ante-partum hemorrhage 10 (6.09%)
Results
During the study period, 213 non-elective caesarean sections were
performed, 164 were classified as non urgent caesarean (Group 1) and 49
as emergency caesarean (Group 2).
The parturients’ characteristics of both groups are presented in Table 2.
Table 2. Parturients’ characteristic of emergent and non-urgent caesareans.
Group 1
(n = 164)
Group 2
(n = 49)
p Value
Age (years) 30.54 ± 6.34 30.06 ± 6.47 0.46
Gravity (N) 4 ± 2 3.0 ± 2.0 0.76
Gestational week (weeks) 37.02 ± 3.39 37.04 ± 4.24 0.97
Birth weight (g) 2796 ± 811.7 2508 ± 751.22 0.024*
VBAC no (%) 19 (11.6%) 4 (8.2%) 0.35
Number of Apgar score of < 7 at 1 min 51 (31.1) 25 (51) 0.009
Number of Apgar score of < 7 at 5 min 9 (5.5) 6 (12.2) 0.10
The data is expressed as mean ± S.D or as number (%)
“Student’s” t test for quantitive data
Chi-square for qualitative data
*
Statistically significant
The operation was performed under general anesthesia in 36 (29.1%)
and 15 (69.4%) women, and under spinal anesthesia in 118 (71.9%) and
34 (30.6%) women in Group 1 and 2, respectively (p < 0.05).
4. K.H. Sait50
The median and inter-quartile range (IQR) of DDI were 62.5 min
(45-80) and 41 min (27-68) in the Group 1 and 2, respectively (p <
0.001). In the Group 1, 10.3% delivered within 30 mins compared to 30.6
% in the group 2 (p < 0.05). The mean DDI ± SD was 73.18 ± 75 and 50
± 31.86 in Group 1 and 2, respectively (Table 3). No correlation was
found between the DDI and Apgar score at 1 min or 5 min in both
groups. During the study period, 23 patients required C/S that had come
to the delivery room in labour with history of previous one caesarean
section, four of them were in Group 2 with median DDI 41 min (IQR =
37-82) and mean ± SD 53.5 ± 28.44.
Table 3. Performance time sheet.
Time (min)
Group 1 (n = 164)
N (%)
Group 2 (n = 49)
N (%)
< 15 3 (1.8) 3 (6.1)
< 30 14 (8.5) 12 (24.5)*
< 40 16 (1.8) 8 (16.3)
< 50 25 (15.2) 6 (12.2)
< 60 22 (13.4) 4 (8.2)
> 60 84 (51.2) 16 (32.7)
Chi-square with linear trends p < 0.001* highly significance
Mann-Whitney U test was used as the time difference is non-parametric
Table 4. DDI related to anesthesia type in emergency caesarean section (Group 2).
DDI
Emergency Caesarean Section (N = 49)
GA (N = 15) Spinal (N = 34)
≤ 30 min 3/15 (20.0%) 12/15 (80.0%)
> 30 min 12/34 (35.2%) 22/34 (64.8%)
p = 0.23
In emergency C/S (Group 2), type of anesthesia was not found to
influence the DDI with p-value 0.23 (Table 4).
Discussion
In our study, the goal of 30 min DDI was achieved in 30.6% of
emergency caesarean sections with a mean of 50 min. In comparison, the
previously reported range was between 44 and 71%[3-6,8-10]
. The factors
that may influence the DDI in our institute included, the type of
5. The Decision to Delivery Interval in Emergency and Non-Urgent Cesarean Sections at KAUH 51
anesthesia and the experience of the staff. Regional anesthesia was
associated with longer intervals than general anesthesia[4]
. Furthermore, it
was previously shown that the DDI may be significantly shortened with
improvement in experience of the staff[10]
. Although the rates of general
and spinal anesthesia were statistically different (p < 0.05) in emergency
and non-urgent caesareans in our study, it was found that this difference
did not influence the DDI in emergency caesarean section group. The
question is whether different degree of urgency in the response of the
staff will have a positive effect on perinatal outcome. Intuitively, the
longer is the decision to delivery interval, the poorer the perinatal
outcome should be. No correlation was found between Apgar score and
the decision to delivery interval. Similar results were obtained by other
investigators[2,3,6,11]
. Finally, the question is whether a more lenient
standard should be recommended for the decision to delivery interval.
Helmy et al.[10]
argued that since the 40 min DDI could be achieved in
90% of emergency caesareans, the 40 min standard is more realistic. A
close to 70% achievement was made with a 60 min standard in our center
in emergency caesarean section. It’s believed, that once a decision to
perform a caesarean was made, every effort should be made in order to
accomplish it as soon as possible. Even if it is not associated with better
perinatal outcome, it may reduce maternal anxiety and physician's
liability. Setting the standard at 60 min may result in lowering of the
degree of urgency by the staff as evident from the DDI in non-urgent
caesarean. Therefore, the arbitrary 30 min DDI in emergency caesareans
still seems valid, especially in setting of trial of labour after one
caesarean section. Although this was not achieved in our center, great
benefit was accomplished from our review by promoting increased
awareness of this delay and educate our staff in order to improve the
quality of work.
References
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and Int J Gynaecol Obstet 1999; 66(2): 197-204.
[2] Schauberger CW, Rooney BL, Begiun EA, Schaper AM, Spindler J. Evaluating the
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155.
6. K.H. Sait52
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