PL.36 Category 1 Caesarean Sections and Decision to Delivery Interval: Are We Missing Target?

Background NICE guidelines recommend decision-to-delivery interval (DDI) of 30 minutes for all category 1 Caesarean Sections (Cat1 CS). Methods A retrospective analysis of 50 Cat1 CS carried out in a busy district hospital. Results 44% of all Cat1 CS were done for suspected fetal compromise on CTG, followed by 30% for persistent fetal bradycardia > 6 minutes. 64% deliveries happened during night shift and 34% were undertaken by junior registrars. Decision to perform Cat1 CS was directly taken by consultant in 36% of cases with consultant being first surgeon in 78% of these cases mostly as resident on-call during nights. Mean decision-to-delivery interval was 18.8 minutes with 87% deliveries performed within targeted 30 minutes. 42% of Cat1 CS were performed under general anaesthetic with shortest mean DDI of 14.3 minutes compared to spinal anaesthesia (25 minutes) and epidural top-up (16.7 minutes). 16% had massive PPH > 1.5 litres however average hospital stay was 3 days. 26% babies were admitted to SCBU with 61% being severely acidotic with cord pH < 7.0 or base excess > 12. Mean DDI in these babies was 24 minutes. Conclusion Targeted DDI of 30 minutes is difficult to achieve in 100% of cases. Use of General anaesthesia shortens the DDI interval but has its own implications. Resident on-call consultant night shifts increase direct consultant input and may influence outcomes. A significant number of babies required admission to SCBU with proportion of acidotic babies remaining high. Further measures are required to improve Decision-to-Delivery interval to improve perinatal outcomes.