Download PDF
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)

Also available at
    Permissions and Reprints

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.

KEYWORDS

Emergency cesarean delivery - 30-minute rule

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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Myers R E. Two patterns of perinatal brain damage and their conditions of occurrence.  Am J Obstet Gynecol. 1972;  112 246-276
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 ACOG-AAP .Guidelines for Perinatal Care, 2nd ed. 1988: 71
    Google Scholar
  • 7 Royal College of Obstetricians and Gynaecologists .Report of a joint working group: organizational standards for maternity services. London; RCOG Press 1995
    Google Scholar
  • 8 ACOG-AAP .Guidelines for Perinatal Care, 6th ed. 2007: 159
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Hendrix N W, Chauhan S P. Cesarean delivery for nonreassuring fetal heart rate tracing.  Obstet Gynecol Clin North Am. 2005;  32 273-286
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 40 Langley G J, Nolan K M, Nolan T W, Norman C L, Provost L P. The Improvement Guide. San Francisco; Jossey-Bass 1996
    Google Scholar
  • 41 Ransom S B, Joshi M S, Nash D B. The Healthcare Quality Book. Chicago; Health Administration Press 2005
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Charles W SchaubergerM.D. M.S. 

1900 South Avenue, Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

Email: cwschaub@gundluth.org