Docs seem to know when speedy C-section is needed

Obstetricians in the U.S. appear to exercise good judgment in deciding when an emergency cesarean section is needed, and when the procedure should be started within 30 minutes of the decision to perform a C-section, new research suggests.

In 1989, the American College of Obstetricians and Gynecologists (ACOG) set a guideline that a hospital offering obstetric care should have the capability of beginning an emergency cesarean section within 30 minutes.

“The important word is capability,” Dr. Steven Bloom, from the University of Texas Southwestern Medical Center at Dallas noted in comments to Reuters Health. “Having this potential should not be misconstrued to mean that it is required that all cesareans commence within 30 minutes,” he explained.

To measure so-called “decision-to-incision” times as well as maternal and infant outcomes, Bloom and colleagues analyzed data on 2,808 women who had emergency C-sections at one of 13 university hospitals over a 2-year period.

Virtually all of the cesareans (98 percent) performed for emergency obstetric accidents, such as placental problems or uterine tears, met the 30-minute-or-less guideline.

In addition, approximately two-thirds of all cesareans for “nonreassuring” fetal heart rate met the 30-minute guideline. “Importantly,” Bloom noted, “not all nonreassuring fetal heart patterns are equal and clearly clinical judgment plays a large role in the decision-incision times performed for this indication.”

Measures of newborn compromise were significantly higher in cesareans performed within 30 minutes, “likely attesting to the need for expedited delivery,” the authors note in the July issue of Obstetrics and Gynecology.

Among infants with indications for emergency cesarean delivery who underwent cesarean delivery outside the 30-minute decision-to-incision guideline, “95 percent did not experience a measure of newborn compromise,” the team reports.

“Our findings,” Bloom said, “indicate that obstetrical providers are exercising good judgment as to which cesareans must actually commence within 30 minutes of the decision to operate.”

SOURCE: Obstetrics and Gynecology July 2006.

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