Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France

Abstract

Background: Non-elective caesarean sections may be classified using a three-colour coding system, from code-green caesarean section corresponding to non-urgent delivery (no maternal of foetal compromise) to code-red caesarean section corresponding to emergency caesarean section due to immediate life-threatening maternal or foetal situations. Decision-to-delivery interval≤15min has been advocated in France for code-red caesarean section. This retrospective cohort study aimed to assess the decision-to-delivery interval and the neonatal outcomes according to the anaesthetic technique performed for code red caesarean section in a French tertiary care obstetric unit.

Methods: All women undergoing code-red caesarean section between January 2013 and December 2015 were included. Demographic characteristics and anaesthetic, obstetrical and neonatal outcomes were collected from the patient's electronic medical records.

Results: Among 194 code-red caesarean sections analysed, 127 (65%) were performed under epidural anaesthesia and 67 (35%) under primary general anaesthesia. The median decision-to-delivery interval was 10 [8-12.5] min, and the interval was≤15min in 174 (90%) women. Effective epidural top-up and epidural top-up requiring supplemental sedation were associated with the shortest decision-to-delivery interval. Primary general anaesthesia was independently associated with depressed 5minutes Apgar score.

Conclusion: The decision-to-delivery interval was≤15min in most women, suggesting that optimised organisation ensures short decision-to-delivery interval independently of the anaesthetic technique performed. As general anaesthesia was associated with worse neonatal outcomes, our results support the early insertion of an epidural catheter whenever there is any potential concern that an emergency caesarean section may be required.

Keywords: Caesarean section; Epidural anaesthesia; General anaesthesia; Obstetrics.