Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic

Abstract

General anaesthesia is known to achieve the shortest decision-to-delivery interval for category-1 caesarean section. We investigated whether the COVID-19 pandemic affected the decision-to delivery interval and influenced neonatal outcomes in patients who underwent category-1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre-COVID-19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID-19 pandemic (1 April 2020-1 July 2020) (post-COVID-19 group). Primary outcome measures were: decision-to-delivery interval; number of caesarean sections achieving decision-to-delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5-min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre- and post-COVID-19 groups (risk ratio 0.48 (95%CI 0.37-0.62); p < 0.0001). Compared with the pre-COVID-19 group, the post-COVID-19 group had an increase in median (IQR [range]) decision-to-delivery interval (26 (18-32 [4-124]) min vs. 27 (20-33 [3-102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision-to-delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre- and post-COVID-19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision-to-delivery interval observed during the COVID-19 pandemic did not adversely affect neonatal outcomes.

Keywords: COVID-19; emergency caesarean section; neonatal outcome; obstetrics anaesthesia.

Figure 1

General anaesthesia (GA) rates are presented as risk ratio and 95% confidence interval (CI). Data were analysed using Mantel‐Haenszel chi‐square statistics, stratified by hospital

Figure 2

The significant dependency of general anaesthesia (GA) on indication ordered by neonatal morbidity is shown using non‐parametric regression (median slope: 1.03% (95%CI 0.09–1.86), Spearman’s rho correlation 0.81, p = 0.022). Chi‐square trend analysis shows a significant 5.6% (95%CI 4.2–7.0); p < 0.0001) change in general anaesthesia rate per ordered indication category. There is a significant use of general anaesthesia for the top four indications combined with adverse neonatal outcomes (odds ratio 3.5 (95%CI 2.2–5.4); p < 0.0001). APH, antepartum haemorrhage; CTG, cardiotocography