Implementation of a crash cesarean section policy and its impact on maternal and neonatal outcomes at King Abdulaziz University Hospital: A retrospective study

Abstract

A typical surgical technique for pregnant women with potentially fatal problems affecting the mother or fetus is an emergency cesarean section (ECS). The decision-to-delivery interval (DDI) for ECS should be within 30 minutes. The objective of this study was to investigate crash ECS indications and effects on maternal and neonatal outcomes. In this retrospective study, all women undergoing crash cesarean section (CS) at Obstetrics and Gynecology department at King Abdulaziz University hospital, Jeddah, Saudi Arabia during 2022 and 2023 were evaluated. Data about demographic and obstetric characteristics of mother, ECS indications, DDI, and outcomes for mothers and newborns was gathered from the patient's sheet. One hundred 3 crash CS were performed during study period. Crash CS indications were fetal bradycardia (64.1%), prolapsed cord (24.3%), uterine rupture (6.8%), and severe antepartum hemorrhage (4.9%). D-D time range from 2 to 30 minutes. DDI was ≤15 minutes in 90 patients (87.4%) and >15 minutes in 13 patients (12.6%). Gestational age was <32 weeks (16.7%), between 32 and <37 weeks (15.5%), and ≥37 weeks (68.0%). Good maternal outcome was reported in 89 (86.4%), while 24 (13.6%) had complications. Intensive care unit maternal admission was significantly higher in gestational age 32 to <37 weeks versus <32 weeks and ≥37 weeks of gestation (18.8% vs 5.9% and 2.9%, P = .050). Fetal outcome was good in 69 (67.0%), while 34 (33.0%) had complications. Neonatal body weights, Apgar score at 1, 5, 10 minutes, and umbilical cord arterial pH were significantly decreased in preterm versus termed neonates (P < .0001, P < .0001, P < .0001, P = .014, and P = .003). Moreover, respiratory distress syndrome, jaundice, intubation, neonatal deaths, and sepsis were significantly higher in preterm versus term deliveries (P < .0001, P = .029, P < .0001, P = .010, and P = .031). Good neonatal outcome was significantly higher (P < .0001); while respiratory distress syndrome was significantly lower (P = .007) in deliveries with DDI ≤ 15 minutes versus > 15 minutes. The 30-minute standard for DDI time interval may be a feasible guideline at least for level-3 hospitals. Crash CS indication was mostly due to fetal bradycardia. The maternal and neonatal outcomes were better in term than preterm deliveries. The positive effect of very short intervals on neonatal outcome still needs to be proven.

Figure 1.

Apgar scores after 1, 5, and 10 minutes, neonatal weights (kg) and umbilical arterial pH (UApH) of the neonates delivered by emergency cesarean section in preterm and term neonates. The differences between the gestational age (GA) groups were significant * P < .050, ** P < .010, and *** P < .0001.

Figure 2.

Correlation between umbilical cord arterial PH (UApH) and decision-to-delivery interval (DDI).