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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.
Anaesth Crit Care Pain Med. 2019 12; 38(6):623-630.AC

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.

Authors+Show Affiliations

Department of anaesthesiology and intensive care, hospices Civils de Lyon, Femme-Mère-Enfant hospital, 59, boulevard Pinel, 69500 Bron, France.Department of anaesthesiology and intensive care, hospices Civils de Lyon, Femme-Mère-Enfant hospital, 59, boulevard Pinel, 69500 Bron, France.Department of anaesthesiology and intensive care, hospices Civils de Lyon, Femme-Mère-Enfant hospital, 59, boulevard Pinel, 69500 Bron, France.Department of anaesthesiology and intensive care, hospices Civils de Lyon, Lyon Sud Teaching hospital, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; University of Lyon, Claude Bernard Lyon 1 University, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France.Department of anaesthesiology and intensive care, hospices Civils de Lyon, Femme-Mère-Enfant hospital, 59, boulevard Pinel, 69500 Bron, France; University of Lyon, Claude Bernard Lyon 1 University, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France.Department of anaesthesiology and intensive care, hospices Civils de Lyon, Femme-Mère-Enfant hospital, 59, boulevard Pinel, 69500 Bron, France; University of Lyon, Claude Bernard Lyon 1 University, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France. Electronic address: lionel.bouvet@chu-lyon.fr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31129225

Citation

Bidon, Cyril, et al. "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." Anaesthesia, Critical Care & Pain Medicine, vol. 38, no. 6, 2019, pp. 623-630.
Bidon C, Desgranges FP, Riegel AC, et al. 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. Anaesth Crit Care Pain Med. 2019;38(6):623-630.
Bidon, C., Desgranges, F. P., Riegel, A. C., Allaouchiche, B., Chassard, D., & Bouvet, L. (2019). 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. Anaesthesia, Critical Care & Pain Medicine, 38(6), 623-630. https://doi.org/10.1016/j.accpm.2019.05.005
Bidon C, et al. 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. Anaesth Crit Care Pain Med. 2019;38(6):623-630. PubMed PMID: 31129225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Bidon,Cyril, AU - Desgranges,François-Pierrick, AU - Riegel,Anne-Charlotte, AU - Allaouchiche,Bernard, AU - Chassard,Dominique, AU - Bouvet,Lionel, Y1 - 2019/05/23/ PY - 2019/03/21/received PY - 2019/05/09/revised PY - 2019/05/11/accepted PY - 2019/5/28/pubmed PY - 2019/5/28/medline PY - 2019/5/27/entrez KW - Caesarean section KW - Epidural anaesthesia KW - General anaesthesia KW - Obstetrics SP - 623 EP - 630 JF - Anaesthesia, critical care & pain medicine JO - Anaesth Crit Care Pain Med VL - 38 IS - 6 N2 - 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. SN - 2352-5568 UR - https://www.unboundmedicine.com/medline/citation/31129225/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-5568(19)30113-4 DB - PRIME DP - Unbound Medicine ER -
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