July 3, 2006

Docs seem to know when speedy C-section is needed

By Megan Rauscher

NEW YORK (Reuters Health) - 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

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

SOURCE: Obstetrics and Gynecology July 2006.