Predictions for the decision-to-delivery interval for emergency cesarean sections in Norway.

BACKGROUND: To explain the variation in decision-to-delivery intervals in emergency cesarean sections in Norway.
METHODS: A seven-month prospective registration of all emergency cesareans provided by 24 maternity units. The clinician in charge filled in a predesigned form for each delivery that obtained detailed information about obstetric history, the pregnancy, indication, the date and time of delivery, decision-to-delivery interval, seniority of the surgeon, and neonatal outcome until hospital discharge. To take account of the clustered nature of our observations, data were analyzed by multilevel regression.
RESULTS: 1,511 singleton emergency cesarean sections with known decision-to-delivery interval were included. The average decision-to-delivery interval for all emergency cesarean sections was 52.4 min, for acute cesarean sections 58.7 min, and for urgent emergency operations 11.8 min. Most of the decision-to-delivery interval variation was at patient level, not between departments. Several significant decision-to-delivery interval predictors were identified: 1. abruptio placentae (-54 min), umbilical cord prolapse (-37 min), and fetal stress (-35 min); 2. general anesthesia (versus regional) (-15 min), 3. cesarean sections performed during night-time (-10 min), 4. seniority of the surgeon (-6 min), and 5. cervical opening (for each cm: -6 min).
CONCLUSIONS: The variance in the decision-to-delivery interval was mainly explained by the different nature of the cesarean sections. The most important predictors, which all acted to reduce decision-to-delivery interval, were the three indications abruptio placentae, cord prolapse, and fetal stress. Sections performed during night-time had significantly reduced decision-to-delivery interval. The size of the maternal units as measured by number of deliveries per year was not a significant predictor.