Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scores.

BACKGROUND: We wanted to conduct a prospective study on the dynamics of emergency cesarean section (ECS) in terms of fetal survival and morbidity.
METHODS: The study covered 101 cases of ECS in Helsinki City Hospital, in which the time of alarm, the starting time of the operation, the time of birth, the umbilical arterial gas values, and Apgar scores were known. This group consisted of 60 cases with the operating team in the hospital (group 1) and 41 cases with the team on call (group 2). Means of the parametric variables were compared by the analysis of variance using separate or pooled t-tests after Levene's test of variances. Difference between the rate of adverse outcome (dead or handicapped) in each group was calculated using chi-square test.
RESULTS: In group 1, the time between the clinical decision and the time of delivery (mean +/- s.e.mean) was 13.5 +/- 0.7 min, in group 2, 23.6 +/- 0.9 min. The groups did not differ in terms of birthweight, placental weight, Apgar scores, and umbilical arterial gas values, except for pO2. The mean pO2 in group 1 was lower (1.9 +/- 0.1 kPa) than in group 2 (2.5 +/- 0.2 kPa). p = 0.0023. In group 2, one infant was handicapped by hypoxic ischemic encephalopathy and three fetuses had died in utero. The rate of survivors was significantly higher when the operating team was in hospital (p = 0.05).
CONCLUSION: The risk of fetal loss is evident when the operating team is on call outside the hospital, at least if the alarm to operation interval exceeds 20 minutes. The present study suggests that 24-hour services of anesthesia and operating theater personnel are crucial for optimal management of emergent situations in the delivery room.