Decision-to-Delivery Interval After Implementation of a Specific Protocol for Emergency Cesarean Delivery Because of Category III Fetal Heart Rate Tracings

Abstract

Objective: To assess the frequency of emergency cesarean deliveries with decision-to-delivery intervals (DDIs) of less than 30 minutes after implementation of a code blue protocol following National Institute of Child Health and Human Development (NICHD) category III fetal heart rate (FHR) tracings. The secondary aim was to compare differences in pregnancy outcomes for deliveries completed before and after the 30-minute threshold. Methods: All women undergoing a code blue emergency cesarean delivery between July 2015 and December 2021 were included. Information from electronic medical records, including baseline demographics, clinical characteristics, and pregnancy outcomes were retrospectively reviewed. Results: Among 254 code blue cesarean deliveries, 246 (96.9%) had a DDI of ≤30 minutes. The median DDI was 17 (14.3–20.0) minutes. No significant differences in adverse maternal and neonatal outcomes were detected between deliveries with DDIs greater than and less than 30 minutes. The incidence of stillbirth was higher in the >30 minute-DDI group than in the ≤30 minute-DDI group (12.5% vs. 2%; P = 0.176). Conclusions: After implementation of a code blue protocol for emergency cesarean delivery, a DDI within 30 minutes was achieved in 97% of cases with category III FHR tracings. The incidence of stillbirth was dramatically higher in the >30 minutes-DDI group. We encourage all obstetric units to consider every factor that could reduce the DDI by developing specific, local protocols.