H.-J. Clement

Red, orange and green Caesarean sections: A new communication tool for on-call obstetricians

OBJECTIVE To evaluate the effect of a novel communication tool, related to the degree of urgency for Caesarean sections (CSs), on the decision-to-delivery interval for emergency CS. STUDY DESIGN Red CS are very urgent cases corresponding to life-threatening maternal or foetal situations, orange CS are urgent cases and green CS are non-urgent intrapartum CS. We carried out this cohort study in a French maternity hospital. The study included all emergency Caesarean sections during two 6-month periods, before and after introduction of the code. We compared the decision-to-delivery interval of the two study periods. RESULTS Our study included 174 emergency CS. The mean decision-to-delivery interval after introduction of the code was 31.7 min, significantly shorter (p=0.02) than the 39.6 min interval before introduction of the colour code. Except for the preparation time, each time interval decreased. This included transporting the patient into the operating theatre, and the incision-to-delivery time interval. CONCLUSION This study suggests that the use of the three-colour code could significantly shorten the decision-to-delivery interval in emergency CS. Further prospective studies are needed to confirm this result.

Rapidité d’extraction respective des césariennes et des forceps réalisés en urgence: À propos de 137 extractions pour anomalies du rythme cardiaque fœtal en cours de travail

AIM Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections. MATERIAL AND METHOD A retrospective analysis was performed on 137 cases of forceps deliver (n = 63) and cesarean section (n = 74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004. RESULTS The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84 min +/- 6.54 versus 29.31 min +/- 11.79 p < 0.0001). Maternal and neonatal morbidity were comparable. CONCLUSION This study suggest that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.

Étude du délai décision de césarienne-naissance dans les césariennes en urgence

Resume L’objectif de cette etude retrospective menee au sein de la maternite de la Croix-Rousse (Lyon) est de determiner l’intervalle de temps separant la decision de cesarienne de la naissance de l’enfant. Les cesariennes effectuees en urgence et/ou en cours de travail sur une periode de 6 mois ont ete revues et divisees en deux groupes selon la classification de Lucas : les cesariennes tres urgentes et urgentes (« emergency » et « urgent ») et les autres cesariennes en cours de travail (« scheduled »). Le delai decision-naissance moyen etait de 39,5 minutes dans le premier groupe et de 55,9 minutes dans le deuxieme groupe. Ce delai decision-naissance etait influence de maniere importante par le temps d’installation de la patiente au bloc operatoire. L’amelioration de la communication au sein de l’equipe perinatale pourrait contribuer a diminuer le delai decision-naissance.