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Introduction <p>Rapid delivery is important in cases of umbilical cord prolapse. We established a ‘crash caesarean section’ CODE within our hospital for category 1 caesarean sections. All major societies recommend decision-to-delivery interval of less than 30&#xa0;min.</p> Aims and Objectives <p>(1) To audit DDI in cord prolapse with time motion analysis (2) Impact of the DDI in Cord prolapse on maternal and neonatal outcomes.</p> Materials and methods <p>Present study was a single centre retrospective analysis over a period of 12&#xa0;years (August 2011 to August 2023) where cases of umbilical cord prolapse were retrieved through electronic medical records of the hospital. Decision-to-delivery interval (DDI) was noted and a time motion analysis under following sub parameters were done. A—Decision of crash caesarean to reaching OT (Transfer time), B—Woman reaching operation theatre to start of anaesthesia (OT preparations, manpower, patient factors, anaesthetist availability), C—Start of anaesthesia to Incision, D—Incision to delivery of baby. We excluded cord presentation; period of gestation less than 26&#xa0;weeks and cord prolapse cases occurring outside hospital.</p> Results <p>We had 119 (0.10%) cord prolapse cases (107 singletons and 12 twins). The median DDI was 15&#xa0;min(<sup>12,20</sup>). We had 113 deliveries in DDI ≤ 30&#xa0;min group and 6 cases in DDI &gt; 30&#xa0;min. On detailed breakup analysis of DDI, there was a statistically significant delay of 9&#xa0;min in interval B (reaching OT to start of anaesthesia) in DDI &gt; 30&#xa0;min cohort compared to just 2&#xa0;min delay in same interval in the other cohort. Maternal morbidity (PPH and wound infection) was seen in 7.5% cases. Neonatal resuscitation requirement and 5-min Apgar &lt; 7 was seen to have higher incidence in DDI group &gt; 30&#xa0;min, although the difference was not statistically significant. Overall, there was no significant relation between DDI and maternal neonatal outcomes.</p> Conclusion <p>In a clinical setting which includes a high obstetric volume and protocol “code” based response, rapid Decision-to-Delivery Intervals (DDI) in cases of umbilical cord prolapse with good perinatal outcomes can be comfortably achieved without compromising maternal-foetal safety.</p>

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Emergency Obstetric Response in Cord Prolapse: Analysis of Decision-to-Delivery Interval (DDI) Metrics and its Impact on Obstetric Outcomes

  • 期刊论文

  • 发表日期：

    2025年12月27日

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  • Y. Subhashini,
  • Ayushi Shukla

摘要

Introduction

Rapid delivery is important in cases of umbilical cord prolapse. We established a ‘crash caesarean section’ CODE within our hospital for category 1 caesarean sections. All major societies recommend decision-to-delivery interval of less than 30 min.

Aims and Objectives

(1) To audit DDI in cord prolapse with time motion analysis (2) Impact of the DDI in Cord prolapse on maternal and neonatal outcomes.

Materials and methods

Present study was a single centre retrospective analysis over a period of 12 years (August 2011 to August 2023) where cases of umbilical cord prolapse were retrieved through electronic medical records of the hospital. Decision-to-delivery interval (DDI) was noted and a time motion analysis under following sub parameters were done. A—Decision of crash caesarean to reaching OT (Transfer time), B—Woman reaching operation theatre to start of anaesthesia (OT preparations, manpower, patient factors, anaesthetist availability), C—Start of anaesthesia to Incision, D—Incision to delivery of baby. We excluded cord presentation; period of gestation less than 26 weeks and cord prolapse cases occurring outside hospital.

Results

We had 119 (0.10%) cord prolapse cases (107 singletons and 12 twins). The median DDI was 15 min(12,20). We had 113 deliveries in DDI ≤ 30 min group and 6 cases in DDI > 30 min. On detailed breakup analysis of DDI, there was a statistically significant delay of 9 min in interval B (reaching OT to start of anaesthesia) in DDI > 30 min cohort compared to just 2 min delay in same interval in the other cohort. Maternal morbidity (PPH and wound infection) was seen in 7.5% cases. Neonatal resuscitation requirement and 5-min Apgar < 7 was seen to have higher incidence in DDI group > 30 min, although the difference was not statistically significant. Overall, there was no significant relation between DDI and maternal neonatal outcomes.

Conclusion

In a clinical setting which includes a high obstetric volume and protocol “code” based response, rapid Decision-to-Delivery Intervals (DDI) in cases of umbilical cord prolapse with good perinatal outcomes can be comfortably achieved without compromising maternal-foetal safety.