Decision-to-delivery interval (DDI) for emergency cesarean sections in Polish healthcare system

Abstract

Cesarean section is one of most common obstetric procedures, with the incidence of 33.9-43.1% of all labors in Poland. If the indication for cesarean section is ‘immediate threat to maternal or fetal life’, then the procedure must be performed without delay. The fact that time elapsed between decision to operate and delivery (decision-todelivery interval, DDI) affects fetal outcome has been widely discussed. Poland lacks recommendations for optimal DDI in emergency cesarean section but some foreign scientific associations, universally recognized as an authority, recommend DDI not to exceed 30 minutes in such cases. Our review attempts to determine the most significant factors affecting DDI, which can be divided according to the competence and responsibility of people involved in the functioning of the obstetrics department. Obstetrician-depending factors include appropriate diagnosis of indications for cesarean section and proficiency during procedure (incision-to-delivery interval). Midwives are responsible for preparation of the patient and the operating theater, as well as transport of the patient. Anesthesiologists deem patients eligible for anesthesia and are also responsible for efficiency of its administration. Furthermore, few additional factors which seem to be fundamentally important in achieving optimal DDI have been identified and they depend on hospital management decisions, namely sufficient number of qualified staff, regular training in emergency procedures, availability of operating theaters, as well as fast and safe transportation of patients between the admission room, obstetrics department and operating theaters. In conclusion, we wish to emphasize that optimal DDI depends on proper collaboration of numerous teams, what may be important when discussing personal responsibility in obstetric failures.