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首页> 外文期刊>American Journal of Obstetrics and Gynecology >The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome
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The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome

机译：缩短紧急剖宫产分娩间隔对母婴结局的影响

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Objective To study the effect of a departmental program designed to shorten the decision-to-delivery interval (DDI) for emergency cesarean section (ECS) for nonreassuring fetal heart rate (NRFHR) on maternal and neonatal outcome. Study Design A protocol for managing ECS that included documenting precise time-intervals, identification of delaying obstacles and debriefing of each case, was implemented from March 2011. All women who delivered by ECS for NRFHR, as the only indication were included. Detailed information regarding DDI, maternal intraoperative and postoperative complications, and neonatal early outcomes were compared before (period-P1) (-27 months) and after (period 2) (+27 months) program implementation. Results During 54 months of study, 593 ECS DDI were included. Mean DDI decreased at period 2 (12.3 ± 3.8 min, n = 301) compared with period 1 (21.7 ± 9.1 min, n = 292), P <.001. Rate of cord pH ≤7.1 and 5 min Apgar score ≤7 decreased at period 2 compared with period 1, P =.016 and P =.031, respectively. Worse composite neonatal outcome decreased at period 2 compared with period 1, 15.6% vs 32.2%, respectively, P ≥.001. Composite maternal outcome did not differ between the groups. Worse neonatal outcome was dependent on time period (period 1), odds ratio, 2.12; 95% confidence interval, 1.27-3.55; P =.004 and on gestational age at delivery, odds ratio, 0.68; 95% confidence interval, 0.62-0.76; P <.001. Conclusion Introduction of a management protocol to shorten DDI in ECS for NRFHR was associated with improved early neonatal outcome without change in maternal complications.
机译：目的研究旨在缩短无法确定胎儿心率（NRFHR）的紧急剖宫产（ECS）的决定分娩间隔（DDI）对产妇和新生儿结局的影响的部门计划。研究设计自2011年3月起实施了一项管理ECS的协议，其中包括记录精确的时间间隔，确定延迟的障碍和每个案例的情况汇报。所有包含ECS为NRFHR分娩的妇女均包括在内。在实施方案之前（-P1）（-27个月）和之后（方案2）（+ 27个月），比较了有关DDI，产妇术中和术后并发症以及新生儿早期结果的详细信息。结果在研究的54个月中，包括593个ECS DDI。与阶段1（21.7±9.1分钟，n = 292）相比，阶段2（12.3±3.8分钟，n = 301）的平均DDI降低，P <.001。与第1阶段相比，第2阶段的脐带pH值≤7.1和5 min Apgar得分≤7的比率分别降低，P = .016和P = .031。与第1阶段相比，第2阶段的较差的复合新生儿结局降低了15.6％和32.2％，P≥.001。两组间的孕产妇综合结局无差异。较差的新生儿结局取决于时间段（时间段1），优势比为2.12; 95％置信区间1.27-3.55; P = .004，分娩时的胎龄，比值比为0.68; 95％置信区间0.62-0.76; P <.001。结论引入缩短NRFHR ECS中DDI的管理方案可改善新生儿的早期结局，而不会改变孕产妇并发症。

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