Recommendation ID
CG132/2
Question
Decision-to-delivery interval (category 2 urgency):- A prospective study to determine whether the decision-to-delivery interval has an impact on maternal and neonatal outcomes when there is a category 2 level of urgency for Caesarean Section (CS).
Important primary outcomes would be:
• fetal wellbeing (such as cord blood gases, Apgar score at 5 minutes, hypoxic encephalopathy, neonatal respiratory problems, unanticipated admission to neonatal intensive care unit (NICU), duration of stay in the NICU) maternal wellbeing (such as haemoglobin levels on day 2, need for blood transfusion, duration of hospital stay controlled for prolonged neonatal stay and general health/wellbeing).
Valuable secondary outcomes could include:
• fetal trauma at delivery
• iatrogenic maternal bladder or bowel injury
• postoperative maternal infectious morbidity
• establishment of breastfeeding
• psychological outcomes for women, such as the development of postnatal depression/posttraumatic stress disorder.
Any explanatory notes
(if applicable)
Why this is important:- This research is important to inform the ongoing debate about the management of category 2 Caesarean Section (CS). The 'continuum of risk' in this setting has been recognised. However, the majority of work in this area, looking at maternal and fetal outcomes, generally considers unplanned CS as a whole group without making any distinction between degrees of urgency. Furthermore much of this work is retrospective. The majority of women who undergo intrapartum CS fall into the category 2 level of urgency (Thomas et al. 2001) and therefore specific information for this group could affect and benefit many women and contribute to the delivery of equity of care.
Delay in delivery with a compromised fetus may result in major and long-term harm including cerebral palsy and other major long-term disability. The immediate and long-term effect on a family of the birth of a baby requiring life-long specialised care and support is enormous. If such harm could be avoided by appropriate haste this would be an important improvement in outcome. However, if such haste is of no benefit then any related risk of adverse maternal outcome needs to be minimised. A large amount of NHS and other state funding is used to provide continuing care for infants who are disabled as a result of delay in delivery and in providing lifelong support for the child and their family. In addition, large sums of public money are spent on litigation and compensation in some
of these cases through the Clinical Negligence Scheme for Trusts (CNST). If research helped to minimise the impact of delay in delivery this would reduce the costs of continuing care to the state and the burden to the child, their family and the wider community. More realistic and more relevant expectations for the decision-to-delivery interval based on evidence would inform debate within the legal system and may help to reduce the cost to the
state of related litigation.

Source guidance details

Comes from guidance
Caesarean section
Number
CG132
Date issued
November 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No