Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Yuen KWT, Hui CMO
Affiliation :
Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital (PYNEH)
Introduction :
Crash CS in PYNEH is equivalent to category 1 CS where there is an immediate threat to the life of the mother/ fetus. Improving timely accessibility to anaesthetists and theatre services is likely to influence maternal and neonatal outcomes. The National Institute for Health and Care Excellence states that 30 minutes should be the audit standard for category 1 caesareans. The American College of Obstetricians and Gynecologists recommends that decision-to-delivery interval (DDI) in emergency caesarean delivery should be within 30 minutes. It is not possible to identify all women or babies who are at risk of rapid deterioration, but we must be able to respond appropriately in the event of an emergency.
Objectives :
To evaluate the DDI in PYNEH and its effect on perinatal and maternal outcomes in crash caesarean section.
Methodology :
A retrospective audit was conducted at PYNEH from August 2022 to July 2023. Mothers who underwent crash caesarean section were included. The parity, maturity, indication of crash caesarean section, type of anaesthesia, DDI, maternal adverse outcomes and perinatal outcomes were recorded. The primary outcome was DDI and secondary outcomes were perinatal and maternal outcomes.
Result & Outcome :
There were 24 crash CS over the one year period. One-hundred-percent of crash CS achieved a DDI of less than 30 minutes. The median DDI was 12 mins and the mean DDI (standard deviation) was 12.3 mins (+/- 3.56 mins). The longest DDI was 19 mins and the shortest was 6 mins. Fetal distress (79.2%) was the commonest indication. The mean (median, range) APGAR scores are 6.67 (8, 0-9) at 1 min, 8.63 (10, 0-10) at 5 min and 9.21 (10, 2-10) at 10 min. 8 (33.3%) neonates required admission to neonatal ICU.
For maternal outcome, one mother had blood loss greater than 1L with tranexamic acid and transfusion of blood products given, she required post-operative ICU care. She was later suspected to have amniotic fluid embolism. None of the mothers have other complications in terms of aspiration, difficult intubation, dental damage or allergy reaction.
Conclusion
One-hudred-percent crash CS were done within the generally accepted and adopted recommendation of 30 minutes in PYNEH and the mean DDI is 12.3 mins. Further studies are warranted to investigate the association if other parameters would be more directly related to outcomes.
