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Immediate birth – an analysis of women undergoing time critical birth in a tertiary referral obstetric hospital
Abstract Number: SA-21
Abstract Type: Original Research
Introduction:Rapid anesthesia for emergency birth is a core requirement for an obstetric anesthesiologist. A request for an immediate birth may be due to life-threatening fetal &/or maternal conditions. Hospitals often have an emergency code system for these time critical emergencies. In our institution an emergency “Code Green” activates the system for immediate birth. We aimed to review the number of women undergoing Code Green CS, the indications for Code Green CS, the type of anesthesia used, the decision to delivery interval(DDI), & maternal & neonatal outcomes.
Method:After IRB approval, all Code Green births(January 1 2013 & December 31 2014) were analysed. The DDI based on anesthesia type was assessed using Kruskal-Wallis one-way analysis of variance on ranks & Dunns’ method for multiple comparison of groups. Analyses were performed comparing groups using non-parametric tests.
Results:14,115 women birthed between 2013-2014. 387 women underwent Code Green births-322(83%) by CS. The mean±SD age, gestation & body mass index for women undergoing Code Green CS was 32±8.3 years, 39±3.8 weeks, 26±5.5 kg.m-2. The most common indication for Code Green CS was prolonged fetal bradycardia (>5 minutes) (n=204, 53%), however cord prolapse (n=17, 4%) produced the most rapid DDI median (IQR) 14(13-16)vs17(14-23) minutes(p=0.005) for the whole group. Epidural top-up anesthesia was the commonest anesthetic method(Table). 8% of women undergoing neuraxial anaesthesia were converted to general anaesthesia(GA) during CS. 62% of Code Green CS occurred after-hours(between 17:00pm–06:59am) with 1 in 3 women having a general anaesthesia(GA – either initial GA or conversion to GA).Of the 103 GAs there was 1 failed intubation(1%)(successful ventilation). 11(3.4%) women were admitted to higher acuity care. There were no maternal deaths. Babies born with a DDI >30 minutes were significantly less likely to have a time to establish respiration of >1 minute (16.7%vs22.6%, P<0.001), but had a hospital stay of more than 3 days (60.0%vs38.9%, p<0.05).
Conclusions:Immediate CS is a common emergency occurring after-hours. Fastest DDI is achieved with GA however epidural top-up anesthesia only marginally prolongs DDI. Neuraxial failure requiring conversion to GA needs to be anticipated. DDI has little relationship to short-term neonatal morbidity, likely due to shorter DDIs in more at risk fetuses. Rapid DDI is achieved with an integrated emergency response system.