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Category of caesarean delivery, anaesthetic times and neonatal outcomes.
Abstract Number: SAT-01
Abstract Type: Original Research
The Royal College of Obstetricians and Gynaecologists introduced a classification system for caesarean delivery (CD), in 2010, to grade the urgency of surgery. Category 1 CD describes an immediate threat to the life of the mother or fetus and is the most urgent and category 4 CD represents a planned CD at a time to suite the mother and obstetricians. The time to provide anaesthesia for these different categories of CD has not been well studied. We analysed the different categories of CD, the time taken for anaesthesia to be delivered and neonatal outcomes. We also examined the effect of maternal body mass index (BMI) on anaesthetic time.
We obtained ethical approval to analyse data from 3 separate databases used within labour ward. These were the anaesthetic procedure, operating theatre and obstetric databases. Paired data were used from each database over a 5-year period (2009-2014). We examined the relationship between the category of CD and the anaesthetic time (defined as the time taken from entering theatre to being ready for surgery) as well as neonatal outcome parameters; admission to neonatal intensive care and arterial cord pH. Statistical analysis was performed using R (version 3.3.0 2016-05-03), survival analysis was performed by Cox’s proportional hazards regression model.
The 3 databases contained 59,333 cases. We had complete paired data for women undergoing CD in 8,524 sets of records. As the urgency of CD increased the time taken to deliver the anaesthetic decreased. The anaesthetic times for category 1,2,3,4 CD were 11 [7-18], 21 [15-29], 28 [21-37] and 33 [24-43] minutes respectively (median and interquartile range shown). There was no difference in the rates of admission to the neonatal intensive care unit or arterial cord pH when compared to the anaesthetic time. Compared to normal BMI (18.5-25) anaesthetic times were longer in overweight (BMI 25-30) patients (hazard ratio 0.92; 95% confidence interval 0.87-0.96; P 0.002) and obese patients (BMI >35) (HR 0.81;95% CI 0.75-0.86;P<0.001).
This is the largest published dataset analysing anaesthetic time and category of CD. The categorisation of obstetric urgency for CD is an effective means to communicate the speed at which the baby requires delivery and in this study correlated well with anaesthetic times. As the mothers BMI increases so does the anaesthetic time. This is an important factor when preparing a woman for category 1-2 CD and may influence the use of, and consent for epidurals during labour in this group of parturients.