Compliance with recommended decision to delivery interval (DDI) for assisted vaginal births
Dr Marwan Nassar, Anaesthetic Registrar ; Dr Arani Pillai, Anaesthetic Consultant ; Queens Medical Centre, Nottingham University Hospitals
Introduction
• The classification of urgency of caesarean sections should guide 100% of 1
operative births; both vaginal and abdominal .
• Decision to delivery interval (DDI) should not exceed 30 minutes for category 2
one (CAT1) and 75 minutes for category two (CAT2) births .
• We assessed our 4500 births per year maternity unit’s compliance with the recommended DDI for operative vaginal births.
Methods
• Theauditwasregisteredwithlocalauditdepartment.
• Data for instrumental births in theatre between May & August 2021 were
collected retrospectively.
• Dataincludedcategoryofurgency,timesfor:activepushing,decisiontodeliver, arrival in theatre, anaesthesia start, procedure start, delivery, and mode of anaesthesia.
• Reasonsfordelaywereinvestigated.
• Documentationofcategorywasoftenincompleteandwaspostulatedfromthe
indication for instrumental birth.
• Results were summarized using median and interquartile range (IQR) for numeric variables and percentages for categorical variables.
Results
• Weincluded54Instrumentalbirths,nine(17%)CAT1and45(83%)CAT2.
• Median(IQR)DDIwas35(28-47)minsand57(47-66)minsforCAT1andCAT2,
respectively (Figure 1).
• SixCAT1births(66.67%)andfiveCAT2(11.1%)birthswerenon-compliant.
• Mainreasonsidentified:
• delayintransferringpatients22(14-32)minutes • unavailablesecondtheatre/theatreteam
Discussion
• MDTdiscussionattributedthepoordocumentationtolackof awareness of need for categorisation. Perception was that instrumental birth was not urgent.
• Plannedinterventions:
(1) Computerpromptthatrequirescategorisationofevery
operative birth.
(2) Newstandardoperatingprocedure(SOP)thatdemands:
a) Category for each emergency obstetric theatre case
to be communicated by tannoy bleep
b) CAT1 cases come to theatre as soon as possible
following the bleep
c) Theatre staff actively collect CAT2 cases when theatre
is ready
d) Clear documentation of a change in urgency whether
an upgrade to CAT 1 or downgrade to CAT 2 , especially if second emergency team is needed.
(3) Guidanceonappropriateutilisationofsecondobstetric theatre have been drafted.
(4) Reauditisplannedafterchangesareimplemented
Figure 1: Decision to delivery interval by category of instrumental birth
References
1. Robertson L, Knight H, Prosser-Snelling E et al. Each baby counts in 2018 – lessons learned and future directions, Obstetrics, Gynaecology & Reproductive Medicine 2018; 28:253-257.
2. Intrapartum care for healthy women and babies - Clinical guideline [CG190] Published: 03 December 2014 Last updated: 21 February 2017 https://www.nice.org.uk/guidance/cg190/chapter/recommendations#second-stage-of-labour