Cord Gas Analysis, Decision-to-Delivery Interval, and the 30-Minute Rule for Emergency Cesareans

Our primary objective was to examine the relationship between umbilical arterial gas analysis and decision-to-delivery interval for emergency cesareans performed for nonreassuring fetal

status to determine if this would validate the 30-minute rule.

For this retrospective cohort study, all cesarean deliveries performed for nonreassuring fetal status from September 2001 to January 2003 were reviewed. A synopsis of clinical information

that would have been available to the clinician at the time of delivery and the last hour of the electronic fetal heart rate tracing prior to delivery were reviewed by three different

maternal–fetal medicine specialists masked to outcome, who classified each delivery as either emergent (delivery as soon as possible) or urgent (willing to wait up to 30 minutes for

delivery) since immediacy of the fetal condition is the key factor affecting the type of anesthesia used.

Of 145 cesareans performed for nonreassuring fetal status during this period, 117 patients met criteria for entry, of which 34 were classified as emergent and 83 as urgent. Kappa correlation

was 0.35, showing only fair/moderate agreement between reviewers. In the emergent group, general anesthesia was more common (35.3%, 10.8%, p=0.003), and the decision-to-delivery interval

was 14 minutes shorter (23.0±15.3, 36.7±14.9 minutes, p