
Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans
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ABSTRACT OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: 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_<0.001). Linear regression showed a statistically significant relationship between increasing
decision-to-delivery interval and umbilical arterial pH (_r_=0.22, _p_=0.02) and base excess (_r_=0.33, _p_<0.001) showing that delivery proceeded sooner for most of those with the worst
cord gases, with a gradual improvement over time. For the 13 (11%) neonates with cord gases placing them at increased risk for long-term neurologic sequelae, the decision-to-delivery
interval was 24.7±14.6 minutes (range 6 to 50 minutes), and 3/13 (23%) were classified as urgent rather than emergent. CONCLUSION: Electronic fetal monitoring shows considerable variation in
interpretation among maternal–fetal medicine specialists and is not a sensitive predictor of the fetus developing metabolic acidosis. There is no deterioration in cord gas results after 30
minutes, and most neonates delivered emergently or urgently for nonreassuring fetal status even when born after 30 minutes have normal cord gases. The 30-minute rule is a compromise that
reflects the time it takes the fetus to develop severe metabolic acidosis, our imprecision in its identification, and its rarity in the presence of nonreassuring fetal monitoring. Access
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SIMILAR CONTENT BEING VIEWED BY OTHERS OPTIMAL DURATION OF CARDIOTOCOGRAPHY ASSESSMENT USING THE IPREFACE SCORE TO PREDICT FETAL ACIDEMIA Article Open access 29 July 2022 FETAL MONITORING
FROM 39 WEEKS’ GESTATION TO IDENTIFY SOUTH ASIAN-BORN WOMEN AT RISK OF PERINATAL COMPROMISE: A RETROSPECTIVE COHORT STUDY Article Open access 02 December 2021 BLOOD GAS MEASURES AS
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AFFILIATIONS * Department of Gyn-Ob, Division of Maternal–Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Cynthia J Holcroft MD, Ernest M Graham MD, Abimbola
Aina-Mumuney MD & Janice L Henderson MD * Ross Medical School, Dominica, West Indies Karishma K Rai MD * Department of Anesthesia, Johns Hopkins University School of Medicine, Baltimore,
MD, USA Donald H Penning MD Authors * Cynthia J Holcroft MD View author publications You can also search for this author inPubMed Google Scholar * Ernest M Graham MD View author
publications You can also search for this author inPubMed Google Scholar * Abimbola Aina-Mumuney MD View author publications You can also search for this author inPubMed Google Scholar *
Karishma K Rai MD View author publications You can also search for this author inPubMed Google Scholar * Janice L Henderson MD View author publications You can also search for this author
inPubMed Google Scholar * Donald H Penning MD View author publications You can also search for this author inPubMed Google Scholar ADDITIONAL INFORMATION Statistical Consultant: Elizabeth A.
Johnson, MS, Bloomberg School of Public Health, Biostatistics Department, Johns Hopkins University, USA. Presented at the annual meeting of the Society of Obstetrical Anesthesia and
Perinatology, Phoenix, AZ, USA, May 14–17, 2003. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Holcroft, C., Graham, E., Aina-Mumuney, A. _et al._ Cord
Gas Analysis, Decision-to-Delivery Interval, and the 30-Minute Rule for Emergency Cesareans. _J Perinatol_ 25, 229–235 (2005). https://doi.org/10.1038/sj.jp.7211245 Download citation *
Published: 23 December 2004 * Issue Date: 01 April 2005 * DOI: https://doi.org/10.1038/sj.jp.7211245 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this
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