Health & body · 2010
How much do maternity units vary in anesthesia use and guideline compliance for urgent caesarean births?
For category-1 caesarean sections, units reported general anaesthetic rates ranging from 6% to 100%, with a median of 51%. Although 81% used the NICE urgency classification, only 42%, 14% and 9% complied with its recommended decision-to-delivery intervals for categories 1, 2 and 3, respectively.
Details
A national survey about anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. The response rate was 70%.
For category-1 caesarean sections, the median general anaesthetic rate was 51%, with an interquartile range (IQR) of 29%–80% and a full range of 6%–100%. For categories 1–3 combined (non-elective/emergency), the median was 12% (IQR 9%–16%; range 3%–93%). For category-4 caesarean sections (elective), it was 4% (IQR 2%–5%; range <1%–18%).
The main caesarean operating theatre was on the delivery suite in 151 units (88%), and 112 units (66%) also had a second theatre there.
The standard urgency classification described in the NICE caesarean section guideline was used by 139 units (81%). However, only 72 units (42%) complied with the guideline's recommended decision-to-delivery interval of ≤30 minutes for category-1 caesarean sections. For category-2 sections, 24 units (14%) complied with the recommended interval of ≤30 minutes; for category-3 sections, 16 units (9%) complied with the recommended interval of ≤75 minutes.
Practice in smaller units was similar to that in larger units. However, smaller units had less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite.
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