Evidence map›Paper›PMID 28927497›Full record

ArticleDeutsches Arzteblatt international2017

Decision-to-Delivery Time and Perinatal Complications in Emergency Cesarean Section.

Günther Heller, Erik Bauer, Stefanie Schill, Teresa Thomas, Frank Louwen, Friedrich Wolff, Björn Misselwitz, Stephan Schmidt, Christof Veit

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PubMed Full text at PMC Publisher
In one paragraph

Article in Deutsches Arzteblatt international, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
1.8field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 45 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 2 countries.

Günther HellerInstitute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany; Department of Obstetrics and Prenatal Medicine, University Hospital of Frankfurt, Frankfurt, Germany; Women's Hospital Holweide, Kliniken der Stadt Köln, Cologne, Germany; Hesse Quality Assurance Office (GQH), Eschborn, Germany; Department of Obstetrics and Perinatal Medicine, University Hospitals of Gießen and Marburg, Marburg site, Marburg, Germany.
Erik Bauer
Stefanie Schill
Teresa Thomas
Frank Louwen
Friedrich Wolff
Björn Misselwitz
Stephan Schmidt
Christof Veit
Krankenhaus Köln-Holweide · DEDr. A. Ramachandran's Diabetes Hospitals · INGoethe University Frankfurt · DEInstitute for Quality and Efficiency in Health Care · DEKliniken der Stadt Köln · DEUniversitätsklinikum Gießen und Marburg · DEUniversity Hospital Frankfurt · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundA decision-to-delivery interval (DDI) of no more than 20 minutes has long been considered a requirement for cesarean sections, even though there have hardly been any studies on this topic. We retrospectively investigated data relevant to DDI for emergency cesarean sections performed for the most common indications, namely, suspected and documented fetal asphyxia.

methodsWe analyzed data on emergency in-hospital cesarean sections in the period 2008-2015. Low 5- and 10-minute Apgar scores (a scheme with points awarded for breathing, heart rate, muscle tone, skin coloration, and the elicitability of reflexes) were the primary endpoints; acid-base status in arterial cord blood and in-hospital neonatal death were the secondary endpoints. The raw analysis was supplemented by an analysis adjusted for various factors including gestational age, maternal age, and obstetrical presentation.

resultsData from 39 291 neonates were included. The DDI was up to 10 minutes in 64.6% of cases, from 11 to 20 minutes in 34.3%, and over 20 minutes in 1.1%. Low Apgar scores were less common in children whose emergency cesarean sections were performed within 10 minutes or within 20 minutes. For example, the adjusted odds ratio for a 10-minute Apgar score below 4 was 0.49 (95% confidence interval [0.25; 0.96] when a DDI of more than 20 minutes was used as the reference criterion.

conclusionThis is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so.

Indexed as

Cesarean SectionDecision MakingEmergenciesApgar ScoreAsphyxia NeonatorumFemaleHumansInfant, NewbornPregnancyPregnancy OutcomeRetrospective StudiesTime Factors

Identifiers

PMID28927497
PMCPMC5615394
OpenAlexW2801431678

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.