Emergency caesarean delivery: Is there an ideal decision-to-delivery interval?

Background. -Among data on medical liability for obstetrical practice in tabour ward, one of the claims concerns the decision-to-delivery interval during emergency caesarean section, for which an optimal time is frequently advocated. A realistic review on this subject is needed. Literature review. - It mainly allows to note that: unlike current opinion, neonatal prognosis is more dependent on the causal pathology than on decision - to-delivery interval; the transfer time to the operating theater, which represents approximately half of this interval, should benefit an internal audit for each maternity as it is mainly dependent on organization and architectural specifications; the choice of mode of anesthesia in relation with the obstetrical context and the induction time have a strong incidence, which shows the importance of a good communication between the obstetrician and the anesthesist. Conclusion. - A detailed analysis of obstetrical context and of each sequence of the decision-to-delivery interval is more efficient and realistic for evaluation in medical liability cases than an optimal gold standard. In addition, it allows a prophylactic reflexion for a risk management approach in each tabour ward. (c) 2007 Elsevier Masson SAS. Tous droits reserves.