to Pregnancy Reviews
A recent editorial in the BMJ addresses the issue
of the 30-minute rule (1).
For purposes of audit, the CNST 1996 (Clinical Negligence
Scheme for Trusts) advocates that, in the case of severe
obstetric emergencies, the time from decision to delivery
is ideally within 30 minutes (2).
The implication is that if this time standard is not
met, then there is suboptimal or even negligent care.
2 recent papers that have audited their care, show
that only about 50 - 66% are meeting the standard,
with 88% of deliveries achieved within 40 minutes (3,4).Admission
to the NNU (excluding the premature deliveries) is
not significantly different between these 2 groups
In fact, there is no good evidence toshow that 30 minutes
is a critical threshold for intrapartum hypoxia (5).
Scenarios requiring urgent delivery:
1. FBS PH<7.2
2. Abnormal CTG
3. Uterine Rupture
4. Cord Prolapse
5. Placental Abruption
1. James D. Caesarean section for fetal
distress. BMJ 2001;322:1316-7, Abstract
2. CNST (1996). Health Service Litigation Authority, London
3. MacKenzie IZ. Prospective 12 month study of 30-minute decision to delivery
intervals for "emergency" caesarean section. BMJ 2001;322:1334-5, Abstract
4. Tuffnell DJ. Interval between decision and delivery by caesarean section
- are current standards achievable? BMJ 2001;322:1330-3, Abstract