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Cord Gas Analysis, Decision-to-Delivery Interval and the 30-Minute Rule for Emergency Cesareans

Journal of Perinatology volume 25, page 616 (2005)Cite this article

Dear Editor:

We appreciate the comments of Dr. Ross whose work we referred1 to in our paper on cord gas analysis and the 30-minute rule for emergency cesareans.2 We would like to correct the misconception that the flat regression line in our paper suggests that the individual fetus does not develop metabolic acidosis between decision and delivery. The individual normally oxygenated fetus can certainly develop metabolic acidosis in as little as 19 to 29 minutes as we state using the calculations of doctors Ross and Gala. These data are present in the discussion section of our paper. The question we are attempting to answer is, how accurate is electronic fetal monitoring in identifying the truly compromised fetus developing metabolic acidosis, and is electronic fetal monitoring sensitive and specific enough to validate the 30-minute rule as measured by cord gas analysis? All the patients in our study had an emergency cesarean delivery for nonreassuring fetal status. Electronic fetal monitoring was the tool used to diagnose these patients as having nonreassuring fetal status. As electronic fetal monitoring has become more widely used we have seen the incidence of cesarean deliveries increase from 5% in the early 1960s to almost 25% today, with much of this increase due to cesareans done for nonreassuring fetal status. The incidence of cerebral palsy in term infants during this period has remained unchanged. As mentioned by Dr. Ross the 30-minute rule does reflect the requirements for hospitals to assemble their operating teams recognizing logistical limitations. We are trying to find out if there is a scientifically verifiable clinical basis for the 30-minutes rule rather than just practical considerations of assembling the operating team.

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References

  1. Ross MG, Gala R . Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol 2002;187:1–9.

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  2. Holcroft CJ, Graham EM, Aina-Mumuney A, Rai KK, Henderson JL, Penning DH . Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans. J Perinatol 2005;25:229–235.

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Authors and Affiliations

  1. Maternal-Fetal Medicine (C.J.H., E.M.G), Baltimore, MD, USA

    Cynthia J Holcroft MD & Ernest M Graham MD

  2. Anesthesiology and Critical Care Medicine (D.H.P.), Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA

    Donald H Penning MD

Authors
  1. Cynthia J Holcroft MD
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  2. Ernest M Graham MD
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  3. Donald H Penning MD
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Holcroft, C., Graham, E. & Penning, D. Cord Gas Analysis, Decision-to-Delivery Interval and the 30-Minute Rule for Emergency Cesareans. J Perinatol 25, 616 (2005). https://doi.org/10.1038/sj.jp.7211350

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  • DOI: https://doi.org/10.1038/sj.jp.7211350

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