The problem with this classification was that all non elective cases were categorised as emergencies irrespective of their nature of urgency. Formerly, caesarean deliveries were categorised as elective and emergency. Improving anaesthetic care is one of the key areas of action in the MBRRACE – UK Maternal report 2017. Emergency anaesthesia has high maternal and child morbidity and mortality. This gives us an indirect indicator of caesarean sections performed for emergent indications. Of all deliveries, in 7.6% of cases, the decision to conduct caesarean section was taken after the onset of labour pains. The incidence of caesarean deliveries in India as per the National Family Health Survey report was 17.2%. Haemorrhage is said to be the leading cause of mortality worldwide. Failed intubation, failed neuraxial block, extensive neuraxial block, awareness under anaesthesia, thromboembolism, amniotic fluid embolism, haemorrhage and maternal collapse are some of the complications. In category 2 and 3 caesarean sections, spinal anaesthesia still remains the technique of choice. Rapid sequence spinal anaesthesia is replacing general anaesthesia for many of the category 1 indications.
Although general anaesthesia is considered to have higher morbidity and mortality, category 1 caesarean sections may still warrant this technique. The management of these emergencies involves a rapid assessment, with minimal investigations.
This is used as an audit tool for the efficiency of an obstetric service. The target decision to delivery interval for category 1 caesarean section is less than 30 min. Caesarean sections are classified depending on the urgency into four categories. In 7.6% of cases, the decision to conduct a caesarean section was taken after the onset of labour pains. The incidence of caesarean sections as per the National Family Health Survey published in 2015–16 was 17.2%. Obstetric emergencies are a challenge both for the obstetrician and the anaesthesiologist.
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