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Implementation of a scientific approach to intrapartum care : the Emergency Caesarean Section-Decision Optimising Tool (EC-DOT) to eliminate avoidable harm to mothers and babies
Chandraharan, Edwin Perez-Bonfils, Anna Gracia Muhammad, Sadia Deshpande, Deepika Sukumaran, Suganya Mappa, Ilenia
Chandraharan, Edwin
Perez-Bonfils, Anna Gracia
Muhammad, Sadia
Deshpande, Deepika
Sukumaran, Suganya
Mappa, Ilenia
Affiliation
Global Academy of Medical Education & Training, London; Autonomous University of Barcelona, Spain; Maidstone and Tunbridge Wells NHS Trust; Cloudnine Group of Hospitals, Kids India Clinic, Bangalore, India; George Eliot Hospital NHS Trust, Nuneaton; Sapienza Università di Roma, Rome, Italy
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Publication date
2025-11-05
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Abstract
Safe intrapartum care requires masterly observation, timely interventions, verbalization and escalation (MOTIVE) to optimize maternal and perinatal outcomes. In clinical situations where continuation of labor is deemed likely to worsen maternal and perinatal outcomes, emergency cesarean sections, if performed at the right time, have the potential to improve maternal and/or perinatal outcomes, when an immediate and safe spontaneous or operative vaginal birth is not feasible. However, unnecessary emergency cesarean sections for presumed "fetal or obstetrician's distress" or "delayed progress of labour" may significantly increase the risks of maternal complications such as postpartum hemorrhage, wound infections and sepsis, pain, venous thrombo-embolism as well as long term adverse consequences such as placenta accreta spectrum disorders, uterine rupture and stillbirths. Conversely, the failure to ensure timely interventions due to the misclassification of cardiotocographs (CTG) as "suspicious" may lead to increased risks of hypoxic ischemic encephalopathy (HIE), neonatal encephalopathy (NNE) or perinatal deaths. The Emergency Cesarean Section-Decision Optimizing Tool (EC-DOT) has been developed to promote a systematic, scientific and logical approach prior to finalizing the decision to perform an emergency cesarean section during labor, thereby reducing the likelihood of avoidable harm to women and babies.
Citation
Chandraharan E, Gracia Perez-Bonfils A, Muhammad S, Deshpande D, Sukumaran S, Mappa I. Implementation of a scientific approach to intrapartum care: the Emergency Caesarean Section-Decision Optimising Tool (EC-DOT) to eliminate avoidable harm to mothers and babies. J Matern Fetal Neonatal Med. 2025 Dec;38(1):2576482. doi: 10.1080/14767058.2025.2576482. Epub 2025 Nov 5.
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Article
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© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.