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

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.