A Retrospective Review of Decision to Delivery Time Interval for Foetal Distress at a Central Hospital.

Abstract

The aim of this study was to describe the trajectory of emergency caesarean deliveries for foetal distress at Chris Hani Baragwanath Academic Hospital (CHBAH). A retrospective, contextual, descriptive study, using consecutive convenience sampling was done reviewing all the records of emergency caesarean deliveries for foetal distress at CHBAH in February 2019 until a minimum sample size of 385 was reached. During the study period, a total of 617 caesarean deliveries were done, of which 572 (92.7%) were emergencies. Foetal distress accounted for 395 (69.1%) of the emergency caesarean deliveries. No emergency caesarean delivery for foetal distress conformed to the 30-minute DDI and the mean (SD) DDI was 411 (291) minutes. The mean (SD) 5-minute and 10-minute Apgar scores were 8.4 (1.6) and 9.6 (1.3), respectively. There was a significant difference between the type of anaesthetic (general or neuraxial), with those receiving general anaesthesia having shorter anaesthetic start to cut time (p=0.0110). However, those delivered following neuraxial anaesthesia had better 5-minute (p=0.0002) and 10-minute (p=0.0175) Apgar scores. This study showed that a DDI of 30-minutes, was not achieved at CHBAH during the study period. Most babies diagnosed with foetal distress pre-delivery had 5-minute and 10-minute Apgar scores inconsistent with this diagnosis. This over-diagnosis of foetal distress in some cases could have led to delays in delivery of babies who had actual foetal distress and where a 30-minute DDI could have improved outcome.