Abstract
BackgroundDecision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania.MethodsThis was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant.ResultsA total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40–120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5thminute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63–1.64) and hospital stay (OR: 1.02; 95% 0.63–1.64).ConclusionsContrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the urgency of caesarean section in order to prevent maternal and neonatal morbidity and mortality.
Highlights
Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby
Emergency c/sections were conducted for women with 2 or more previous scars who were scheduled for elective c/sections but started labouring while in the ward
There was no difference in age, residence, marital status and occupation distribution between those operated within 75 min or those who were operated beyond 75 min (Table 1)
Summary
Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. According to the American College of Obstetrics and Gynecology (ACOG)& American Academy of Pediatrics (AAP) recommendation, the emergency caesarean section should be performed in a time phase of 30 min from the decision to conduct it [2]. Decision to Delivery interval (DDI) is the time interval from decision made to perform an emergency caesarean section till the delivery of the baby [1]. If the DDI is pushed over 75 min a significant maternal and neonatal morbidities and mortalities are likely to occur [4]. A recent study in Nigeria by Bello and colleagues [4] reported 5.1% perinatal mortality that was statistically significant with increase in DDI beyond 75 min. Other composite outcomes that have been attributed to increased DDI by previous authors include 1% of both fresh and macerated still births,5%
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