Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital

Abstract

Background In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members. Objective To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor’s decision were also explored. Methods Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1–3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression. Results Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13–2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32–0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001). Conclusions In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.

Impact of 'decision-to-delivery' interval on maternal and perinatal outcomes: A retrospective study of emergency caesarean section from 2017 to 2021 at a secondary health facility in Nigeria

“…This study also showed that DDI was associated with adverse perinatal (increased SCBU admissions and foetal and neonatal deaths). Similar studies conducted in Nigeria [6.7], Somaliland [22] and Uganda [23], also showed increased deaths due to delayed DDI. The poor perinatal outcomes in this study are not unexpected considering the fact that factors such as prolonged labour due to delayed DDI may lead to perinatal asphyxia and increased risk for neonatal sepsis, with subsequent negative impact on the health of the foetus and newborn after birth.…”