Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

Abstract

Background: In many low and medium human development index countries, the rate of maternal and neonatal morbidity and mortality is high. One factor which may influence this is the decision-to-delivery interval of emergency cesarean section. We aimed to investigate the maternal risk factors, indications and decision-to-delivery interval of emergency cesarean section in a large, under-resourced obstetric setting in Uganda. Methods: Records of 344 singleton pregnancies delivered at ≥24 weeks throughout June 2017 at Mulago National Referral Hospital were analysed using Cox proportional hazards models and multivariate logistic regression models. Results: An emergency cesarean section was performed every 104 min and the median decision-to-delivery interval was 5.5 h. Longer interval was associated with preeclampsia and premature rupture of membranes/oligohydramnios. Fetal distress was associated with a shorter interval (p < 0.001). There was no association between decision-to-delivery interval and adverse perinatal outcomes (p > 0.05). Mothers waited on average 6 h longer for deliveries between 00:00-08:00 compared to those between 12:00-20:00 (p < 0.01). The risk of perinatal death was higher in neonates where the decision to deliver was made between 20:00-02:00 compared to 08:00-12:00 (p < 0.01). Conclusion: In this setting, the average decision-to-delivery interval is longer than targets adopted in high development index countries. Decision-to-delivery interval varies diurnally, with decisions and deliveries made at night carrying a higher risk of adverse perinatal outcomes. This suggests a need for targeting the improvement of service provision overnight.

Predictors of Intrapartum Stillbirths among Women Delivering at Mulago Hospital, Kampala, Uganda

“…This could be due to the long-time interval between the decisions to conduct a cesarean section to the time it was performed. 27,28 In a busy labor ward like the one in Mulago hospital, there are shortages of doctors and anesthetists to perform the cesarean section. Sometimes the theatre space is inadequate when mothers who need to use the facility are too many.…”

Decision to delivery interval and associated factors for emergency cesarean section: a cross-sectional study

“…After calculating to the nearest minute, 30 min was used as a cutoff point to say recommended/delayed [ 4 , 16 ].…”

Stillbirth, neonatal and maternal mortality among caesarean births in Kenya and Uganda: a register-based prospective cohort study

“…With limited relevant data in the registries and no access to maternal death reviews, we could not ascertain the cause and time of death, associated complications, and time between decision to incision, limiting the ability to interpret these results. At Mulago National Referral Hospital in Uganda, shorter decision-to-CS delivery times were associated with fetal distress, while longer times were associated with pre-eclampsia and premature rupture of membranes (PROM), hinting towards increased attention and action to ensure fetal well-being 28. This could be because mothers who have pre-eclampsia or PROM may require stabilisation or antenatal corticosteroids prior to CS, unlike mothers who are diagnosed with non-reassuring fetal heart tones.…”