Decision to incision interval for emergency caesarean section and postoperative outcomes in a resource limited rural Kenyan public hospital

Abstract

Background: Standard guidelines recommend that delivery by caesarean section should be ideally initiated within 30 minutes of the decision to operate to avoid maternal and foetal compromise in labour. The purpose of this study was to investigate the extent to which these guidelines can be achieved in limited resource hospital.Methods: Authors used a secondary data from 330 patient's files of women who had a caesarean section from December 2013 retrospectively to January 2012.Results: The main indications for caesarean section was obstructed labour (18.5%) for mothers and foetal distress (6.4%). Though 74% of the mothers gave consent to be operated within the 30-minute guideline, only 3% were prepared for operation within this period. Only 24% of the caesarean sections were conducted within one hour after the decision was made for the operation. About 38% of the women, and 30% of the babies developed complications after the caesarean section. Haemorrhage was the leading complication in mothers while the main complication for babies was babies with an Apgar score of 5 and below.Conclusions: The 30- minute recommended guideline for caesarean section was not achieved, and there was evidence of adverse post-operative outcome as a result of not meeting the global standards.

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

“…In this study, women who were transferred to the operating room before 15 min showed a statistically significant association with recommended DDI than women who were transferred after 15 min. This finding was consistent with study findings in India, Nigeria, Kenya, and Gondar, Ethiopia [ 9 , 10 , 19 , 21 , 22 ].…”

“…This discrepancy may be due to a lack of funds for surgical materials and the absence of post-service billing in the study area of Nigeria, as patients’ relatives usually pay surgical fees before the operation is performed. The findings of this research were also greater than those of studies conducted in Tanzania and Kenya, which were 12 and 3%, respectively [ 8 , 10 ]. The difference may be that studies in both countries were conducted before the initiation of saving lives through the SaLTS) initiative in East Africa, which was started in late 2016.…”

“…The sample size was calculated using the single population proportion formula with the assumption of 95% CI, and 12% of women who had recommended decision to delivery interval in Tanzania [ 10 ]. A 10% non-response rate and 3.7% margin of error were used to obtain a sample size of 327.…”

Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data

“…Contrary to our findings, elsewhere in Nepal, a country with similar economic conditions as Tanzania but considerably lower gross domestic product per capita compared to Kenya, a significant reduction of neonatal mortalities, including CD-related, has been found [57]. To highlight the difference, for instance, a comparison can be made between two parallel studies [58,59] from matching district-level hospitals with similar year of data collection and numbers of cesarean deliveries (330 vs 327) in Kenya [58] and Nepal [59]. The majority (43%) of patients in Nepal hospitals were of disadvantaged lower caste comparable to patients in the refugees`area in northeastern Kenya.…”

Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

“…To save lives when obstetric and newborn complications arise, women should receive definitive treatment within 30 min or less. 24 25 The standard approach if complications arise during childbirth in primary care settings is to refer women to hospitals. However, transporting acutely ill patients is challenging even in high-income settings with fully equipped advanced life support ambulances, reliable communication and good roads.…”