Evaluation of decision to delivery time interval and its effect on feto-maternal outcomes and associated factors in category-1 emergency caesarean section deliveries: prospective cohort study

Temesgen, Mamaru Mollalign; Gebregzi, Amare Hailekirose; Kasahun, Habtamu Getinet; Ahmed, Seid Adem; Berhe, Yophtahe Woldegerima

doi:10.1186/s12884-020-2828-z

Cited by 31 publications

(58 citation statements)

References 27 publications

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“…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 ].…”

Section: Discussionsupporting

confidence: 93%

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

Kitaw

limenh

Getie

et al. 2021

BMC Pregnancy Childbirth

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Background Emergency cesarean section is a commonly performed surgical procedure in pregnant women with life-threatening conditions of the mother and/or fetus. According to the Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists, decision to delivery interval for emergency cesarean sections should be within 30 min. It is an indicator of quality of care in maternity service, and if prolonged, it constitutes a third-degree delay. This study aimed to assess the decision to delivery interval and associated factors for emergency cesarean section in Bahir Dar City Public Hospitals, Ethiopia. Method An institution-based cross-sectional study was conducted at Bahir Dar City Public Hospitals from February to May 2020. Study participants were selected using a systematic random sampling technique. A combination of observations and interviews was used to collect the data. Data entry and analysis were performed using Epi-data version 3.1 and SPSS version 25, respectively. Statistical significance was set at p < 0.05. Result Decision-to-delivery interval below 30 min was observed in 20.3% [95% CI = 15.90–24.70%] of emergency cesarean section. The results showed that referral status [AOR = 2.5, 95% CI = 1.26–5.00], time of day of emergency cesarean section [AOR = 2.5, 95%CI = 1.26–4.92], status of surgeons [AOR = 2.95, 95%CI = 1.30–6.70], type of anesthesia [AOR = 4, 95% CI = 1.60–10.00] and transfer time [AOR = 5.26, 95% CI = 2.65–10.46] were factors significantly associated with the decision to delivery interval. Conclusion Decision-to-delivery intervals were not achieved within the recommended time interval. Therefore, to address institutional delays in emergency cesarean section, providers and facilities should be better prepared in advance and ready for rapid emergency action.

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Section: Discussionsupporting

confidence: 93%

“…This study found that 20.3% of EmCS were performed within the recommended time interval of DDI. This is in line with a study conducted in Gondar, Ethiopia, which was 19.3% [ 19 ]. This may be due to the similarity in the accessibility of logistics in hospitals and the practice and experience of professionals.…”

Section: Discussionsupporting

confidence: 92%

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

Kitaw

limenh

Getie

et al. 2021

BMC Pregnancy Childbirth

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“…This outcome was in parallel with a study done at University of Gondar specialized hospital which concluded that 19.6% of clients who undergoes emergency CS were born with the recommended DDI of 30 minutes. 19 But the result was lower than a study conducted in Oman showing that in 23.8% of emergency CS deliveries, a DDI less than 30 minutes was achieved. 20 …”

Section: Discussionmentioning

confidence: 66%

Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020

Ayele¹,

Kassa²,

Mihretie³

et al. 2021

IJWH

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Purpose Although its fetal outcomes and practicality are unclear time interval between decision-to-delivery ≤30 minutes in emergency caesarean section (CS) is the internationally accepted standard of practice. This study aimed to determine whether a decision to delivery interval (DDI) of approximately 30 minutes was achieved in daily practice, its fetal outcomes, and associated factors among emergency caesarean section delivery at South Gondar Zone Hospitals, Northwest Ethiopia. Patients and Methods Retrospective cross-sectional study was carried out from August 1–30/2020 among emergency caesarean sections. Information was collected from the birth register book and individual files of standardized facility booking forms. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. A bivariable and multivariable logistic regression analysis was conducted and a significant association was recorded at p<0.05. Results Only 17.5% of parturients attained a decision-to-delivery interval ≤30 minutes. The average median of decision to delivery interval was 54 minutes with interquartile range (IQR) of 48–80 minutes. Time taken to collect material with Adjusted odds ratio (AOR=10.3, 95% CI 5.87–45.7), time of decision (AOR=0.32, 95% CI, 0.15–0.67), and time taken from decision to delivery to delivery of anesthesia (AOR=4.74, 95% CI, 1.30–17.3) were the predictors of prolonged delivery time interval. Significant fetal adverse outcomes were not observed in a decision to delivery interval higher than 30 minutes. Conclusion In most cases, delivery was not completed within the prescribed ≤30-minutes interval, particularly in developing countries with infrastructural challenges, however, fetal outcomes were not directly correlated. Despite lack of substantial linkage between the delivery time declaration and fetal events, an unreasonable gap from the decision-making to birth of the child is not appropriate and should be discouraged.

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“…Conversely the decision to delivery interval was longer during spinal anesthesia but the low APGAR score and other worse perinatal outcomes were more associated with general anesthesia [ [21] , [22] , [23] ]∗∗,∗∗,∗∗. There is study showing longer time of decision to delivery interval than the recommended time (30 min) for category 1-cesarean section and this was more associated with time taken to collect surgical materials), time spent between decision and arrival to the operation theater and time taken from arrival at the operation theater to the immediate start of skin incision [ 24 ]∗∗. Neonatal morbidity have been compared for general and spinal anesthesia during emergency cesarean section and the General anesthesia was more associated with low 1-min APGAR score, longer time of hospitalization, higher incidence of morbidity, and lower umbilical blood pH [ 25 ]∗.…”

Section: Discussionmentioning

confidence: 99%

Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting

Agegnehu

Gebregzi

Endalew

2020

International Journal of Surgery Open

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Background Globally obstetric anesthesia is being done under spinal and epidural than general anesthesia (GA) for most caesarean sections (CSs). This is because GA is associated with failed endotracheal intubation and aspiration of gastric contents. Eventhough general anesthesia is the fastest method for anesthetizing a category 1 cesarean section, it is associated with increased maternal mortality and morbidity. Spinal anesthesia is the preferred regional technique for cesarean section but failure sometimes occurs. To minimize the time factor of spinal anesthesia as well as to avoid the side effects of general anesthesia ‘rapid sequence spinal ‘(RSS) has developed as a novel approach in cases of category one cesarean sections. Methods The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions. Discussion Neuraxial anesthetic techniques have several advantages which include low risk of aspiration and failed intubation, avoidance of central nervous system (CNS) and respiratory depressant drugs, the ability to maintain a wakeful state of mother enjoying the experience of delivery of baby and also lower incidence of blood loss. ‘Rapid sequence spinal’ described to minimize anesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anesthesia if there are delays or problems. To do rapid sequence spinal anesthesia safely and timely, cooperative work is mandatory with good team relation for those simultaneous and necessary tasks. Conclusion The choice of anesthetic in Cesarean section has long been recognized as one of prime importance, because there are two lives to safeguard instead of one. A balance must be struck between the anesthetic dictated by the general condition of the mother and that suited to the needs of the fetal respiratory system.

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Evaluation of decision to delivery time interval and its effect on feto-maternal outcomes and associated factors in category-1 emergency caesarean section deliveries: prospective cohort study

Cited by 31 publications

References 27 publications

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

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

Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020

Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting

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