Decision Delivery Interval and Perinatal Outcome of Emergency Caesarean Sections at a Tertiary Institution in Nigeria

Chukwudi, Onyedikachi Edwin; Okonkwo, Chukwunwendu Anthony

doi:10.12669/pjms.305.5470

Cited by 15 publications

(18 citation statements)

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“…The results of this study demonstrated that the median DDI among patients with emergency cesarean delivery was 82 minutes, and only 3.5% has DDI ≤30 minutes. This is corresponded to previous studies that DDI was commonly longer than the 30-minute recommendation in real clinical practice, especially among developing countries [ 4 5 6 10 11 12 13 ]. However, the results also showed that 48% had DDI ≤75 minutes, which is the suggested time for non-life-threatening cesarean delivery [ 7 ].…”

Section: Discussionsupporting

confidence: 90%

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Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand

2018

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ObjectiveTo determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and associated factors.MethodsA total of 431 pregnant women who were indicated for emergency cesarean delivery were included. Clinical information and timing of process after decision until delivery and pregnancy outcomes were evaluated.ResultsMean age was 30 years, and 59.4% were nulliparous. Mean gestational age at delivery was 37.9 weeks. The decision was made during normal office hour in 33.2%. Median decision-to-operating room interval, decision-to-incision interval, and DDIs were 45, 70, and 82 minutes, respectively. Only 3.5% of patients had DDI ≤30 minutes, while 52.0% had DDI >75 minutes. During after office hours, every time interval was significantly shorter and 4.9% had DDI ≤30 minutes compared to 0.7% in normal office hours (P=0.001). Compared to other indications, time intervals were significantly shorter in those with non-reassuring fetal heart rate (FHR), and DDI ≤30 minutes was achieved in 18.8% vs. 0.8% (P<0.001). Shortest DDI was observed among those with non-reassuring FHR during after office hours. Neonatal outcomes were comparable between different DDIs.ConclusionOnly 3.5% of emergency cesarean delivery had a DDI ≤30 minutes (median 82 minutes). Significant shorter time intervals were observed in those with non-reassuring FHR during after office hours.

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Section: Discussionsupporting

confidence: 90%

“…In developed countries, achievement of 30-minute goal as recommended among cases diagnosed with fetal distress was approximately 40%–65% [ 5 6 9 10 ]. Meanwhile, in developing countries, the achievement has been reported to be only 0%–20% [ 11 12 13 ].…”

Section: Introductionmentioning

confidence: 99%

Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand

2018

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“…In this study decision of CS to anesthesia time longer than 15 minutes has a statistically significant relationship with prolonged DDI (AOR=4.74, 95% CI, 1.30–17.3). The finding was in line with studies from Uganda, 26 Tanzania, 21 Nigeria 7 , and Kenya 27 which revealed that gaps in the formulation and induction of anesthesia were statistically linked with prolongation of DDI. This might be explained by most of the time anesthetists were not available at the ward and were more active somewhere in the hospital when needed for operation.…”

Section: Discussionsupporting

confidence: 86%

“…On the contrary, our result is higher than research conducted in Tanzania which found that only 12.3% of emergency CS was achieved by a DDI of less than 30 minutes and the median of DDI was 60 minutes (IQR 40–120 minutes). 21 Our findings are also higher than those of 5.7% in Nigeria 7 and 5.2% in South Africa. 22 The variation may be explained due to the time gap between studies and socio-demographic differences.…”

Section: Discussioncontrasting

confidence: 56%

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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“…7,8 However, there is currently little evidence that a DDI of ≤30 minutes is the norm in emergency CS cases. 9 In particular, achieving a DDI of ≤30 minutes in cases of fetal intolerance to labour can be very challenging.…”

Section: Application To Patient Care -In the Current Study It Was Fomentioning

confidence: 99%

Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases: Repeated cross-sectional study from Oman

Tashfeen

Patel

Hamdi

et al. 2017

SQUMJ

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abstract:Objectives: In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI) of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS) cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. Methods: This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of <7 at five minutes, admission to the Special Care Baby Unit (SCBU) or a stillbirth. Results: In the initial cycle, a DDI of ≤30 minutes was achieved in 23.8% of 84 cases in comparison to 44.6% of 83 cases in the second cycle. In the third cycle, 60.8% of 79 women had a DDI of ≤30 minutes (P <0.001). No significant differences in perinatal outcomes for cases with a DDI of ≤30 minutes versus 31-60 minutes were observed; however, a DDI of >60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P <0.001 each). Factors causing DDI delays included obtaining consent for the CS procedure, a lack of operating theatre availability and moving patients to the operating theatre. Conclusion: The identification of factors causing DDI delays may provide opportunities to improve perinatal outcomes.

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Decision Delivery Interval and Perinatal Outcome of Emergency Caesarean Sections at a Tertiary Institution in Nigeria

Cited by 15 publications

References 0 publications

Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand

Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand

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

Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases: Repeated cross-sectional study from Oman

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