Evaluation of decision to delivery interval and its effect on feto‐maternal outcomes in Category‐I emergency cesarean section deliveries in Phuentsholing General Hospital, 2020: A retrospective cross‐sectional study

Abstract

Background and Aims When there is an immediate threat to maternal or fetal life, it is recommended to deliver within 30 min of the decision to have favorable perinatal outcomes. However, there is no data on the delivery intervals for Category‐I emergency cesarean section in Bhutan. The study evaluated the decision to delivery interval (DDI) and its effect on perinatal and maternal outcomes in Category‐I emergency cesarean section. Methods A retrospective cross‐sectional study was conducted at the Phuentsholing General Hospital, Bhutan, from January 1, 2020 to December 31, 2020. Mothers who underwent Category‐I emergency cesarean section were included. The demographic variables, patient transfer time, anesthesia time, operation time, DDI, and maternal and perinatal outcomes were recorded in a standard proforma. The data were analyzed using SPSS version 23. Results Of 78 Category‐I emergency cesarean sections, only 23 (29.5%) of the cases were able to perform within 30 min of the DDI. The median (interquartile range) DDI was 37 (30–44) min. More time was taken by anesthetists to administer anesthesia (20 [15–8] min). Fetal distress (40, 51.3%) was the commonest indication. The longest DDI was around 39 min for prolonged labor, and the shortest was 26 min for failed instrumental delivery. Over half of the newborns delivered more than 30 min of DDI had low APGAR scores (25, 32.1%) at 1 min and meconium was present (23, 29.5%). Intensive care was required in 11 (14.1%), of which there was 1 (1.3%) neonatal death. Conclusion The Category‐I emergency cesarean sections performed within recommended DDI of 30 min were much less. The main delay was due to the longer time taken for the patient transfer and time taken by the anesthetists to administer anesthesia. Perinatal outcomes were favorable when the deliveries were conducted within 30 min of DDI.

Decision to delivery interval for emergency caesarean section in Eastern Uganda: A cross-sectional study

“…The world Health Organization (WHO) recommends a decision to delivery interval of 30 to 75 minutes depending on the context [ 11 ]. However, data from developing countries shows almost 30% of emergency caesarean sections were performed within 30minutes of the decision to deliver [ 12 ].…”

Decision to Delivery Time and Its Predictors Among Mothers Who Underwent Emergency Cesarean Delivery at Selected Hospitals of Northwest Ethiopia, 2023: Prospective Cohort Study [Letter]

“…2 The study conducted by Beker Ahmed Hussein et al used a prospective cohort study conducted in a Northwest Ethiopian hospital on women who underwent emergency cesarean delivery, the method used was appropriate, but it is necessary to pay attention to other variables that can influence the results to be achieved, namely demographic variables, patient transfer time, anesthesia time, operation time, decision to delivery interval, and maternal and perinatal outcomes were recorded in a standard proforma. 3 In this research, Beker Ahmed Hussein et al found that only 21.8% of women gave birth during the decision. Recommended delivery time (DDT) is under 30 minutes.…”

Effect of Decision-to-Delivery Time of Emergency Cesarean Section on Adverse Newborn Outcomes at East Gojjam Zone Public Hospital, Ethiopia, March 2023: Multicenter Prospective Observational Study Design

“…This study shows that a decision-to-delivery time interval above 30 minutes significantly affected the first-minute Apgar score, which is consistent with a study finding in Phuentsholing Hospital. 27 This is because they only analyze urgent cases, which might have a major impact on the Apgar score of the first minute, whereas this study covers all categories and uses a comparable urgent indication sample. On the other hand, contrary findings were reported from a study done in Ethiopia, Tanzania, Nigeria, and India.…”

“…This study shows that a decision-to-delivery time interval above 30 minutes significantly affected the first-minute Apgar score, which is consistent with a study finding in Phuentsholing Hospital. 27 This is because they only analyze…”

“…The sample size for this study was determined by using a single population proportion formula by considering the following assumptions; 29.5% proportion of decision to a delivery time of emergency cesarean section done, 27 95% level of confidence, and 5% margin of error.…”