Decision to delivery interval and predictors for delayed decision to delivery interval among women delivering by emergency caesarean section at a tertiary hospital, Southwestern Uganda: a prospective cohort study.
Julius Businge, Stuart Turanzomwe, Mathiang Agany Akol, Caxton Kakama, Rogers Kajabwangu, Michael Kanyesigye, Henry Mark Lugobe, Musa Kayondo, Joseph Ngonzi, Onesmus Byamukama
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Abstract
Background: Emergency caesarean section (EMCS) is a life-saving procedure carried out with urgency appropriate to the risk posed to the safety of baby and/or the mother. A decision to delivery interval (DDI) is the time from making the decision for cesarean section to delivery of the neonate. Delayed DDI can result in adverse obstetric outcomes and is thus an indicator of poor quality obstetric care. This study aimed to determine the decision to delivery interval and predictors for delayed decision to delivery interval among women delivering by emergency caesarean section at Mbarara Regional Referral Hospital in South western Uganda.
Methods: We conducted a prospective cohort study on women delivering by emergency caesarean section. Women with category I or II indications as per the World Health Organization (WHO) guidelines were consecutively enrolled from December 2023 to March 2024. Delayed DDI was defined as DDI interval > 75 min. We performed a modified Poisson regression analysis to determine predictors for delayed DDI.
Results: A total of 504 participants were enrolled. The mean age of the respondents was 26.4 (± 5.25) years. Majority 453 (89.9%) were married, 282 (56.0%) unemployed and 271 (53.8%) had been referred in. Overall median decision to delivery interval was 167.5 min. The proportion of women with delayed DDI was 77.2% (95% CI: 73.3-80.8). Predictors for delayed DDI were prior caesarean delivery (aRR 1.15, 95%CI:1.02-1.28), need for stabilisation before surgery (aRR 1.15, 95%CI: 1.01-1.39), need to buy sundries (aRR 1.76, 95%CI: 1.20-2.57), Lack of prior communication to the theatre team (aRR 1.14, 95%CI: 1.03-1.25), unavailability of theatre operating room (aRR 1.23, 95%CI: 1.14-1.32), unavailability of sterile linen (aRR 1.18, 95%CI: 1.03-1.35) and unavailability of anaesthesia provider (aRR 1.40, 95%CI: 1.26-1.55).
Conclusion: Majority of the women at MRRH experience delayed DDI and it takes about 3 h to have an EMCS. Women with a prior caesarean section, those who require stabilization before surgery, the need to buy sundries, the lack of operating room, and lack of prior communication to the theatre team, sterile linen and anaesthesia provider are predictors for delayed DDI. We recommend mobilization of resources to address these health system gaps.
期刊介绍：
BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
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