Predictors of prolonged decision-to-delivery interval in emergency caesarean section in Northern Uganda: a historical cohort study.

IF 2.2 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Pub Date : 2026-12-01 Epub Date: 2026-06-11 DOI:10.1080/01443615.2026.2685034

Henry Ochola, Ronnie Omoro, Paul Buga, Emintone Ayella Odong, Oscar Ocaya, Rogers Kajabwangu, Nelly Atim, Harriet Akello, Judith Praiselyn Acayo, Doris Ekwem, Jovia Namuddu, Derrick Mukurasi, Enock Lukyamuzi, Hudson Onen, Maurine Lenia, Martha Gimono, Emily Webb, Oona Campbell, Ronald Komata, Jerom Okot, Emmanuel Ochola, Sande Ojara

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引用次数: 0

Abstract

Background: Delays in decision-to-delivery interval (DDI) during emergency caesarean section (CS) may increase the risk of adverse maternal and neonatal outcomes. Evidence on health-system and provider-related factors influencing DDI in low-resource settings remains limited. We examined whether surgeon cadre, operating theatre location, and the presence of intern healthcare professionals were associated with prolonged DDI in a tertiary hospital in Northern Uganda.

Methods: We conducted a historical cohort study at St. Mary's Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. Effect modification by emergency CS indication was assessed.

Results: Of the 760 participants enrolled (median DDI was 51 minutes [IQR: 36-67]), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to fully-licensed doctors (adjusted odds ratio [aOR]: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (aOR: 0.89; 95% CI: 0.61-1.28) and (aOR: 0.71; 95% CI: 0.50-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication.

Conclusions: Emergency CS performed by junior doctors was associated with increased odds of prolonged DDI compared with procedures performed by fully-licensed doctors. These findings highlight the importance of strengthening supervision, mentorship and emergency obstetric training for junior doctors in resource-limited settings. Operating theatre location and the presence of intern healthcare professionals were not significantly associated with prolonged DDI.

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乌干达北部紧急剖宫产中决策至分娩间隔延长的预测因素：一项历史队列研究

背景：紧急剖宫产（CS）中决策至分娩间隔（DDI）的延迟可能会增加孕产妇和新生儿不良结局的风险。在低资源环境中，卫生系统和提供者相关因素影响DDI的证据仍然有限。我们研究了在乌干达北部的一家三级医院，外科医生干部、手术室位置和实习医疗保健专业人员的存在是否与延长DDI有关。方法：我们在乌干达北部三级医院圣玛丽医院进行了一项历史队列研究，涉及急诊CS的妇女（2022年9月6日至2024年6月1日）。采用Logistic回归检验延长DDI（≥60分钟）与外科医生骨干、手术室位置和实习生存在之间的关系，并对混杂因素进行调整。评估紧急CS指征改良效果。结果：在760名参与者中（平均DDI为51分钟[IQR: 36-67]）， 36.0%的参与者延长了DDI。初级医生实施的急诊CS延长DDI的几率是正式执业医生的两倍（调整优势比[aOR]: 2.07; 95% CI: 1.38-3.10）。手术室位置和实习生的存在分别与DDI延长无关（aOR: 0.89; 95% CI: 0.61-1.28）和（aOR: 0.71; 95% CI: 0.50-1.02）。没有统计学上显著的证据表明这些关联因CS适应症而异。结论：与有执照的医生相比，初级医生进行的急诊CS与延长DDI的几率增加有关。这些发现突出了在资源有限的环境中加强对初级医生的监督、指导和急诊产科培训的重要性。手术室位置和实习医疗保健专业人员的存在与延长DDI没有显著相关。

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来源期刊

Journal of Obstetrics and Gynaecology 医学-妇产科学

CiteScore

2.40

自引率

7.70%

发文量

398

审稿时长

6 months

期刊介绍： Journal of Obstetrics and Gynaecology represents an established forum for the entire field of obstetrics and gynaecology, publishing a broad range of original, peer-reviewed papers, from scientific and clinical research to reviews relevant to practice. It also includes occasional supplements on clinical symposia. The journal is read widely by trainees in our specialty and we acknowledge a major role in education in Obstetrics and Gynaecology. Past and present editors have recognized the difficulties that junior doctors encounter in achieving their first publications and spend time advising authors during their initial attempts at submission. The journal continues to attract a world-wide readership thanks to the emphasis on practical applicability and its excellent record of drawing on an international base of authors.