Decision-to-Delivery Interval and Obstetric Outcomes of Emergency Caesarean Sections in a Nigerian Teaching Hospital
DOI:
https://doi.org/10.30442/ahr.0903-05-207Abstract
Background: Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS).
Objective: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital.
Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25.
Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients’ relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p<0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI > 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049).
Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foeto-maternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutes as a benchmark.
References
National Health for Health and Care Excellence (NICE). NICE guideline 192: Caesarean birth. Updated 21 June 2023. Available from: https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805. Accessed 5 August 2023.
Kitaw TM, Limenh SK, Chekole FA, Getie SA, Gemeda BN, Engda AS. Decision to delivery interval and associated factors for emergency caesarean section: a cross-sectional study. BMC Pregnancy Childbirth 2021;21(1):1-7. https://doi.org/10.1186/s12884-021-03706-8
Temesgen MM, Gebregzi AH, Kasahun HG, Ahmed SA, Woldegerima YB. 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. BMC pregnancy and childbirth. 2020;20(1):1-1. https://doi.org/10.1186/s12884-020-2828-z
Soltanifar S, Russell R. The National Institute for health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. Int J Obstet Anesth. 2012;21(3):264–72. https://doi.org/10.1016/j.ijoa.2012.03.004
Obstetricians ACo, Safety GCoP. Improvement Q: ACOG Committee Opinion No. 487: preparing for clinical emergencies in obstetrics and gynecology. Obstet Gynecol. 2011;117(4):1032–4. https://doi.org/10.1097/AOG.0b013e31821922eb.
Bello FA, Tsele TA, Oluwasola TO. Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital. Int J Gynecol Obstet. 2015;130(3):279-83. https://doi.org/10.1016/j.ijgo.2015.03.036
Thomas J, Paranjohy S, "Royal College of Obstetricians and gynaecologists: clinical effectiveness support unit," The National Sentinel Caesarean Section Audit Report, RCOG Press, London, UK, 2001.
Yakasai IA, Ahmed ZD, Okonofua FE. Decision delivery interval in emergency cesarean section in tertiary centre in Northern Nigeria. Orient J Sci Res. 2012;1:16–23.
Fyneface-Ogan S, Mato CN, Enyindah CE. Decision to delivery Interval: Reasons for delay. J Med Biomedical Res. 2009;8(1):72–78.
Onah HE, Ibeziako N, Umezulike AC, Effetie ER, Ogbuokiri CM. Decision-delivery interval and perinatal outcome in emergency caesarean sections. J Obstet Gynaecol. 2005;25:342–6. https://doi.org/10.1080/01443610500119671
Chukwudi OE, Okonkwo CA. Decision - delivery interval and perinatal outcome of emergency caesarean sections at a tertiary institution. Pak J Med Sci. 2014;30(5):946-50. https://doi.org/10.12669/pjms.305.5470
Gupta S, Naithani U, Madhanmohan C, Singh A, Reddy P, Gupta A. Evaluation of decision-to-delivery interval in emergency cesarean section: a 1-year prospective audit in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2017;33(1):64. https://doi.org/10.4103/0970-9185.202197
Orji EO, Ojofeitimi EO, Esimai AO, Adejuyigbe E, Adeyemi AB, Owolabi OO. Assessment of delays in receiving delivery care at a tertiary healthcare delivery centre in Nigeria. J Obstet Gynaecol. 2006;26(7):643-4. https://doi.org/https://doi.org/10.1080/01443610600903628
Olusanya O, Okpere EE, Ezimokhai M. Scoring system for social class. West Afr J Med 1995;4:4
Onwudiegwu U, Makinde ON, Ezechi OC, Adeyemi A. Decision-caesarean delivery interval in a Nigerian university hospital: implications for maternal morbidity and mortality. J Obstet Gynecol 1999;19(1):30-33.
Owonikoko KM, Olabinjo AO, Bello-Ajao HT, Adeniran MA, Ajibola TA. Determinants of Decision to Delivery Interval (DDI) in Emergency Caesarean Sections in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Nigeria. Clinics Mother Child Health 2018;15:294. https://doi.org/10.4172/2090-7214.1000294.
Cavallaro FL, Marchant TJ. Responsiveness of emergency obstetric care systems in low‐and middle‐income countries: A critical review of the “third delay”. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(5):496-507. https://doi.org/10.1111/aogs.12071
Obembe T, Fonn S. Affording unavoidable emergency surgical care-The lived experiences and payment coping strategies of households in Ibadan metropolis, Southwestern Nigeria. PLoS ONE. 2020;15(5):e0232882. https://doi.org/10.1371/journal.pone.0232882
Adesunkanmi AO, Ubom AE, Olasehinde O, Fasubaa OB, Ijarotimi OA, Adesunkanmi AR, et al. Impact of COVID-19 on the cost of surgical and obstetric care: experience from a Nigerian teaching hospital and a review of the Nigerian situation. Pan Afr Med J. 2020;37(Suppl 1):15. https://doi.org/10.11604/pamj.supp.2020.37.15.25935.
Wong TCT, Lau CQH, Tan EL, Kanagaligam D. Decision-to-delivery intervals and total duration of surgery for caesarean sections in a tertiary general hospital. Singap Med J 2017;58(6):332. https://doi.org/10.11622%2Fsmedj.2016098
Ijarotimi OA, Ubom AE, Olofinbiyi BA, Kuye‐Kuku T, Orji EO, Ikimalo JI. COVID‐19 and obstetric practice: A critical review of the Nigerian situation. Int J Gynecol Obstet 2020;151:17-22. https://doi.org/10.1002/ijgo.13325
World Bank. Nurses and Midwives (per 1000 People). 2013. Available online: http://dataworldbankorg/indicator/SHMEDNUMWP3?end=2013&locations=NG&start=2009&year_low_desc=false
Akinlusi FM, Rabiu KA, Durojaiye IA, Adewunmi AA, Otun AA, Oshodi YA. Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria. BMC Pregnancy Childbirth 2018;18:1-9. https://doi.org/10.1186/s12884-017-1643-7
Shiru MM, Abdul IF, Ubom AE, Olabinjo AO, Oriji PC, Fiebai PO. Blood reservation and utilisation practice for Caesarean section in Ilorin, Nigeria. Trop Doct 2023;53:20-25. https://doi.org/10.1177/00494755221123191
Kaoje AU, Musa AU, Okafoagu NC, Ibrahim H, Raji MO, Ango UM. Public beliefs, attitude and practice of voluntary non-remunerated blood donation among residents in Sokoto, Nigeria. Central Afri J Public Health. 2017;3(6):90-6. https://doi.org/10.11648/j.cajph.20170306.11.
Durosinmi MA, Mabayoje VO, Akinola NO, Adegunloye AB, Alabi AO. A retrospective study of the prevalence of antibody to HIV in blood donors at Ile-Ife, Nigeria. Niger Postgrad Med J 2003;10(4):220-3.
Hirani BS, Mchome BL, Mazugun NS, Mahande MJ. The decision delivery interval in emergency caesarean section and its associated maternal and fetal outcomes at a referral hospital in northern Tanzania: a cross-sectional study. BMC Pregnancy and Childbirth 2017;17:411. https://doi.org/10.1186/s12884-017-1608-x
Radhakrishnan G, Yadav G, Vaid NB, Ali H. Factors affecting "decision to delivery interval" in emergency caesarean sections in a tertiary care hospital: a cross-sectional observational study. Int J Reprod Contracept Obstet Gynecol 2013;2(4):651-656. https://doi.org/10.5455/2320-1770.ijrcog20131231.
Cronjé L, Andisha E. Evaluating the decision-to-delivery interval in category 1 emergency caesarean sections at a tertiary referral hospital. S Afr J Obstet Gynaecol. 2019;25(3):95-9.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Annals of Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.
