Decision-Delivery Interval and Perinatal Outcome in Emergency Caesarean Section:A University Teaching Hospital...

The recommended time for decision-delivery-interval (DDI) in emergency caesarean section is 30 minutes, though this is rarely achieved in practice. Good perinatal outcome has been achieved with DDI up to 240 minutes.

To evaluate the average time it took to deliver the baby by emergency caesarean section after the decision had been taken and determine the effect on perinatal outcomes when this time exceeded 240 minutes.

This prospective observational study was undertaken in Lagos State University Teaching Hospital between January and May 2009. Data was collected from the case notes of the mothers and the neonates admitted to Special care baby unit(SBCU) using a proforma. The main outcome measures were DDI, 5-minute Apgar score, newborn admission to special care baby unit(SCBU) and perinatal outcome.Odds ratio (OR) with 95% Confidence interval (CI) for factors affecting DDI and perianatal outcomes in different DDI categories were calculated by logistic regression and multivariate analysis with p<0.05 considered statistically significant. All data were analyzed with SPSS17.0 statistical software.

A total of 359 emergency caesarean sections were performed within the study period. None was done within the recommended 30-minute period. The average DDI was 401 + 315 min, with a range of 45-1393 min.Univariate analysis of factors affecting DDl showed that DDI >240 minutes was significantly more likely in urgent as opposed to crash surgery (OR 4.52[95% CI: 2.78-7.35]), in spinal as opposed to general anaesthesia(OR 2.16[95% CI: 1.40-3.30]) and in junior as opposed to senior surgeon (OR 2.52[95% CI: 1.64-3.89]). Concerning foetal out-comes, DDI> 240 minutes was associated with significantly higher incidence of low Apgar scores at 5-minutes(OR 2.09 [95%CI: 1.33-3.29]) and admission to SCBU(OR 1.66[95% CI: 1.07-2.57]) but did not significantly affect perinatal deaths(OR 1.01[ 95%CI: 0.51.2.01]). Multiple logistic regression analysis showed that DDI >240 minutes was significantly influenced by degree of urgency of the surgery (a OR 3.76[95%CI: 2.17-6.53], p=0.005) and rank of surgeon(aOR 0.55[95%CI: 0.48-1.34],p=0.017) but not by type of anaesthesia(a OR 0.80[95% CI: 0.48-1.34],p=0.397). Multiple logistic regression analysis of perinatal outcomes showed that DDI>240 minutes was significantly associated with 5-minute Apgar score (aOR 0.29[95%CI: 0.11-0.79],p=0.015) and admission into SCBU(aOR 2.59[95%CI: 1.01-6.63],p=0.048) but not with perinatal deaths (aOR 1.54[95%CI: 0.66-3.80],p=0.302).

The average DDI in this study was 401 + 315mins. Whilst perinatal deaths were not significantly affected when the time exceeded 240 minutes, 5-minute Apgar scores and SCBU admissions were significantly higher. The 30-minute recommendation may remain the target if these outcomes are to be improved.