Decision delivery interval for emergency caesarean sections at the University Teaching Hospital, Lusaka

Abstract

BACKGROUND: To help improve the foetal outcome, many professional bodies recommend the decision delivery interval (DDI) for emergency caesarean sections should be within 30 minutes. However, studies have not been conclusive to state whether delivering within 30 minutes would significantly improve neonatal and maternal outcome. Though many reports show that the standard decision delivery interval may not be attainable, a workable approach would be to conduct a local study evaluating outcomes from emergency caesarean sections and recommending locally the optimal decision to delivery interval. OBJECTIVES: To determine the decision delivery interval for emergency caesarean sections at the University Teaching Hospital, Lusaka Zambia and the factors that contributed to the interval. DESIGN AND SETTING: An observational cross sectional study carried out at the University Teaching Hospital, Lusaka Zambia in January 2014. A total of 355 patients undergoing emergency caesarean sections were enrolled into the study. Methods: This was an observational cross sectional study conducted between January 2014 to March 2014 at the University Teaching Hospital, Lusaka Zambia. Women were recruited from the labour ward after a decision for an emergency caesarean section was made by the doctors on call. Information on decision delivery interval by indication is presented in tabular form and histogram. The timings of various steps and processed decision delivery interval was tabulated and shown as a histogram. Fetal outcome (whether stillbirth, poor Apgar score (AS<7) and admission to neonatal intensive unit) tabulated against mean DDI for each indication. RESULTS: A total of 355 women scheduled for an emergency caesarean section were enrolled. The mean DDI was 304 min and only 1 was delivered within 30 minutes of decision; the majority of the babies (n=341, 96.1%) were delivered beyond 60 minutes and 67 (18.9%) beyond 8 hours. The longest delay was attributed to decision to trolley arriving in labour ward (when theatre was free) and this accounted for a mean of 252 minutes (86.2% of DDI). Cord prolapse had the shortest mean DDI (99.9mins). The worst perinatal outcome was in those with pre-eclampsia (33.1%) and cord prolapse (28.6%) CONCLUSION: The DDI for emergency caesarean sections at UTH was found to be 304.3 minutes. Few emergency caesarean sections (n=85, 23.9%) are done within 120 minutes (2 hours). Only 0.3% of the cases were done within 30 min and 3.9% within 1 hour. Most of the DDI for emergency sections was accounted for by lack of theatre availability. Prolonged delay from decision to arriving in theatre attributed to long waiting list for surgery. Although the 30 minute DDI should remain the gold standard, achieving it may not be feasible at UTH in the current situation