Audit of decision to delivery interval in a low resource setting

Abstract

Introduction: Caesarean section (C-Section) is the delivery of an infant through the abdomen and it is one of the commonest surgeries performed in women of reproductive age. It is performed as an elective or emergency procedure. Emergency C-Section is carried out when an immediate decision is made to deliver the woman because if delivery is delayed, it may result in unwanted consequences which are maternal or perinatal morbidity and / or mortality. An elective C-Section is planned at a date convenient for both the patient and surgeon. The time interval from when the decision for operative delivery was made and when the delivery took place (decision-to-delivery interval) is important.

Aim and Objective of Clinical Audit: The aim of this clinical audit was to compare the decision to delivery interval with the standard set by professional associations of obstetrics, perinatology and obstetric anaesthesia which is thirty minutes.

Research Methodology: This was a retrospective clinical audit carried out at a Nigerian hospital over seven months. The sources of data were the Caesarean Section registers at the labour ward which included the Csection booking registrar, C-Section reception register and C-Section operating room register.

Results: Five hundred and twenty two emergencies C-Sections were studied. The mean decision-to-delivery interval was 218.03 minutes. Only 4.21% had emergency C-Section carried in less than 30 minutes after the decision to carry out a C-Section was made. 2.30% (12) had decision-to-delivery of less than 15 minutes. Most of the emergency C-Sections were carried out between 151-180 minutes 74(14.18%) after the decision of C-Section was taken.

Conclusion: There is a need to review and address the causes of delay in conducting a Caesarean section after a decision was made, to reduce maternal and perinatal morbidity and mortality.

Keywords: Caesarean Section, Decision, Delivery Time, Emergency