Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study

Abstract

Background
Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to
improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD.
Methods
A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was
conducted. The time–motion documentation of events from decision to delivery was documented; the outcome measures were
perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was
performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant.
Results
The overall mean DDI was 233.99±132.61 minutes (range 44–725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25
minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05
minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes;
P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal
mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health
and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1
CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta
praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic
regression showed no statistical correlation between the DDI and neonatal outcomes.
Conclusion
Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI
greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors
should be addressed to reduce the DDI.