A prospective observational study on decision to delivery interval and perinatal outcome in emergency caesarean section in tertiary care hospital

Abstract

Background: In a life-threatening context, the American College of Obstetrics and Gynecology and the Royal College of Obstetrics and Gynaecology recommended a maximum delay of 30 min between the decision to perform an emergency caesarean delivery and the infant’s birth. This limit is usually not met in a rural tertiary centre in a developing country. If this delay in decision to delivery interval (DDI) had any effect on perinatal outcome was studied in this study. Objectives: 1) To identify the factors causing delay in decision to delivery interval for emergency caesarean section. 2) To assess the effect of decision delivery interval on perinatal outcome. Materials and Methods: This is a prospective cross-sectional observational study conducted in R.L. Jallapa Hospital and Research centre, Department of Obstetrics and Gynecology, attached to Sri devaraj urs Medical College, Kolar during January 2017 to May 2018.A total of 200 pregnant women posted for emergency caesarean delivery were included during the study period. Results: Among 200 participants, 39 (19.5%) belonged to category 1, 82(41%) to category 2 and 79 (39.5%) to category 3. The mean DDI in the study participants was 79.28 ± 28.66 mins. Mean DDI for category 1, 2, and 3 caesarean deliveries were 47.23 ± 13.35 mins, 64.83 ± 11.83 mins and 110.1 ± 13 mins respectively. Among study cases, 72, 5% babies were shifted to mother’s side after caesarean delivery, 27% babies were shifted to NICU and 0.5 % were stillborn. Conclusion: Neonatal outcomes did not differ significantly in between those caesarean deliveries with DDI≤30 mins and those with DDI>30 mins. It is difficult to achieve 30 minute goal in every emergency caesarean delivery and it is also not an indispensible measure to prevent maternal or neonatal morbidities. But DDI of ≤30 mins is not unachievable in case of urgent indications like cord prolapse. Hence it is necessary for each emergency obstetric unit, to effectively triage emergency caesarean deliveries and develop the capability of commencing such cases as fast as possible.