Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study.
Hughes, Noemi J
Patient, Charlotte J
BMC pregnancy and childbirth
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Hughes, N. J., Namagembe, I., Nakimuli, A., Sekikubo, M., Moffett, A., Patient, C. J., & Aiken, C. (2020). Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study.. BMC pregnancy and childbirth, 20 (1), 324. https://doi.org/10.1186/s12884-020-03010-x
Background : In many low and medium human development index countries, the rate of maternal and neonatal morbidity and mortality is high. One factor which may influence this is the decision-to-delivery interval of emergency cesarean section. We aimed to investigate the maternal risk factors, indications and decision-to-delivery interval of emergency cesarean section in a large, under-resourced obstetric setting in Uganda. Methods: Records of 344 singleton pregnancies delivered at ≥24 weeks throughout June 2017 at Mulago National Referral Hospital were analysed using Cox proportional hazards models and multivariate logistic regression models. Results : An emergency cesarean section was performed every 104 minutes and the median decision-to-delivery interval was 5.5 hours. Longer interval was associated with preeclampsia and premature rupture of membranes/oligohydramnios. Fetal distress was associated with a shorter interval (p<0.001). There was no association between decision-to-delivery interval and adverse perinatal outcomes (p>0.05). Mothers waited on average 6 hours longer for deliveries between 00:00-08:00 compared to those between 12:00-20:00 (p<0.01). The risk of perinatal death was higher in neonates where the decision to deliver was made between 20:00-02:00 compared to 08:00-12:00 (p<0.01). Conclusion : In this setting, the average decision-to-delivery interval is longer than targets adopted in high development index countries. Decision-to-delivery interval varies diurnally, with decisions and deliveries made at night carrying a higher risk of adverse perinatal outcomes. This suggests a need for targeting the improvement of service provision overnight.
Humans, Fetal Distress, Emergencies, Pregnancy Outcome, Cesarean Section, Retrospective Studies, Cohort Studies, Decision Making, Pregnancy, Parturition, Time Factors, Adult, Infant, Newborn, Uganda, Female, Young Adult, Perinatal Death
CA is supported by an Isaac Newton Trust[12.21(a)]/Wellcome Trust ISSF [105602/Z/14/Z]/ University of Cambridge Joint Research Grant. This work was supported by NURTURE fellowship to AN, grant number D43TW010132 and the DELTAS Africa Initiative (grant# 107743/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (grant #107743/Z/15/Z) and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. NH was supported by a financial contribution from the Addenbrooke’s Abroad Grant Scheme, provided by Addenbrooke’s Hospital Charitable Trust.
WELLCOME TRUST (107743/Z/15/Z)
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External DOI: https://doi.org/10.1186/s12884-020-03010-x
This record's URL: https://www.repository.cam.ac.uk/handle/1810/305375
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