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Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

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Hughes, Noemi J. 
Namagembe, Imelda 
Nakimuli, Annettee 
Sekikubo, Musa 
Moffett, Ashley 


Abstract: 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 min and the median decision-to-delivery interval was 5.5 h. 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 h 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.


Funder: Addenbrooke's Charitable Trust, Cambridge University Hospitals; doi:

Funder: Isaac Newton Trust[12.21(a)]/Wellcome Trust ISSF [105602/Z/14/Z]/ University of Cambridge Joint Research Grant


Research Article, Pregnancy and childbirth in low and middle income countries, Africa, Cesarean, Decision, Emergency, Obstetrics, Perinatal, Uganda

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BMC Pregnancy and Childbirth

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BioMed Central
Nurture Foundation for Reproductive Research (D43TW010132)
DELTAS Africa Initiative / Wellcome Trust (107743/Z/15/Z)