Emergency Caesarean Sections: Decision to Delivery Interval and Obstetric outcomes in Nsambya Hospital, Uganda-A Cross Sectional Study

Background: Lack of hospital preparedness to perform an emergency cesarean section (EmCS) contributes to maternal morbidity and mortality. Pregnancy outcomes are affected by the Decision to Delivery interval (DDI) yet this time and its effect had not been known in St. Francis hospital Nsambya especially, whether we achieve the 30 minutes' interval that is globally advocated for. Objective: This study aimed to determine the average DDI, its variations with the indications for Emergency cesarean sections and how it affects the maternal and fetal outcomes among women delivering in St. Francis hospital Nsambya. Methods: This was a cross-sectional study implemented between September and December 2015 at St. Francis Hospital Nsambya's postnatal ward. The study population comprised 297 women, consecutively selected, having undergone EmCS. Eligible women were consented and interviewed on either the second or third post-operative day. Their medical records were reviewed and data collected using a structured questionnaire. The DDI was recorded, including time of arrival in theatre and time of anesthesia. Maternal and newborn outcomes were recorded. Double data entry into Epi data software was done, cleaned and exported to stata for analysis. Bivariate and multinomial regression analyses were applied to control for probable confounders. Results: The average DDI was 92 minutes (SD±44.2) The average time from decision to arrival in theatre was 30minutes and from arrival in theatre to anesthesia was 31 minutes. Only 0.7% of participants had a DDI within 30 minutes. The more urgent the indication, the shorter was the DDI. (P = 0.028). The DDI had no significant effect on the maternal outcome, however prolonged stay in theatre was associated with adverse maternal outcome (P = 0.004). 43.4% of babies had an adverse outcome but this had no association with DDI. One still birth had a DDI above 60 minutes. The day-time CS were associated with longer DDI than night time CS but this was not statistically significant. There was no maternal or fetal adverse outcome in mothers who's DDI was within 30minutes. Conclusion: The average DDI for EmCS in Nsambya hospital is 91.89 minutes. This DDI did not significantly affect the outcome of the mother and the baby. A DDI of 30 minutes is not an absolute threshold for influencing obstetric outcome. Delays in theatre were associated with significant maternal morbidity.