DECISION-TO-DELIVERY INTERVAL FOR EMERGENCY CAESAREAN SECTION AND FETO-MATERNAL OUTCOME AT AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA

Abstract

BACKGROUND: Monitoring the time interval from decision to operate to
delivery of fetus for emergency caesarean section, is an important method of
auditing the effectiveness of an obstetric unit.
OBJECTIVES: To determine the decision to delivery interval for emergency Caesarean sections at Aminu Kano Teaching Hospital and the impact on
fetomaternal outcome.
METHODOLOGY: It is a prospective cohort study, where questionnaires were
administered on 350 patients booked for emergency caesarean section before
and at the end of the procedure, at Aminu Kano Teaching Hospital.
RESULTS: 350 mothers for emergency caesarean section were studied. The
mean DDI was 137 minutes with a median of 100 minutes. 12.6% were delivered
within the recommended 30 minutes interval. Majority of the participants had
good maternal outcome (83.4%), while 16.6% had at least one bad outcome
which included: need for blood transfusion (12.6%), prolonged catheterization
(0.6%), Ruptured uterus (0.3%), uncontrolled blood pressure (1.7%), wound
breakdown (0.3%) and clinical infection (1.1%). The decision-to-delivery interval
had no impact on the fetal and maternal outcomes for the major indications of
the emergency caesarean section. Fetal outcomes were good in 62.5%, though
20.9% had low 5 minutes Apgar score, 8% needed NICU admission, 6% were
stillborn and 2.6% were early neonatal death. Anaesthetic delay, lack of theater
space, staff shift/change over time and patient not signing consent for the
operation were the major determinants of the DDI.
CONCLUSION: The average DDI is longer than the recommended 30 minutes
interval. Majority of the cases had good maternal and fetal outcome. There was
no difference in the occurrence of maternal and fetal outcomes in cases done
within the recommended 30 minutes DDI and those done more than 30
minutes.The need for blood transfusion and low 5 minutes APGAR score were
the most common complications. Delays were mostly due to anaesthetist.

DECISION-TO-DELIVERY INTERVAL FOR EMERGENCY CAESAREAN SECTION AND FETO-MATERNAL OUTCOME AT AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA