Is there a safe limit of delay for emergency caesarean section in Ghana? Results of analysis of early perinatal outcome

• Published in: Ghana medical journal Vol. 48; no. 1; pp. 24 - 30
• Main Authors: Oppong, S A, Tuuli, M G, Seffah, J D, Adanu, R M K
• Format: Journal Article
• Language: English
• Published: Ghana Ghana Medical Association 01.03.2014
• Subjects: Adult; Cesarean Section; Emergencies; Female; Ghana; Humans; Infant, Newborn; Original; Perinatal Mortality; Pregnancy; Pregnancy Outcome; Retrospective Studies; Time Factors; Ghana; Ghana; Limits of delay; caesarean section; perinatal outcome
• ISSN: 0016-9560
• DOI: 10.4314/gmj.v48i1.4

To determine the limits of delaying caesarean section in a busy obstetric unit in a developing country setting that is not associated with neonatal survival. Retrospective cohort study of emergency cesarean sections. Indications were sub-divided into imminent threat and no imminent threat to fetal wellbeing. The primary outcomes was a composite measure of adverse perinatal outcome including stillbirth, 5-minute Apgar score < 7 and neonatal intensive care unit admission. Effect of decision-to-delivery interval on perinatal outcomes was evaluated using Kaplan-Meier survival analysis. 495 women met inclusion criteria (142 'imminent threat' group, 353 'no imminent threat' group). The median decision-to-delivery interval was significantly shorter in the 'imminent threat' group (2.25 [95% CI 1.38 - 5.83] versus 3.42 [95% CI 1.83 - 5.85] hours, p <0.001). Only 1.7% and 12.7% sections were performed within 30 minutes and 1 hour, respectively. Risk of the composite outcome was significantly higher in the 'imminent threat group (46.5% versus 31.2%, RR=1.49 [95% CI 1.18 - 1.89], p=0.001). A 95% probability of 'live intact' survival occurred at 1 hr and 2 hrs respectively, for the imminent threat and the no imminent threat groups. Increasing decision-to-delivery interval is associated with higher risk of adverse perinatal outcomes, but a 95% live intact survival can be achieved if the delivery occurs within 2 hours.