Decision-To-Delivery Interval In Non-Elective Caesarean Section: Is It Optimal In Our Hospitals

Abstract

Objectives: To study the time interval from decision to delivery of the baby (DDI) in non ELC/S, factors influencing this period of time, and it's reflection on early neonatal and maternal outcome. Settings: Main capital hospitals, Khartoum Teaching Hospital (KTH), Omdurman Maternity Hospital (OMH), Khartoum North Teaching Hospital (KNTH), Soba University Hospital (SUH). Subjects: 323 non ELC/S done in the period from 1st Jan. to 31st Jan.2003. Results: DDI found to be, 46 minutes (mean) for 273 (84%) EmC/S, 20.5 minutes (mean) for (9%) crash C/S, 66.5 minutes (mean) for 21(7%) urgent C/S. Percentage achievement of DDI < 30 min was 48%, which is comparable with that in the literature. With regard to the factors influencing the DDI like, preparation of the patient requirements, fees, (previous C/S Scar found not affecting DDI nor the state of the lady being educated or not). With general anaesthesia DDI was found to be less than DDI with spinal anaesthesia and the difference was statistically significant (P>0.05) but not affecting the early neonatal and maternal out come, seniority of the operator was also found to affect the DDI (SUH) and the difference between non EIC/S DDI done by registrar and that done by house-officer was statistically significant also (P > 0.05) but also not affecting the outcome. Early neonatal outcome in EmC/S group (273) we had one ENND and 272 were in good condition, 11(4%) were admitted in NICU and discharged in good condition, Apgar score at 1 min <3 =1, Apgar score at 5 min >7 =272, average weight 3.1kg. In the crash C/S 29(9%) Apgar score at 1 myn <3 =0, Apgar score at 5 min >7 =29, no admission in NICU average weight 2.9 kg. For urgent C/S 21(7%), Apgar score at 1 min <3 =0, Apgar score at 5 min >7 =21, admission to NICU were 4(19%) of the urgent group. Discharged in good condition average weight 2.8kg. With regard to maternal outcome all were favourable all 323 non EIC/S recover smoothly from anaesthesia (where G.A was used in 83%). Day three maternal haemoglobin was 70% (mean) for the EmC/S, 69% for crash C/S, and 71.5% for the urgent C/S. The need for maternal blood transfusion was like that, 3.2% for EmC/S [273 (84%)], 6.8% of the crash C/S [29 (9%)], and 0% for urgent C/S [21 (7%)]. Conclusion: In 323 non EIC/S, 48% were done in less than or equal 30 minutes. Short-term neonatal and maternal outcome was favourable.