The impact of decision – delivery interval on maternal and fetal outcome: a three- year experience in a tertiary hospital.
Background: Human resources development has been identified as a very important tool in improving maternal and child health. An enhanced human resource capability helps in the reduction of the decision delivery interval (DDI), which has been identified as a key factor in improving the feto-maternal outcome in emergency caesarean delivery (ECD) for fetal and maternal reason.
Aim: This study aims to find out the feasibility of 30-minute decision-delivery interval (DDI) and the average decision-delivery interval in our setting, the effect of delayed decision-delivery interval on maternal and fetal outcome; to identity the prevailing factors and to proffer solutions.
Materials and Methods: This was a retrospective study carried out over a 3-year period between 1st January 2011 and 31st December 2013. The case notes of 577 patients who had emergency caesarean delivery during this period were reviewed and information relating to socio-demographic characteristics, indications for the caesarean delivery, decision-delivery interval, reasons for delay and feto-maternal outcome were obtained. All cases of preterm deliveries, intra-uterine fetal demise and multiple pregnancies were excluded.
Results: The prevalence of caesarean delivery during this period of study was 36.4% with 83.3% done as emergency. Seventy One percent of the parturients were multiparous women who were mostly unbooked (54.8%). The indication for surgery was fetal distress in majority of cases (40.4%). None of the parturient was delivered within 30 minutes of decision and the mean DDI was 120.35±40.26 minutes overall but lower for cases of fetal distress (96.38±34.72 minutes, P<0.001). The major reasons for delay in delivery were laboratory challenges and financial constraint (63.6% and 53.4% respectively). There was a statistically significant reduced mean time interval for instituting general anaesthesia compared with spinal anaesthesia. Severe fetal morbidity and mortality occurred with increase in DDI but was not shown to be statistically significant. Perinatal mortality rate among study group was 7.3%. Maternal mortality and near misses increased with increase in DDI and was shown to be significant (P=0.014). The maternal mortality rate from this study was 2.6%.
Conclusion: The decision-delivery interval of 30- minutes is difficult to achieve in low resource settings; even in the face of emergency, due to prevailing factors which include poor human capital development, poor standard of living, bad attitude of health workers and infrastructural challenges.
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