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. 2014 Mar;48(1):24-30.
doi: 10.4314/gmj.v48i1.4.

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

S A Oppong  1 , M G Tuuli  2 , J D Seffah  1 , R M K Adanu  3
Affiliations

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

S A Oppong et al. Ghana Med J. 2014 Mar.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Ghana; Limits of delay; caesarean section; perinatal outcome.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for live ‘intact survival as a function of decision-to-delivery interval
Figure 2
Figure 2
Kaplan-Meier survival curves for live ‘intact’ survival for the three leading indications for emergency caesarean sections.
Figure 3
Figure 3
The effect of decision-to-deliver interval on stillbirth
See this image and copyright information in PMC

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