The effects of resource improvement on decision-to-delivery times for cesarean deliveries in a Ghanaian regional hospital

Abstract

Objective: To evaluate the effects of having a dedicated obstetric operating room (OR) on the decision-to-delivery interval (DDI) in a large referral hospital in Ghana.

Methods: An observational study was undertaken of all patients undergoing cesarean delivery at Ridge Regional Hospital, Accra, before (pre-OR; August-September 2011) and after (post-OR; August-September 2012) introduction of an obstetric OR. The primary outcome was the DDI.

Results: In total, 581 cesareans were performed in the pre-OR period and 574 in the post-OR period. Overall, the median DDI decreased from 259 min (interquartile range [IQR] 161-432) in the pre-OR period to 195 min (IQR 138-319) in the post-OR period (P<0.001). DDI was lower in the post-OR period than in the pre-OR period for both emergency (175 min [IQR 126-241] vs 220 min [IQR 146-315]; P<0.001) and elective (1828 min [IQR 1432-2985] vs 4291 min [IQR 2992-5862]; P<0.001) cesarean deliveries. Only one emergency cesarean-in the post-OR period-was conducted within the recommended 30-minute timeframe.

Conclusion: An obstetric OR lowered the DDI for cesarean delivery; however, a realistic timeframe for emergency cesareans in low-income countries remains to be determined.

Keywords: Cesarean delivery; Decision-to-delivery interval; Neonatal outcomes; Sub-Saharan Africa.