Impact of decision-operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at mulago hospital.
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Delay, decision-operation interval, bad pregnancy outcomes. TITTLE: Impact of decision-operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at mulago hospital. BACKGROUND: The maternal mortality ratio (MMR) at mulago national referral hospital is estimated at 600 deaths/100,000 live births which is higher than the national ratio of 435/100,000 live births. Uganda’s neonatal mortality ratio NMR is also high at 29/1000 live births. Pregnancy outcomes are at times related to the decision-operation (DOI) yet from hospital records and literature the DOI and its determinant factors were not well described. OBJECTIVE: To determine the mean DOI, the maternal and foetal outcomes related to the DOI and to determine the factors that determine the DOI among mothers who undergo emergency caesarean section at mulago hospital. METHODS: This was a prospective cohort study of women in mulago hospital that had emergency caesarean section from October to novemner 2008. Consecutive sampling was used to enrol 351 participants who were followed from the time of the decision of operation to the 3rd postoperative day. RESULTS: All 351 mothers who had emergency caesarean section (EmCS) had their results analysed. Only 1.1% participants had DOI within 30 minutes, 39.2% were operated within 4 hours of the decision and 4.8% after 24 hours from the decision. The overall DOI averaged 465 minuted with a medium of 320 minutes. On average bad outcomes were noted in 41.3% participants but they were higher (51.8%) among the under 20 year old gravidae than in older gravidae. They included obstructed labour (5.7%), Low minute Apgar score (12.5%), need for neonatal intensive care unit (NICU) admission (12.0%) and perinatal deaths (10.9%). Servival analysis showed bad outcomes to increase 2 ½ hours from the decision to operate. Among the determinants of DOI, lack of theatre space and personnel factors like shift change over delays and absenteeism / late coming were the commonest. CONCLUSIONS: The average DOI for EmCS in mulago is about 7 ½ hours with bad outcomes like obstructed labour and perinatal deaths noted in many cases that increased with DOI over 2 ½ hours. Delays were mostly due to lack of theatre space and personnel factors. RECOMMENDATIONS: Most personnel sensitization and training on better time management and theatre space allocation need to be ensured to reduce the waiting time for EmCS. Alarger study to follow-up participants for atleast 6 weeks is needed to assess outcomes.