Decision to delivery time interval and outcomes in emergency caesareans by a general practitioner: a crosssectional study from a rural referral center in Karnali Province of Nepal

Abstract

Introduction: Caesarean section, a life-saving surgery, is being performed routinely in rural and remote hospitals by obstetricians, general practitioners and advanced skilled birth attendants for prevention of maternal and neonatal morbidity. Recommended decision-to-delivery interval (DDI) time of 30 minutes in Category I and 75 minutes in Category II caesareans are difficult to achieve in resource-limited settings. This study aimed to study decision to delivery time interval in emergency caesareans in a CEONC center in rural Nepal and subsequent pregnancy outcomes.
Method: Descriptive cross-sectional study was conducted at Chaurjahari Hospital in Rukum-West over six-month period. Patient characteristics, indications, DDI and pregnancy outcomes were studied.
Result: Total number of deliveries was 450, of which 99 (22%) were caesarean deliveries. Sixty-Nine (69.7%) were emergency caesareans. Fourty-Eight (70%) caesareans were Category I with median DDI of 64 minutes (IQR 53- 78). 21(30%) were Category II with a median DDI of 68 minutes (IQR 60-89). Altogether, DDI of 30 minutes and 75 minutes were achieved in 3 (4.3%) and 47 (68.1%) of emergency caesareans, respectively. 57 (83%) mothers and 63 (91.3%) newborns had good outcomes with uneventful recovery. There were no maternal deaths. Two (2.9%) newborns died during NICU care, and 1(1.4%) was a fresh stillbirth.
Conclusion: Recommended decision to delivery interval of 30 minutes was difficult to achieve in resource-limited settings. Three-quarters of emergency caesareans were performed within a 75-minute interval. Shortest DDI was 13 minutes. Though, maternal and fetal outcomes were largely satisfactory, it was necessary to further lessen DDI with due precautions to ensure quality care delivery.