The effect of time of day of unscheduled caeserian sections on perinatal and maternal outcomes in Kenyatta national hospital, Nairobi, Kenya

Abstract

Introduction: Large multicenter studies done in teaching hospitals in USA and Europe showed no important differences in maternal and neonatal morbidity after unscheduled cesarean section delivery according to work shift. There were however no studies which had been done at Kenyatta National Hospital (KNH). Objectives: The objective of the study was to compare the 72 hour post delivery maternal and neonatal outcomes among patients undergoing unscheduled cesarean section during the night and day shifts in KNH. Study Design: A prospective cohort study in which the exposed group was those patients who had undergone unscheduled cesarean section during the night while the control group was those patients who had undergone unscheduled cesarean section during the day was conducted between February and April 2015 at Kenyatta National Hospital (KNH). The incidence of poor maternal and neonatal outcomes within the first 72 hours post cesarean section was compared between the two groups. Study Population: This comprised all postnatal mothers who had undergone unscheduled cesarean section at Kenyatta National Hospital and were within 72hours post operation in the postnatal wards, PACU and Intensive Care Unit. Results: Between the months of February 26th and April 2nd 2015, a total of 240 patients undergoing unscheduled caesarean sections at the Kenyatta National Hospital were recruited into the study including 120(50%) patients who had an operation performed during the night shift and 120(50%) during the day shift. Data was collected prospectively. There was no significant difference in the socio-demographic characteristics of patients according to shifts. Most procedures were conducted under regional anesthesia with no significant differences between day and night surgeries. The leading indications for unscheduled CS during the day and night were: NRFS, obstructed labor and elective CS converted to emergency CS in that order. Conversion of Elective Cesarean section to Emergency CS was significantly more common during the night compared to during daytime. Poor maternal and neonatal outcomes did not show a significant difference depending on time of surgery. xii Conclusion: The study showed that there was no significant difference in pregnancy outcomes between unscheduled cesarean section done during the day compared to those done during the night. Recommendations: Regular clinical audits should be performed and interventions carried out promptly with the aim of reducing poor pregnancy outcomes, patients scheduled for elective cesarean section should be operated on as planned to reduce the high numbers of unscheduled cesarean section done at night due to conversion of these elective cases to emergency cases and that Kenyatta National Hospital should continue with the current schedule in terms of resource provision in both shifts since it has been shown not influence adverse pregnancy outcomes.