Case records and commentaries in Obstetrics and Gynaecology

Abstract

The decision to delivery time interval (DDI) is an important measure of the preparedness of obstetric team in handling emergencies. Different institutions have different levels of response time depending on their level in the health care delivery system. The two hospitals studied are at two different levels. evaluation of the DDI in emergency caesarean deliveries in KNH and HBDH and their effect on the maternal and foetal outcome. Prospective study carried out in the two hospitals over four months (January to April 2006). Results were computed and anillyscd using SPSS computer package. A total of 638 women underwent emergency caesarean section in KNH and 615 were analysed because they had proper recordings of the times that were of interest. In HBDH, 54 women underwent emergency caesarean section and 52 had met the criteria thus analysed. The population at HBDH was relatively younger and of higher parity with a Mean of 24 years versus 28 years for the population at KNH (a p-value <0.001) The time between decision making and patient being received in theater had a range of IS-ISO minutes for KNH and 26-180 for HBDH with a significant difference between the two hospitals (p-value of <0.001). The time taken before delivery of the infant had a range of IS-55 minutes for KNH while for HBDH it was 15-GO minutes. The time difference was not significant. There appears to have been no relationship between the foetal outcome and the times taken from decision making to delivery of the baby (p value 0.8 for KNH and 0.3 [or HBDH). The Apgar score was found to be low for those that had a shone DDI. Those that had a shorter DDI had a life threatening diagnosis (as Per Lucas classification). The OOI did not have an effect on the maternal outcome in both institutions.

Homalsay District Hospital had a significantly longer DDI. The shorter OOf was associated with a lower Apgar score.