Abstract:
Objective: To determine the limits of delaying caesarean
section in a busy obstetric unit in a developing
country setting that is not associated with neonatal survival.
Methods: Retrospective cohort study of emergency
cesarean sections. Indications were sub-divided into
imminent threat and no imminent threat to fetal wellbeing.
The primary outcomes was a composite measure
of adverse perinatal outcome including stillbirth, 5-
minute Apgar score < 7 and neonatal intensive care
unit admission. Effect of decision-to-delivery interval
on perinatal outcomes was evaluated using Kaplan-
Meier survival analysis.
Results: 495 women met inclusion criteria (142 ‘imminent
threat’ group, 353 ‘no imminent threat’ group).
The median decision-to-delivery interval was significantly
shorter in the ‘imminent threat’ group (2.25
[95% CI 1.38 - 5.83] versus 3.42 [95% CI 1.83 - 5.85]
hours, p <0.001). Only 1.7% and 12.7% sections were
performed within 30 minutes and 1 hour, respectively.
Risk of the composite outcome was significantly higher
in the ‘imminent threat group (46.5% versus 31.2%,
RR=1.49 [95% CI 1.18 – 1.89], p=0.001). A 95%
probability of ‘live intact’ survival occurred at 1hr and
2hrs respectively, for the imminent threat and the no
imminent threat groups
Conclusion: Increasing decision-to-delivery interval is
associated with higher risk of adverse perinatal outcomes,
but a 95% live intact survival can be achieved
if the delivery occurs within 2 hours.