Decision to delivery interval and associated factors among Lucas category 1 caeserean indications in Kawempe National Referral Hospital

Abstract

Background: Emergency caesareans often face delays to start in developing countries like Uganda. This leads to maternal and neonatal morbidity and mortality rates to be much higher in developing countries than in developed ones It is recommended that all facilities that provide comprehensive obstetric care should respond to obstetric emergencies within a specified time frame. This study aimed to determine the decision to delivery interval and its associated factors among mothers with category 1 caesarian section indications which included placental abruption, cord prolapse, or severe fetal distress. Methods: This was a cross-sectional study conducted at Kawempe National Referral Hospital. The study population comprised mothers with category 1 caesarian section indications. The decision-to-delivery interval was calculated as the difference between the time of cesarian section decision and the time the baby was delivered. A questionnaire was used to collect information on socio-demographic, obstetric, and system factors that may have affected the decision-to-delivery interval. Ethical approval was sought from SOMREC; participation was voluntary, and privacy and confidentiality were maintained at all times. Results: The average DDI was 170.6 minutes and the median was 128 minutes. Only 115 (26.6%) had a DDI of ≤ 75 minutes and 21 (4.9%) had a DDI of <30 minutes. Prolonged DDI was found to be significantly associated with mothers age, less likely in younger age than old maternal age (aOR=0.5 (0.21 - 0.909), P=0.046) and was more likely in mothers with past obstetric complications of excessive vaginal bleeding (aOR=3.9 (1.092 - 13.668), P=0.036), prolonged labor (aOR=3.7 (1.043 - 12.894), p=0.043), fetal malpresentation (aOR=5.3 (1.044 - 26.614), P=0.044) and history of hypotensive disorders of pregnancy (aOR=4.8 (1.202 - 19.733), P=0.027). Conclusions: DDI exceeded 75 minutes in over three quarters of mothers with Category 1 cesarean sections with maternal age and past obstetric complications as the major ass associated factors. There is need to strengthen emergency obstetric care systems to allow swift interventions in obstetric emergencies in Uganda. Key words: Caesarean Section, Decision to delivery interval, Incision time, Lucas Category.