Decision To Delivery Time and Its Predictors Among Mothers Who Underwent Emergency Cesarean Delivery At Selected Hospitals of Northwest Ethiopia, 2023: Prospective Cohort Study

Abstract

Background

The decision to delivery time is the interval between the decision and the childbirth by emergency caesarean delivery. The Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists recommend that the decision to delivery time interval is less than 30 min. Additionally, the decision to delivery time varies across institutions and countries.

Objective

The aim of this study was to determine the decision to delivery time and its predictors among women who underwent emergency cesarean delivery at selected hospitals of Northwest Ethiopia, 2023.

Methods

An institutional-based prospective cohort study was conducted at selected hospitals of Northwest Ethiopia, among women who underwent emergency cesarean delivery from November 1 to January 30, 2023. A total of 285 participants were enrolled, and data collected using structured and pre-tested questionnaires. A systematic sampling technique was used. Data were entered into Epi-Data version 4.6 and then exported to STATA 15 for further analysis. The log rank test was utilized to compare group differences. The time is estimated by using the Kaplan–Meier curve and Cox proportional-hazard regression analysis was carried out to determine the predictors.

Results

From 285 participants, 56 (21.8%) women delivered within the recommended 30 min. The overall median survival time was undetermined and the restricted mean survival time was 48.9 min (95% CI: 47.4–50.5). The average decision to delivery time is affected among women who hesitate to accept consent (AHR: 0.17, 95% CI: 0.02–1.25), cord prolapses (AHR: 1.36, 95% CI: 0.46–3.94), rank of surgeon (AHR: 0.42. 95% CI: 0.42–1.08), no free operation room table (AHR: 0.27, 95% CI: 0.28–0.94), regional anesthesia (AHR: 0.56, 95% CI: 0.25–1.28), and use of a bladder flap (AHR: 0.33, 95% CI: 0.16–0.85).

Conclusion

Overall decision to delivery times among women who underwent emergency cesarean section at selected hospitals were longer than the recommended time.

Keywords:

• decision time
• emergency cesarean delivery

Abbreviations

ACOG, American College of Obstetrician and Gynecologist; ANC, Antenatal care; AHR, Adjusted hazard ratio; BPRC, Birth preparedness and complication readiness; CPD, Cephalo-pelvic disproportion; DCSH, Debre Markos Comprehensive Specialized Hospital; DDT, Decision to delivery time; CD, Cesarean delivery; EmCD, Emergency cesarean delivery; NRFHR, Non-reassuring fetal heart rate; OR, operation room; RCOG, Royal College of Obstetricians and Gynecologists.

Data Sharing Statement

Data will be available from the corresponding author on reasonable request.

Ethical Approval and Informed Consent

All methods were conducted according to the ethical standards of the Declaration of Helsinki. Ethical clearance was obtained from an institutional Research Ethics Review Board (IRB) of University of Gondar with reference number MIDW/30/2015 E.C. In addition, a letter of ethical approval was sent to Debre Markos Comprehensive Specialized Hospital and Lumame Primary Hospital and permission was obtained from the hospital’s administrators. Informed, voluntary, written, and signed consent was obtained from the head of the hospital and mothers. There are no study participants under the age of 18 years. The standard safety measures for the prevention of COVID-19 were strictly followed throughout the data collection period. Before conducting the interviews, information was given to the participants and they were assured for voluntary participation, confidentiality, and freedom to withdraw from the study at any time. The nature and significance of the study was explained to the participants.

Acknowledgment

We would like to thank the study participants for their time and the data collectors and supervisors for their commitment.

Author Contributions

All authors made a significant contribution to the work reported, that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

A total fund of 25000 Ethiopian birr with a project code of MIDW/30/2015 E.C was received from University of Gondar office of research and publication directorate director.