Evaluating the decision-to-delivery interval in category 1 emergency caesarean sections at a tertiary referral hospital

Background. Caesarean sections (CS) in low- and middle-income countries are still afflicted with high complication rates for both mothers and neonates. A target decision-to-delivery (DDI) interval <= 30 minutes in category 1 emergency CS is the recommended standard of care, although the impact of this target on perinatal outcomes and its practicality is unclear. Objectives. The purpose of this retrospective study was to evaluate whether a DDI <= 30 minutes was achieved in daily practice and to describe the indications for category 1 emergency CS. Methods. We conducted a retrospective descriptive study at King Edward VIII Hospital, KwaZulu-Natal, Durban, South Africa, between 1 January and 30 June 2017. Alternate Category 1 cases were selected from an existing departmental database. Relevant data were extracted from standardised institutional booking forms and entered onto a data collection tool. Results. A total of 153 patients were enrolled in this study; no stillbirths were recorded. Only 5.2% (n=8/153) of the parturients achieved a DDI <= 30 minutes. The overall median (IQR) DDI was 75.0 (58 - 97) minutes with a range of 13 - 341 minutes. There was no significant difference in the median DDI between neonates with a 5-minute Apgar >= 7 or <7. Fetal distress (81.0%) and placental abruption causing significant antepartum haemorrhage (13.7%) were the most common indications for CS. Conclusion. The study demonstrated that achieving a DDI of 30 minutes within the current organisational structure, institutional policies and staffing pattern is very rare. However, units should still benchmark against the internationally recommended 30-minute target as an indicator of unit efficiency and to improve quality of care. Despite absence of correlation between the DDI and the 5-minute Apgar score, unjustified delay from the decision-making to delivery of the baby is not acceptable.