Impact of decision–operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at Mulago hospital

摘要: Background: A maternal mortality ratio (MMR) of 600 deaths/100,000 live births at Mulago National Referral Hospital in Kampala is higher than the national ratio of 435/100,000 live births. Uganda’s neonatal mortality ratio (NMR) also stands at 29/1000 live births. Pregnancy outcomes are at times related to the decision-operation interval (DOI) yet from hospital records and literature the DOI and its determinant factors were not well described. Objective: To determine the mean DOI, the maternal and foetal outcomes relative to the DOI and to determine the factors that determine the DOI among mothers who undergo emergency caesarean section (EmCS) at Mulago hospital. Methods: This was a prospective cohort study of women who had EmCS in Mulago hospital from October to November 2008. Consecutive sampling was used to enrol participants who were followed from the time of the decision of operation to the 3rd postoperative day. Results: All 351 mothers who had EmCS had their results analysed. Only 1.1% participants had DOI within 30 minutes, 36.8% were operated after 8 hours of the decision. The overall DOI averaged 465 minutes with a median of 320 minutes. On average bad outcomes were noted in 41.3% participants but they were higher (51.8%) among the teenage gravidae than in older gravidae. They included obstructed labour (5.7%), low 5-minute Apgar score (12.5%), need for neonatal intensive care unit (NICU) admission (12.0%) and perinatal death (10.9%). Survival analysis showed bad outcomes to increase 2½ hours from the decision to operate. Among the determinants of DOI, lack of theatre space and personnel …