Decision - delivery interval and perinatal outcome in emergency caesarean sections
| Autor: | Effetie Er, N. Ibeziako, Hyacinth E. Onah, AC Umezulike, Ogbuokiri Cm |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Time Factors Population Nigeria Pregnancy Intensive care Infant Mortality medicine Humans Prospective Studies education Prospective cohort study Emergency Treatment education.field_of_study business.industry Cesarean Section Gold standard Infant Newborn Pregnancy Outcome Obstetrics and Gynecology medicine.disease Confidence interval Emergency medicine Apgar Score Intensive Care Neonatal Observational study Apgar score Female business |
| Zdroj: | Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 25(4) |
| ISSN: | 0144-3615 |
| Popis: | Recent studies have cast doubt on the recommended 30-min decision--delivery interval (DDI) in emergency caesarean sections. The practicability, justification, anticipated beneficial effect on neonatal outcome and its medico-legal implications have been questioned. We set out to determine (1) the DDI for emergency caesarean sections in two Nigerian tertiary care centres (2) the effect of DDI on perinatal outcome (particularly if the DDI is longer than the internationally recommended 30 min) and (3) the factors causing delays in intervention if any. This was a prospective observational study of consecutive cases of emergency caesarean sections performed at the two centres over an 8-month period. The main outcome measures were: indication for the caesarean, the decision-baby delivery interval, 1-min and 5-min Apgar scores, newborn admission to special care, perinatal death and reasons for any delay in decision - delivery interval beyond 30 min. The data were analysed with descriptive and inferential statistics and regression equations at the 95% confidence level. A total of 224 emergency caesarean sections were performed in the two institutions within the period of study. None of the caesarean sections was done within the recommended 30-min interval. Despite this, there was no significant correlation between the DDI and perinatal outcome. The major causes of delays in DDI were anaesthetic delays in both centres and difficulty in sourcing essential materials in one of the centres. The recommended 30-min DDI in emergency caesarean section is not currently feasible in Nigeria. Although the 30-min interval should remain the gold standard, DDI up to 3 hours may not be incompatible with good perinatal outcome as shown in this study. As in other studies, anaesthetic delay is the major cause of delay in carrying out emergency caesarean sections. Finally, since prolonged DDI may not be the cause of an adverse perinatal outcome in the majority of cases, litigation on these grounds may be unjustified. |
| Databáze: | OpenAIRE |
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