An evaluation of the decision-to-incision interval for caesarean sections at Chris Hani Baragwaneth Academic Hospital
Williams, Melissa Denielle
Background The decision-to-incision interval (DTII) at Chris Hani Baragwanath Academic Hospital (CHBAH) was unknown, the main objective of this study was to evaluate the DTII for emergency caesarean sections (EMCS) at CHBAH, a tertiary hospital in Soweto, Johannesburg. The caesarean section (CS) rate at CHBAH has steadily increased over the past few years; however the infrastructure and staffing at CHBAH has remained the same.Methods This was a cross sectional retrospective study of women who had a CS at CHBAH from the 1st of May 2016 to the 31st of May 2016. The hospital files were retrieved for the data collection. Results A total of 464 files were used. The median age of the women was 28 years and the median parity was two. The median DTII was 354.5 minutes (IQR: 190-595.75; range: 30-10570). Suspected uterine rupture achieved the shortest median decision-to-anaesthetic interval (DTAI) of 50 minutes (IQR: 920-145; range: 20-145) and foetal compromise had the longest median DTAI of 545 minutes (IQR: 232.5-808; range: 180-1355.The median DTAI was 350 minutes (IQR: 175-627; range: 20-10545). The top three Robson Ten Group Classification System (RTGCS) were groups 5, 10 and 1 which contributed 62.5% to the CS rate. The majority of the indications for elective caesarean section (ELCS) were previous CS (85.1%). The most frequent indications for EMCS were FD (58.1%). An adverse maternal morbidity occurred in 23 (5%) women, with PPH and the need for blood transfusion being the predominating factor. One hundred and twenty four (25.5%) neonates required admission. The main admission reason was respiratory distress. Conclusion The DTII was 4.7 times the 75 minute recommended NICE Guidelines for a category 2 CS and six times longer than the proposed 60 minutes stipulated in the Guidelines for Maternity Care in South Africa.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in the speciality of Obstetrics and Gynaecology to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020