An evaluation of the decision-to-incision interval for caesarean sections at Chris Hani Baragwanath Academic Hospital

Abstract

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