Abstract:
Background: An emergency cesarean section requires prompt delivery to reduce the risk for a pregnant woman or newborn. Studies have been conducted to investigate the relationship between decision-to-delivery time and neonatal outcomes, but the findings are contradictory. The feasibility and practicability of the recommended decision-to-delivery time and its impact on adverse fetal outcomes aren’t clear from recent studies, particularly in low-resource settings like our country, Ethiopia. Objective: To assess the association between the decision to delivery time of an emergency cesarean section on adverse neonatal outcomes at East Gojjam Zone Public Hospital. Method and material: An observational, multicenter prospective study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 352 mother-newborn pairs were studied. Direct observation and face-to-face interviews was undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. Measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05.
Result: The proportion of emergency cesarean cases delivered within 30 minutes was 21.9%. The study found a significant relationship between the first-minute low Apgar score and the delayed decision-to-delivery time interval (OR = 2.6, 95% CI: 1.1–6, p = 0.03). In addition, determinant factors for poor 1st-minute Apgar scores include danger signs during pregnancy (AOR: 2.9, 95% CI: 1.1–7.8, p = 0.03), women referred from another facility (AOR: 2.6, 95% CI: 1.5–4.6, p = 001), and non-reassuring fetal heart rate (AOR: 4.2, 95% CI: 1.1–17, p = 0.04). A delayed decision-to-delivery time interval is not statistically significantly associated with a low 5th-minute Apgar score or neonatal intensive care unit (NICU) admission. Conclusion and Recommendation: the study found unfavorable 1st minute Apgar score and a longer decision-to-delivery period than recommended. This duration and negative newborn outcomes may be reduced by increasing and involving comprehensive obstetric and neonatal care facilities with skilled emergency obstetric surgeons, such as clinical midwife, integrated emergency surgeon officer and physician
