article · BMC Pregnancy and Childbirth
International clinical guidelines recommend that emergency caesarean deliveries take place within thirty minutes of the decision being made, serving as a critical indicator of maternity care quality. An evaluation conducted in public hospitals in Bahir Dar, Ethiopia, assessed adherence to this standard and examined the institutional factors causing delays. Only 20.3% of emergency caesarean sections achieved a decision to delivery interval under the recommended thirty-minute threshold. The investigation found that delays were significantly linked to several operational and clinical variables, including patient referral status, the time of day the procedure occurred, the seniority of the operating surgeons, the type of anaesthesia administered, and the transfer time within the facility. The findings demonstrate that addressing these systemic delays requires hospitals to establish better advance preparation and readiness for rapid emergency interventions.
When life-threatening maternal or fetal emergencies arise, every minute of delay increases the risk of severe complications or death. Demonstrating that four out of five emergency deliveries exceed global timeliness targets highlights critical gaps in hospital systems. Pinpointing specific operational bottlenecks, such as internal transfer delays and staffing issues, provides healthcare administrators with clear targets for streamlining emergency obstetric response.
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BACKGROUND: Emergency cesarean section is a commonly performed surgical procedure in pregnant women with life-threatening conditions of the mother and/or fetus. According to the Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists, decision to delivery interval for emergency cesarean sections should be within 30 min. It is an indicator of quality of care in maternity service, and if prolonged, it constitutes a third-degree delay. This study aimed to assess the decision to delivery interval and associated factors for emergency cesarean section in Bahir Dar City Public Hospitals, Ethiopia. METHOD: An institution-based cross-sectional study was conducted at Bahir Dar City Public Hospitals from February to May 2020. Study participants were selected using a systematic random sampling technique. A combination of observations and interviews was used to collect the data. Data entry and analysis were performed using Epi-data version 3.1 and SPSS version 25, respectively. Statistical significance was set at p < 0.05. RESULT: Decision-to-delivery interval below 30 min was observed in 20.3% [95% CI = 15.90-24.70%] of emergency cesarean section. The results showed that referral status [AOR = 2.5, 95% CI = 1.26-5.00], time of day of emergency cesarean section [AOR = 2.5, 95%CI = 1.26-4.92], status of surgeons [AOR = 2.95, 95%CI = 1.30-6.70], type of anesthesia [AOR = 4, 95% CI = 1.60-10.00] and transfer time [AOR = 5.26, 95% CI = 2.65-10.46] were factors significantly associated with the decision to delivery interval. CONCLUSION: Decision-to-delivery intervals were not achieved within the recommended time interval. Therefore, to address institutional delays in emergency cesarean section, providers and facilities should be better prepared in advance and ready for rapid emergency action.
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DOI: 10.1186/s12884-021-03706-8
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