title: Is there a safe limit of delay for emergency caesarean section in Ghana? Results of analysis of early perinatal outcome.
abstract: OBJECTIVE
  To determine the limits of delaying caesarean section in a busy obstetric unit in a developing country setting that is not associated with neonatal survival.
  
  
  METHODS
  Retrospective cohort study of emergency cesarean sections. Indications were sub-divided into imminent threat and no imminent threat to fetal wellbeing. The primary outcomes was a composite measure of adverse perinatal outcome including stillbirth, 5-minute Apgar score < 7 and neonatal intensive care unit admission. Effect of decision-to-delivery interval on perinatal outcomes was evaluated using Kaplan-Meier survival analysis.
  
  
  RESULTS
  495 women met inclusion criteria (142 'imminent threat' group, 353 'no imminent threat' group). The median decision-to-delivery interval was significantly shorter in the 'imminent threat' group (2.25 [95% CI 1.38 - 5.83] versus 3.42 [95% CI 1.83 - 5.85] hours, p <0.001). Only 1.7% and 12.7% sections were performed within 30 minutes and 1 hour, respectively. Risk of the composite outcome was significantly higher in the 'imminent threat group (46.5% versus 31.2%, RR=1.49 [95% CI 1.18 - 1.89], p=0.001). A 95% probability of 'live intact' survival occurred at 1 hr and 2 hrs respectively, for the imminent threat and the no imminent threat groups.
  
  
  CONCLUSIONS
  Increasing decision-to-delivery interval is associated with higher risk of adverse perinatal outcomes, but a 95% live intact survival can be achieved if the delivery occurs within 2 hours.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
authors.forename: S A
authors.initials: SA
authors.lastname: Oppong
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Tuuli
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
authors.forename: J D
authors.initials: JD
authors.lastname: Seffah
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: R M K
authors.initials: RM
authors.lastname: Adanu
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D005869:Ghana; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013997:Time Factors
keywords: Ghana; Limits of delay; caesarean section; perinatal outcome