title: Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital.
abstract: OBJECTIVE
  To determine the decision-to-delivery interval (DDI) for emergency cesarean deliveries (CDs) at a tertiary center in Nigeria, to evaluate causes of delay, and to assess the effects of delays on perinatal outcomes.
  
  
  METHODS
  Between September and November 2010, a prospective, observational study was undertaken at University College Hospital, Ibadan. Events that occurred after a decision to perform an emergency CD were recorded. Associations between outcomes and the DDI were analyzed.
  
  
  RESULTS
  Among 235 emergency CDs included, 5 (2.1%) occurred within 30 minutes and 86 (36.6%) within 75 minutes. The mean DDI was 119.2±95.0 minutes. Among CDs with a DDI of more than 75 minutes, logistic factors were the reason for delay in 65 (43.6 %) cases. No significant associations were recorded between DDI and the 5-minute Apgar score, admission to the special-care baby unit, or perinatal mortality (P>0.05 for all). In multivariate analysis, neonates delivered after 75 minutes were significantly less likely to die during the perinatal period than were those delivered within this period (odds ratio 0.13, 95% confidence interval 0.03-0.66; P=0.01).
  
  
  CONCLUSIONS
  Institutional delays in CDs need to be addressed. However, the DDI could be less important for perinatal outcome than are some other factors, such as the severity of the indication.
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria. Electronic address: dr.nikebello@yahoo.com.
authors.forename: Folasade A
authors.initials: FA
authors.lastname: Bello
authors.affiliation: Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
authors.forename: Taiwo A
authors.initials: TA
authors.lastname: Tsele
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Oluwasola
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009549:Nigeria; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult
keywords: Cesarean delivery; Decision-to-delivery interval; Perinatal mortality; Perinatal outcomes