Decision to Delivery Interval in Emergency Cesarean Section at Two Academic Hospitals in Yogyakarta and Central Java, Indonesia

Abstract

Background: The international guideline suggests that the ideal DDI is 30 minutes for grade 1 and grade 2 CS, but they are still hardly achieved. Therefore, the main purpose of this study was to determine the DDI for grade 1 and 2 CS, and its determinants in two academic hospitals.Methods: A prospective cohort study was conducted using pregnant women who underwent grade 1 and 2 emergency CS. Data regarding demographic characteristics of the subjects were extracted from the medical record, while DDI and its components were measured by direct observation. Odds ratio was used to determine the association between DDI and its determinants.Results: The median DDI for grade 1 and 2 CS in the main academic hospital were 112.5 minutes and 181 minutes respectively, longer than their duration in the affiliated hospital with 80 minutes for grade 1 CS and 104 minutes for grade 2 CS. The significant determinants for a 75-minute DDI in the main academic hospital were grade of CS (OR: 0.12; 95%CI: 0.01-1.05; p: 0.047), indication of CS (OR: 0.77; 95%CI: 0.6-0.89; p: 0.014), and anesthesiologist response time (OR: 9.18; 95%CI: 2.21-38.13; p: 0.001), while in the affiliated academic hospital, operating room waiting time was the only significant determinants (OR: 6.18; 95%CI: 2.07-18.48; p: 0.001).Conclusions: DDI for emergency CS still exceeded the standard in academic hospitals with different determinants causing the delay. Strengthening interprofessional collaboration should be implemented systematically.