Decision-to-delivery interval and associated factors among women undergoing emergency caesarean section in public hospitals of West and North Gojjam Zones, Northwest Ethiopia: A cross-sectional study, 2024

Background The decision-to-delivery interval is the time between the decision to perform an emergency cesarean section and the delivery of the newborn. Prolonged decision-to-delivery interval increase the risk of adverse maternal and neonatal outcomes, including fetal hypoxia, neonatal morbidity, and maternal complications. World Health Organization recommend that delivery should occur within 30 minutes when there is an immediate threat to the life of the mother or fetus. According to the World Health Organization classification, emergency cesarean sections are categorized based on urgency, with Category 1 indicating an immediate threat to maternal or fetal life requiring rapid intervention. However, achieving the recommended decision-to-delivery interval remains challenging in low-resource settings. Therefore, this study aimed to assess delayed decision-to-delivery interval and identify factors among women undergoing emergency cesarean section in public hospitals, Northwest Ethiopia. Methods Institution-based cross-sectional study was conducted from January to March 2024 among 523 women who underwent emergency cesarean section in public hospitals. Participants were selected using systematic random sampling. Data were collected using a pretested interviewer-administered questionnaire, medical record review, and an observational checklist assessing operating room readiness and availability of surgical materials. Data were entered into Epi-Data and analyzed using SPSS. Binary logistic regression analysis was used to identify factors. Result The proportion of delayed decision-to-delivery interval (>30 minutes) was 79.9% (95% confidence interval: 76.2–83.3). Non-availability of operating room materials (adjusted odds ratio= 12.0; 95% confidence interval: 1.6–89.7), lack of a free operating room (adjusted odds ratio = 4.9; 95% confidence interval: 2.27–10.47), and cesarean section performed by integrated emergency obstetric surgeons (adjusted odds ratio = 2.98; 95% confidence interval: 1.03–8.62) were significantly associated with delayed. Conclusion Only one-fifth of emergency caesarean sections met the recommended 30-minute standard. Delays were mainly related to operating room availability, shortages of surgical materials, and surgery performed by integrated emergency obstetric surgeons rather than gynaecologists. Addressing these system-level and human resource constraints, and conducting further qualitative or quality improvement studies, is recommended.