Decision-to-Incision Time of an Emergency Cesarean Delivery on Prolong Labour: Application of Partograph use at Kwadaso Municipal Hospital in the Ashanti Region of Ghana

Decision-to-incision time is the interval between the moment a decision is made to perform a cesarean section and the time of the incision on the abdominal wall. Ineffective monitoring and documentation of contractions using the partograph by healthcare providers can delay the decision and execution of the incision. The study is a cross-sectional study using a quantitative approach, involving a sample of 54 healthcare providers as primary data and 384 selected partograph entries as secondary data. A systematic sampling approach was used for the secondary data, while a convenience sampling approach was used for the primary data. The study aims to estimate the decision-to-incision time for emergency cesarean sections during prolonged labor, assess the effective use of the partograph on birth outcomes, identify challenges in decision-making for cesarean sections during prolonged labor, and educate healthcare professionals on proper documentation of the partograph. Findings from the study indicated that an estimated incision time of 407.835 minutes (approximately 7 hours) from the start of admission is needed to decide on a cesarean delivery. A time frame between 6 hours 50 minutes and 7 hours 8 seconds could be considered by surgeons when using the partograph during prolonged labor. An estimated time of 112.811 minutes (approximately 1 hour and 8 minutes) is needed for spontaneous vaginal delivery when regular contractions occur, with or without oxytocin augmentation. A stable fetal heart rate of approximately 142 beats per minute is required for delivery. Documentation findings revealed poor practices among some healthcare providers, with 43.6% of respondents indicating gaps in documentation. A model for documentation was presented as follows: logit (Outcome of delivery) = -0.251 + 0.033(gravidae) – 1.207(parity) – 37.64(date of admission) + 39.486(time of admission) + 19.898(ruptured membrane) – 20.55(amniotic fluid) + 1.640(descent of head) – 0.003(contractions per 10 minutes) – 0.115(oxytocin) + 0.360(drugs and fluids) + 0.307(pulse and blood pressure) – 0.388(temperature) – 0.188(urine) – 0.023(fetal heart rate). When properly documented, this model will predict either cesarean delivery or spontaneous vaginal delivery. A higher proportion of the selected healthcare providers were female (92.6%), with only 7.4% being male, making the study predominantly female. The majority were married (68.3%), while 31.5% were unmarried. The age distribution indicated that 42.6% of respondents were between 30 and 39 years old, followed by those between 20 and 29 years. In terms of occupation, 50.0% were staff midwives, 27.8% were senior midwives, 18.5% were medical officers, and 3.7% were principal midwives. While not all respondents understood every indicator on the partograph, a substantial proportion (74.1%) did. Factors contributing to delays in decision-making for incision, which subsequently delay cesarean delivery, included lack of renewal of NHIS cards, financial constraints related to top-up payments by pregnant mothers, inadequate anesthesia materials, and insufficient recovery rooms, operating theaters, and admission beds among healthcare providers. Additionally, the religious beliefs of pregnant mothers and their relatives favoring spontaneous vaginal delivery significantly contributed to delays in incision time for cesarean delivery. In summary, the study concluded that the partograph is an important tool for monitoring a pregnant mother during delivery, and timely intervention is critical.