A Bizzarre Cause of Delay in Category 1 Indication for Emercency Caesarean Section.

Abstract

The National guidelines of most developed countries suggest a target of 30 minutes of the decision to delivery interval for category 1 emergency cesarean section. Such guidelines may not be feasible in poorly resourced countries and busy obstetric settings. Traditionally, category 1 emergency caesarean section is performed within 30 minutes of taking the decision in order to reduce maternal and perinatal morbidities and mortalities. Outside this time frame, adverse pregnancy outcome increases significantly. In low resource countries, women have limited powers in taking decisions over their own health and that of their children, irrespective of their education status. When their husbands are not around, this further increase decision-intervention intervals with possible increased risk of feto-maternal morbidities and mortalities. We report a case of a booked 27 years old primigravida, a Legal Practitioner, who developed severe preeclampsia at gestational age of 35 weeks and 6 days. The mother’s condition necessitated an emergency caesarean section and she was counseled for the operation but could not consent because her husband, who is a Pastor and was at the middle of his was not around to give consent for the surgery. The surgery was done 3 hours and 30 minutes after the decision was taken. Intra-operative findings revealed mild placenta abruption, which actually was a maternal and perinatal near-miss.