Impact of Surgeon cadre, theatre location, and presence of intern healthcare professionals on decision-to-delivery interval in women undergoing emergency caesarean section in Northern Uganda: a historical cohort study

Impact of Surgeon cadre, theatre location, and presence of intern healthcare professionals on decision-to-delivery interval in women undergoing emergency caesarean section in Northern Uganda: a historical cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Surgeon cadre, theatre location, and presence of intern healthcare professionals on decision-to-delivery interval in women undergoing emergency caesarean section in Northern Uganda: a historical cohort study Henry Ochola, Ronnie Omoro, Paul Buga, Emintone Ayella Odong, and 18 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6491008/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Emergency caesarean sections (CS) are critical to avert adverse maternal and neonatal outcomes. The Decision-to-Delivery Interval (DDI), the interval between making the decision and achieving delivery of a newborn in an emergency CS, impacts maternal and neonatal outcomes. Although the World Health Organisation recommends achieving a DDI of <30 minutes, this is often difficult in resource-constrained areas. This study assessed the influence of the surgeon’s cadre, operating theatre location, and presence of intern healthcare professionals on DDI and whether these relationships differed by CS indication. Methods: We conducted a historical cohort study at St. Mary’s Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. We also assessed effect modification by CS indication. Results: Of the 760 participants enrolled (median DDI was 51 minutes (IQR: 36-67)), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to senior doctors (adjusted OR: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (OR: 0.89; 95% CI: 0.61-1.28) and (OR: 0.71; 95% CI: 0.51-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication. Conclusions: Emergency CS performed by junior doctors is associated with increased odds of prolonged DDI compared to those performed by senior doctors, emphasising the need to strengthen training, supervision, and mentorship for inexperienced surgeons. While theatre location and intern presence were not significantly associated with DDI, further research across diverse settings is warranted. Emergency caesarean section decision-to-delivery interval surgeon cadre low-resource setting Northern Uganda Figures Figure 1 Background Surgical delivery by emergency caesarean section (CS) serves to avert adverse maternal or newborn outcomes (1). When vaginal delivery becomes problematic or entirely unfeasible, CS becomes an essential element of emergency obstetric care (EmOC) (2). The four-tier categorisation framework established by Lucas and colleagues classifies indications of CS according to the level of procedural urgency (3). Measuring the interval between making the decision and achieving delivery of a newborn by an emergency CS, known as the Decision-to-Delivery Interval (DDI), is an important clinical metric (4). To ensure the best possible outcomes for both mother and newborn, conducting emergency CS promptly is critical (5). Whilst the World Health Organisation (WHO) advocates for DDI under 30 minutes (6), attaining this standard proves difficult in resource-constrained environments due to numerous systemic limitations (7–9). Healthcare facilities in high-income countries consistently attain DDI of 20 minutes or shorter, primarily through enhanced institutional frameworks and infrastructure (10,11). Contrastingly, most healthcare environments in low- and middle-income countries face numerous obstacles, including delays in patient preparation (12), lengthened theatre preparation times (13) and limited operating theatre availability (14), all adding to delayed DDI. Evidence suggests that proficient cross-disciplinary interaction and teamwork among medical staff can substantially minimise delays in achieving optimal DDI (15). Research findings regarding DDI impact remain mixed—some findings demonstrated no effect of delayed DDI on maternal or foetal outcomes (16,17), while others, especially those conducted in sub-Saharan Africa, demonstrated a relationship between extended DDI and higher likelihood of adverse outcomes to the mothers (18) and their newborns (8,19). Research at Uganda's Mulago National Referral Hospital revealed a mean DDI of 5.5 hours, with delayed DDI associated with unfavourable newborn events (20). The unique healthcare landscape across Northern Uganda faces unique challenges stemming from historical conflict and economic deprivation, factors likely extending DDIs in regional health facilities. Nevertheless, neither the duration of DDIs nor the healthcare facility factors influencing them have been thoroughly investigated in this region or other comparable post-conflict areas. Our study investigation aimed to assess how surgeon cadre, operating theatre proximity to the ward, and the presence of intern healthcare professionals affect DDI among women undergoing emergency CS in a Northern Ugandan tertiary hospital. Additionally, we explored whether these relationships varied according to specific CS indications. Methods Study design and setting We carried out a historical cohort study design at St. Mary's Hospital Lacor, a 482-bed private non-profit Catholic referral hospital located in Gulu City, Northern Uganda. This facility mainly caters to patients from the Acholi, Lango, West Nile, and Karamoja subregions, plus South Sudan. The Maternity unit, within the Department of Obstetrics and Gynaecology, handles approximately 6,000 births yearly, including roughly 1800 CS, with nearly 600 classified as emergency CS (21). The Maternity unit employs three obstetricians, four medical officers, 28 midwives, and auxiliary support staff. Emergency CS deliveries are executed by either junior doctors (interns) or senior doctors (medical officers or obstetricians). A team of 14 anaesthetists with varying credentials provide both spinal and general anaesthesia in both operating theatres. Maternal and foetal monitoring during labour utilises WHO labour care guides and cardiotocography conducted by midwives and doctors. As a fee-based service, payment for emergency CS is remitted by the patient or family members following procedure completion. Study population We retrospectively extracted data for women at ≥24 weeks of gestation admitted to St. Mary’s Hospital Lacor’s maternity unit, who required emergency CS as determined by a doctor. Indications comprised foetal distress, cord prolapse, placenta previa, placental abruption, eclampsia, obstructed labour, failed vacuum extraction, or previous CS scars in active labour. We excluded participants with multiple pregnancies and gestational age <24 weeks. Data collection Research data was obtained from the hospital emergency CS records between 6 September 2022 and 1 June 2024. Data access occurred on 2 September 2024 using a standardised extraction tool to ensure consistency across all participants, regardless of exposure status. Variables Our primary outcome variable was DDI (in minutes), defined as the time from the decision to perform an emergency CS to the time of delivery of the baby. DDI was categorised as prolonged (≥60 minutes) or not prolonged (<60 minutes) according to the local performance guidelines(22). The exposure variables comprised: Surgeon cadre performing the emergency CS - Juniors or senior doctors (medical officers or obstetricians). Juniors were defined as intern doctors completing mandatory post-graduate clinical experience before full licensure; medical officers as fully licensed general practitioners; and obstetricians as licensed doctors with specialist training in reproductive health. Operating theatre - Emergency CS were carried out in either the labour-suite theatre (operating 8 hours on weekdays) or a main theatre (105 metres - nearly 3 minutes’ walk from the labour-suite), functioning continuously with 1-2 tables reserved for emergency CS. The main theatre was preferred for potentially complicated CS due to its proximity to the intensive care unit. Presence of intern health professionals – Intern doctors, midwives, nurses, and pharmacists, annually by Uganda’s Ministry of Health, supplement St. Mary’s Hospital Lacor’s workforce. Given deployment inconsistencies, we identified periods of their absence (1 April 2023 to 6 August 2023) versus presence (remaining timeframe). Covariates: included maternal age, parity, residence, gestational age (determined by last normal menstrual period), referral status, emergency CS indication, operation day, staff shift, and anaesthesia type. Sample size Using the two-proportion formula, we determined a minimum required sample size of 760 participants. Assuming that 31% of emergency CS performed by senior doctors were prolonged DDI (>75 minutes) according to a previous study in Uganda(4). This sample size could detect a 32% relative difference in the proportion of prolonged DDI for emergency CS done by juniors compared to senior doctors, with a 0.05 significance level and 80% power. Statistical methods We conducted statistical analyses using STATA 18. For descriptive statistics, we calculated means and standard deviations (normally distributions), medians and interquartile ranges (skewed distributions), and frequencies with percentages (categorical variables). Univariable analysis employed chi-squared tests and logistic regression to assess associations between exposures, covariates, and prolonged DDI, presenting percentages, crude odds ratios (OR), 95% confidence intervals (CI), and likelihood ratio test (LRT) p-values. We conducted a minimal model analysis to identify important confounders, treating maternal age as an a priori confounder. We identified specific confounders for each exposure-outcome relationship: for surgeon cadre , we considered work shift, operation day, presence of juniors, gestational age, and parity; for theatre location , we included the above covariates plus area of residence; and for presence of interns , only maternal age was retained. Pre-operative delay point and anaesthesia type were considered mediators rather than confounders in the surgeon's cadre-DDI pathway. For multivariable analysis, we used causal modelling and a forward modelling approach, constructed three final models, each including one primary exposure, age, and identified important confounders. We assessed multicollinearity by comparing natural log standard errors. We examined effect modification by emergency CS indication using LRT, comparing final adjusted models with/without interaction terms. For missing data, we implemented complete case analysis for our primary analysis and examined the impact of additional adjustment for the variables with >5% missing data sensitivity analysis. All statistical tests used a two-sided p<0.05 significance threshold. Results Study population From a total of 772 women who underwent emergency CS between 6 September 2022 and 1 June 2024, 760 (98.4%) fulfilled our inclusion criteria and were enrolled in the analysis. We excluded women with gestational age <24 weeks (3/772, 0.4%) and those with multiple pregnancies (9/772, 1.2%). The final study cohort comprised 760 women who were followed up from the time emergency CS was indicated until delivery. All participants completed follow-up with no attrition (Figure 1). Figure 1 . Flow diagram of participant selection Demographic and Clinical Characteristics The study population had a mean age of 25 years (standard deviation, SD: 6.0), with most participants (56.7%, n=431) falling within the 20–29-year age category. The women had a median parity of 1 (interquartile range, IQR: 1-3), with multiparous women constituting 35.3% (n=268) of the cohort. Pregnancies had a median gestation age of 39 weeks (IQR: 38-40), and the majority of deliveries (66.5%, n=410) occurred at term. Most participants (59.6%, n=453) were referred from other health facilities to St. Mary’s Hospital Lacor. Participants predominantly resided in non-urban districts of Uganda (70.1%, n=533), and spinal anaesthesia was administered in 83.3% (n=633) of emergency CS. Stillbirths occurred in 24 (3.2%) deliveries, while birth asphyxia occurred in 18.7% (n=142) of the deliveries. The leading indication for emergency CS was previous scar in active labour, 37.9% (n=288) of the emergency CS (Table 1). Exposure variables and primary outcome Emergency CS were predominantly performed by senior doctors (74.9%, n=503) and took place in the hospital’s main theatre (76.6%, n=582). The median DDI was 51 minutes (IQR: 36-67), with approximately two-thirds (64.0%, n=486) delivering within 60 minutes of the decision. Most emergency CS were performed during the periods when intern healthcare professionals were available (74.9%, n=569) (Table 1). Table 1 : Characteristics of women and their newborn outcome who underwent emergency CS (N=760). Characteristics n (%)* Surgeon’s cadreꝉ Junior 169 25.2 Medical officer 471 70.1 Specialist 32 4.8 Theatre Main 582 76.6 Labour-suite 178 23.4 Presence of internsꝉ Present 569 74.9 Absent 189 24.9 Point of pre-operative delay None 138 18.2 Ward 186 24.5 Theatre 186 24.5 Ward+theatre 250 32.9 DDI (minutes) Median(IQR) 51 36-67 <60 486 64.0 ≥60 274 36.0 Maternal age (years) Mean(SD) 25.0 6.0 <20 153 20.1 20-29 431 56.7 ≥30 176 23.2 Gestational age (weeks)ꝉ Median(IQR) 39 38-40 Preterm 95 12.5 Term 410 66.5 Post-term 57 7.5 Parityꝉ a Median(IQR) 1 1-3 Nulliparous 176 23.2 Primiparous 213 28.0 Multiparous 268 35.3 Grand multiparous 100 13.2 Referral status No 307 40.4 Yes 453 59.6 Staff shift** Morning 237 31.2 Afternoon 214 28.2 Night 309 40.7 Operation dayꝉ Weekday 488 64.2 Weekend/public holiday 270 35.5 Residence Urban 227 29.9 Non-urban 533 70.1 Indication of emergency CS Previous CS 288 37.9 Foetal distress 125 16.5 Obstructed labour 148 19.5 Others 199 26.2 Type of anaesthesiaꝉ Spinal anaesthesia 633 83.3 General anaesthesia 38 5.0 Newborn outcome Stillbirth 24 3.2 Birth asphyxia 142 18.7 Normal 594 78.2 Abbreviations: DDI, decision to delivery interval; CS, caesarean section; SD, standard deviation; IQR, inter-quartile range. a Parity refers to previous pregnancies delivered alive or dead after 24 weeks of gestation grouped into nulliparous, primiparous, multiparous, and grand multiparous (0, 1, 2-4 and ≥5 respectively) ꝉMissing data: Gestational age 198 (26.1%), parity 3 (0.4%), type of anaesthesia 89 (11.7), surgeon cadre 88 (11.6%), opeartion day 2 (0.3%) and presence of interns 2 (0.3). * Percentages may not add up to 100.0% due to rounding and missing data. **Staff shift – Morning (08:00-13:59 hours), afternoon (14:00-19:59 hours), and night (20:00-07:59 hours). Unadjusted analysis Relationship between exposures and DDI: Junior doctors performing emergency CS were associated with higher odds of prolonged DDI compared to senior doctors, with delays occurring in 51.5% (87/169) of the junior-led procedures versus 31.0% (156/503) of senior-led procedures (OR: 2.36, 95% CI: 1.65-3.37; p<0.0001). Operating theatre location showed no significant association with prolonged DDI, with comparable proportions of prolonged DDI in the main theatre (36.1%; 210/582) and labour-suite theatre (36.0%; 64/178) (OR: 0.99, 95% CI: 0.70-1.41;p=0.98). Concerning intern healthcare professional presence, a higher proportion of prolonged DDI was noted when interns were present (38.0%; 216/569) than absent (30.2%; 57/189), though the association was weak (OR:0.71, 95% CI: 0.50-1.01; p=0.05) (Table 2). Association between covariates and DDI: Women experiencing both ward and theatre-related delays had a higher proportion of prolonged DDI than those with delays restricted to one area. Nulliparous participants had a higher proportion of prolonged DDI than primiparous, multiparous, and grand multiparous women. Higher proportions of prolonged DDI were observed during afternoon and night shifts than during morning shifts. Emergency CS performed under spinal anaesthesia had higher proportions of prolonged DDI than those performed under general anaesthesia (Table 2). Table 2 : Factors associated with prolonged DDI in emergency caesarean sections (N=760). Variable N (%)* Prolonged DDI n (%)* OR (95% CI) p-value Surgeon’s cadreꝉ Senior doctor 503 (74.9) 156 (31.0) 1 <0.0001 Junior 169 (25.2) 87 (51.5) 2.36 (1.65-3.37) Theatre Main 582 (76.6) 210 (36.1) 1 0.98 Labour-suite 178 (23.4) 64 (36.0) 0.99 (0.70-1.41) Presence of internsꝉ Present 569 (74.9) 216 (38.0) 1 0.05 Absent 189 (24.9) 57 (30.2) 0.71 (0.50-1.01) Point of pre-operative delay a Theatre-related 186 (24.5) 62 (33.3) 1 <0.0001 Ward-related 186 (24.5) 69 (37.1) 1.18 (0.77-1.81) Ward+theatre 250 (32.9) 143 (57.2) 2.67 (1.80-3.97) Maternal age (years) <20 153 (20.1) 57 (37.3) 1.01 (0.69-1.47) 0.51 20-29 431 (56.7) 160 (37.1) 1 ≥30 176 (23.2) 57 (32.4) 0.81 (0.56-1.18) Gestational age (weeks)ꝉ Preterm 95 (12.5) 42 (44.2) 1.37 (0.87-2.16) 0.39 Term 410 (66.5) 150 (36.6) 1 Post-term 57 (7.5) 21 (36.8) 1.01 (0.57-1.80) Parityꝉ b Nulliparous 176 (23.2) 80 (45.5) 1 0.005 Primiparous 213 (28.0) 66 (31.0) 0.54 (0.36-0.82) Multiparous 268 (35.3) 100 (37.3) 0.71 (0.49-1.05) Grand multiparous 100 (13.2) 27 (27.0) 0.44 (0.26-0.76) Referral status No 307 (40.4) 111 (36.2) 1 0.96 Yes 453 (59.5) 163 (36.0) 0.99 (0.73-1.34) Staff shift** Morning 237 (31.2) 70 (29.5) 1 0.02 Afternoon 214 (28.2) 78 (36.5) 1.37 (0.92-2.03) Night 309 (40.7) 126 (40.8) 1.64 (1.15-2.35) Operation dayꝉ Weekday 488 (64.2) 170 (34.8) 1 0.36 Weekend/public holiday 270 (35.5) 103 (38.2) 1.15(0.85-1.57) Residence City 227 (29.9) 88 (38.8) 1 0.31 Non-city 533 (70.1) 186 (34.9) 0.85 (0.61-1.17) Indication of emergency CS Previous CS 288 (37.9) 105 (36.5) 1 0.48 Foetal distress 125 (16.5) 52 (41.6) 1.24 (0.81-1.91) Obstructed labour 148 (19.5) 50 (33.8) 0.89 (0.59-1.35) Others 199 (26.2) 67 (33.67) 0.88 (0.61-1.29) Type of anaesthesiaꝉ Spinal 633 (83.3) 235 (37.1) 1 0.04 General 38 (5.0) 8 (21.1)) 0.45 (0.20-1.00) Abbreviations: DDI, decision to delivery interval; CS, caesarean section; OR, odds ratio; CI, confidence interval. a Women without any delays documented 138 (18.2%) excluded to overcome zero cells when assessing point of delay-prolonged DDI association b Parity refers to previous pregnancies delivered alive or dead after 24 weeks of gestation grouped into nulliparous, primiparous, multiparous, and grand multiparous (0, 1, 2-4 and ≥5 respectively) ꝉMissing data: Gestational age 198(26.1%), parity 3(0.4%), type of anaesthesia 89(11.7), surgeon cadre 88(11.6%). * Percentages may not add up to 100.0% due to rounding and missing data. **Staff shift – Morning (08:00-13:59 hours), afternoon (14:00-19:59 hours), and night (20:00-07:59 hours). Adjusted analysis On accounting for confounders, emergency CS conducted by junior doctors were still significantly associated with prolonged DDI compared to senior doctors, with adjusted odds just over two (OR: 2.07, 95% CI: 1.38–3.10; p=0.0004). The operating theatre location showed no statistically significant association with prolonged DDI on adjusting for confounders, with women operated in the labour-suite theatre showing comparable odds of prolonged DDI as those in the main theatre (OR: 0.89, 95% CI: 0.61–1.28; p=0.52). Regarding the presence of intern healthcare professionals, the adjusted analysis also showed no statistically significant association between their absence and prolonged DDI (OR: 0.71, 95% CI: 0.50–1.02; p=0.06) (Table 3). Table 3 : Adjusted associations between surgeons’ cadre, theatre location, and interns’ presence and prolonged DDI. Variable OR (95% CI) p-value OR (95% CI) p-valueꝉ Surgeon’s cadreꝉ Senior doctor 1 <0.0001 1 0.0004 Junior 2.35 (1.64-3.36) a 2.07 (1.38-3.10) c Theatre Main 1 0.91 1 0.52 Labour-suite 0.98 (0.69-1.39) a 0.89 (0.61-1.28) d Presence of interns Present 1 0.05 1 0.06 Absent 0.71 (0.50-1.01) b 0.71 (0.50-1.02) e Abbreviations: DDI, decision-to-delivery interval; OR, odds ratio; CI, confidence interval. ꝉ Likelihood ratio p-values a OR adjusted for maternal age b Crude OR c OR adjusted for maternal age, parity group, presence of juniors, operation day of the week, and staff shift (N=667). d OR adjusted for maternal age, parity group, indication of emergency caesarean section, area of residence, and calendar day of the week (N=755). e OR adjusted for age (N=670). Effect modification by indication of emergency CS There was no statistically significant evidence to suggest that the association between surgeon’s cadre, choice of operating theatre, and the presence of intern healthcare professionals and the odds of prolonged DDI differed by the indications of the emergency CS (p=0.83, p=0.47, and p=0.88, respectively) as in Table 4 [see Additional file 1] . Sensitivity analysis Accounting for gestational age in the final model (in addition to confounders in the primary analysis) the adjusted association between surgeon’s cadre and choice of operating theatre and the odds of prolonged DDI association produced comparable findings to the primary analysis (OR: 2.00, 95% CI: 1.30-3.09, p=0.002, N=487, and OR: 0.91, 95% CI: 0.59-1.41, p=0.67, N=559 respectively) as in Table 5 [see Additional file 1]. Discussion Our findings demonstrate that emergency CS performed by junior doctors were associated with significantly increased odds of having prolonged DDI compared to those performed by senior doctors. We found no statistically significant evidence of association between the operating theatre location and the odds of prolonged DDI. Similarly, the presence of intern healthcare professionals was not significantly associated with prolonged DDI. Furthermore, there was no statistically significant evidence that the associations between surgeon’s cadre, operating theatre location, and intern presence and prolonged DDI differed by the indication for emergency CS. The observed association between emergency caesarean sections performed by junior doctors and a prolonged decision-to-delivery interval underscores the critical role of surgical expertise in delivering prompt emergency obstetric interventions. This finding is consistent with previous studies that have reported that inexperienced surgeons are more prone to procedural delays during emergencies (20,23). It emphasises the importance of improving education, guidance, and oversight provided to junior doctors to refine their ability to make timely decisions and effectively perform emergency CS (24). The lack of a significant association between operating theatre location and prolonged DDI is a novel contribution to the literature. Despite the main theatre at St. Mary’s Hospital Lacor being situated 105 metres away from the labour suite, our findings may suggest that efficient coordination and systematic organisation at the hospital could mitigate the potential delays caused by this spatial separation. Elements such as the readiness of surgical teams, prompt accessibility of anaesthetic services, and general operational effectiveness may play a more significant role in influencing the decision-to-delivery interval than the theatre's physical location. However, as no previous studies have specifically examined this dynamic, further studies across diverse settings are necessary to substantiate this observation. The absence of significant evidence of association between the presence of intern healthcare professionals and the prolonged DDI may suggest that while interns support the healthcare workforce, their presence alone does not markedly impact the timeliness of emergency CS. This finding may imply that other elements, such as the specific roles assigned to interns, the quality of supervision provided, and the cohesion within the surgical team, may be more decisive in ensuring efficiency during emergency CS. Additionally, no studies to date have specifically examined this relationship in contexts such as Uganda’s healthcare system, where a shortage of senior doctors necessitates reliance on interns deployed by the Ministry of Health. Further investigation across similar resource-limited settings is warranted to confirm and expand upon this finding. In addition, we found no evidence that the associations between surgeon cadre, operating theatre location, or presence of intern healthcare professionals and DDI varied according to the indication for emergency caesarean section. This may suggest that the factors influencing delays are broadly similar across different clinical scenarios. Nevertheless, it remains possible that subtle differences by indication could exist but were not detected due to limited statistical power for some subgroups. Future studies with larger sample sizes could explore this further to clarify whether certain indications may be more susceptible to DDI delays in specific contexts. Our study had many strengths. First, the high completeness of data for most key variables strengthens the internal validity of our findings. Second, the cohort design enabled examination of multiple exposure variables and adjustment for potential confounders in the assessment of factors associated with DDI. Importantly, our study addresses an underexplored area by investigating whether the proximity of the operating theatre to the labour suite and the presence of intern healthcare professionals influence DDI, aspects not examined in previous research. However, some limitations must be acknowledged. Our study may have lacked sufficient power to identify nuanced effect modification, and the absence of statistically significant interactions could reflect a Type II error rather than a true lack of differential effects. Furthermore, as a single-centre investigation conducted in a private tertiary hospital, the generalisability of our findings to primary healthcare facilities or public sector hospitals may be limited. Finally, while DDI is a critical clinical metric, we did not directly evaluate maternal or neonatal outcomes in relation to the intervals observed. Our findings highlight the need to enhance emergency obstetric care in resource-limited settings by prioritising structured training, mentorship, and supervision for junior doctors. Structured mentorship schemes or simulation-based training may help reduce delays and improve DDI for emergency CS (25,26). Future research should explore the direct relationship between prolonged DDI and maternal and neonatal outcomes and evaluate interventions such as mentorship or simulation training aimed at reducing DDI delays in this setting. Conclusions Our study demonstrates that emergency caesarean sections performed by junior doctors are associated with significantly increased odds of a prolonged decision-to-delivery interval compared to those performed by senior doctors. In contrast, no significant association was found between operating theatre location or the presence of intern healthcare professionals and prolonged decision-to-delivery intervals. These findings emphasise the importance of structured training, mentorship, and supervision to support junior doctors in delivering timely emergency obstetric care. While our results suggest that efficient coordination may mitigate spatial challenges between labour wards and theatres, further research across diverse settings is warranted. Strengthening surgical capacity at all levels remains critical to improving the quality of emergency obstetric services, particularly in resource-limited settings (27). Abbreviations CI: Confidence intervals CS: Caesarean section DDI: Decision-to-Delivery Interval EmOC: Emergency obstetric care IQR: Interquartile range LRT: Likelihood ratio test OR: Odds ratio WHO: World Health Organisation Declarations Ethics approval and consent to participate Ethical approval was granted by the St. Mary’s Hospital Lacor Research Ethics Committee on 31 January 2024, reference number LACOR-2023-272. Approval was attained before any analysis or use of the clinical data for research purposes commenced on 2 September 2024. The permission to conduct the study at St. Mary’s Hospital Lacor was obtained from the hospital administration. Owing to the retrospective design of the study, the ethics committee waived the requirement for informed consent. Throughout the research process, strict measures were taken to ensure the confidentiality of patient information. Consent for publication Not applicable Availability of data and materials The datasets generated and analysed for this study are available from the corresponding author upon request. Competing interests The authors declare that they have no competing interests related to this study. Funding This study did not receive any external funding. The resources and support for this work were provided by St. Mary’s Hospital Lacor, where the research was conducted. The authors declare no commercial funding related to this study. Authors’ contributions HeO, RO,PB, EAO, OO, RKa, EO, NA, HA, JPA, DE, JN, DM, EL, HO, ML, MG, EW, OC, RKo, JO, and SO contributed to the conception and design of the study. HeO, EW, OC, EO, JO, and RKo performed formal data analysis. HeO, SO, DE, DM, RKa, EW, OC, EO, JO, and RKo contributed to drafting the manuscript. OB and OMA contributed to study implementation and data acquisition. HeO, RO,PB, EAO, OO, RKa, EO, NA, HA, JPA, DE, JN, DM, EL, HO, ML, MG, EW, OC, RKo, JO, and SO critically reviewed and revised the manuscript for key content. HeO prepared the final manuscript. All authors read and approved the final manuscript. Acknowledgements We wish to express our profound appreciation to the participants. We extend our heartfelt gratitude to the doctors, nursing and midwifery staff, anaesthesia team, and non-clinical team of St. Mary’s Hospital Lacor for their assistance and teamwork during the study period. Our sincere appreciation also goes to the hospital administration for allowing us to carry out this research and for their unwavering support. This study owes its success to the general contributions of all those involved. References Soltanifar S, Russell R. The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. 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Determinants of Decision to Delivery Interval (DDI) in Emergency Caesarean Sections in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Nigeria. Clinics Mother Child Health [Internet]. 2018 [cited 2023 Sep 2];15(2). Available from: https://www.omicsonline.org/open-access/determinants-of-decision-to-delivery-interval-ddi-in-emergency-caesarean-sections-in-ladoke-akintola-university-of-technology-teac-2090-7214-1000294-102283.html Bidon C, Desgranges FP, Riegel AC, Allaouchiche B, Chassard D, Bouvet L. Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France. Anaesthesia Critical Care & Pain Medicine. 2019 Dec;38(6):623–30. Kinsella SM. A 20‐minute decision‐delivery interval at emergency caesarean section using general anaesthesia: a clinically‐relevant target. Anaesthesia. 2021 Aug;76(8):1021–5. Kamotho D, Pertet AM, Ogwayo I. Decision to incision interval for emergency caesarean section and postoperative outcomes in a resource limited rural Kenyan public hospital. Int J Reprod Contracept Obstet Gynecol. 2018 Jun 27;7(7):2573. Qadir Khan M, Afridi F, S.Ghayur M. To Determine the Decision to Delivery Interval in Category I Emergency Caesarean Sections in A Tertiary Care Hospital of Peshawar. J Gandhara Med Dent Sci. 2023 Jan 1;10(1):62–5. Prawitasari S, Widyandana D, Hakimi M, Utarini A. Decision to Delivery Interval in Emergency Cesarean Section at Two Academic Hospitals in Yogyakarta and Central Java, Indonesia. Bali Med J. 2021 Apr 1;10(1):266–72. Boriboonhirunsarn D, Sunsaneevithayakul P. A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section. Journal of Obstetrics and Gynaecology. 2022 Jul 4;42(5):999–1003. Igwe PC, Egede JO, Ogah EO, Anikwe CC, Nwali MI, Lawani LO. Association and Determinants of Decision-Delivery Interval of Emergency Caesarean Sections and Perinatal Outcome in a Tertiary Institution. JCDR [Internet]. 2021 [cited 2023 Sep 2]; Available from: https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2021&volume=15&issue=3&page=QC01&issn=0973-709x&id=14596 K DrR, E DrG. A prospective observational study on decision to delivery interval and perinatal outcome in emergency caesarean section in tertiary care hospital. Int J Clin Obstet Gynaecol. 2021 Jan 1;5(1):19–25. Gupta S, Naithani U, Madhanmohan C, Singh A, Reddy P, Gupta A. Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2017;33(1):64. Nair VV, Nair SS, Venugopalan P. Decision to delivery interval in emergency LSCS and its impact on fetal outcome. Int J Reprod Contracept Obstet Gynecol. 2019 Aug 26;8(9):3679. Nelson JP. Indications and appropriateness of caesarean sections performed in a tertiary referral centre in Uganda: a retrospective descriptive study. Pan Afr Med J [Internet]. 2017 [cited 2023 Dec 21];26. Available from: http://www.panafrican-med-journal.com/content/article/26/64/full/ St Mary’s Hospital Lacor. Annual Hospital Report - Financial year July 2021 - June 2022 [Internet]. 2022 Jun p. 25–7. Available from: https://www.lacorhospital.org/wp-content/uploads/2023/08/FY-2021-22-Annual-Report-Fin.pdf Lulgi G, Ochola E, Omona V. Intervention to strengthen the quality of care and empowerment of health personnel in the Acholi region, Northern Uganda: 2018-2021 [Internet]. 2021 Sep p. 29–30. Available from: https://fondazionecorti.it/wp-content/uploads/2014/07/RBF-study-2021.pdf Apako T, Wani S, Oguttu F, Nambozo B, Nahurira D, Nantale R, et al. Decision to delivery interval for emergency caesarean section in Eastern Uganda: A cross-sectional study. Alwy Al-beity F, editor. PLoS ONE. 2023 Sep 27;18(9):e0291953. Mannella P, Pancetti F, Giannini A, Russo E, Montt-Guevara M, Simoncini T. Five actions for five people: emergency cesarean section protocol. BMC Pregnancy Childbirth. 2023 Apr 20;23:272. Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, et al. Does training in obstetric emergencies improve neonatal outcome? BJOG. 2006 Feb;113(2):177–82. Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery. American Journal of Obstetrics and Gynecology. 2005 Nov;193(5):1607–17. Knight HE, Self A, Kennedy SH. Why Are Women Dying When They Reach Hospital on Time? A Systematic Review of the ‘Third Delay’. PLOS ONE. 2013 May 21;8(5):e63846. Additional Declarations No competing interests reported. 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20:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6491008/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6491008/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101789328,"identity":"a7f395cf-b8dc-4a54-8513-54fd7e1514c2","added_by":"auto","created_at":"2026-02-03 15:57:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24503,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of participant selection\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6491008/v1/2b5104977bbe9097a103d455.png"},{"id":102564727,"identity":"aa1281df-b8f5-4bf9-bba3-3879ce99ba04","added_by":"auto","created_at":"2026-02-13 05:25:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1048472,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6491008/v1/ea672ba8-af6d-433d-8ad6-75bf97c44de6.pdf"},{"id":101789327,"identity":"56105daf-0bc1-4228-b671-8303fb46311e","added_by":"auto","created_at":"2026-02-03 15:57:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25461,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1\u003c/p\u003e","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6491008/v1/b36a00bc2bcd82d75ea94433.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Surgeon cadre, theatre location, and presence of intern healthcare professionals on decision-to-delivery interval in women undergoing emergency caesarean section in Northern Uganda: a historical cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eSurgical delivery by emergency caesarean section (CS) serves to avert adverse maternal or newborn outcomes (1). When vaginal delivery becomes problematic or entirely unfeasible, CS becomes an essential element of emergency obstetric care (EmOC) (2). The four-tier categorisation framework established by Lucas and colleagues classifies indications of CS according to the level of procedural urgency (3). Measuring the interval between making the decision and achieving delivery of a newborn by an emergency CS, known as the Decision-to-Delivery Interval (DDI), is an important clinical metric (4). To ensure the best possible outcomes for both mother and newborn, conducting emergency CS promptly is critical (5). Whilst the World Health Organisation (WHO) advocates for DDI under 30 minutes (6), attaining this standard proves difficult in resource-constrained environments due to numerous systemic limitations (7\u0026ndash;9).\u003c/p\u003e\n\u003cp\u003eHealthcare facilities in high-income countries consistently attain DDI of 20 minutes or shorter, primarily through enhanced institutional frameworks and infrastructure (10,11). Contrastingly, most healthcare environments in low- and middle-income countries face numerous obstacles, including delays in patient preparation (12), lengthened theatre preparation times (13) and limited operating theatre availability (14), all adding to delayed DDI. Evidence suggests that proficient cross-disciplinary interaction and teamwork among medical staff can substantially minimise delays in achieving optimal DDI (15). Research findings regarding DDI impact remain mixed\u0026mdash;some findings demonstrated no effect of delayed DDI on maternal or foetal outcomes (16,17), while others, especially those conducted in sub-Saharan Africa, demonstrated a relationship between extended DDI and higher likelihood of adverse outcomes to the mothers (18) and their newborns (8,19). Research at Uganda\u0026apos;s Mulago National Referral Hospital revealed a mean DDI of 5.5 hours, with delayed DDI associated with unfavourable newborn events (20).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe unique healthcare landscape across Northern Uganda faces unique challenges stemming from historical conflict and economic deprivation, factors likely extending DDIs in regional health facilities. Nevertheless, neither the duration of DDIs nor the healthcare facility factors influencing them have been thoroughly investigated in this region or other comparable post-conflict areas. Our study investigation aimed to assess how surgeon cadre, operating theatre proximity to the ward, and the presence of intern healthcare professionals affect DDI among women undergoing emergency CS in a Northern Ugandan tertiary hospital. Additionally, we explored whether these relationships varied according to specific CS indications.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design and setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe carried out a historical cohort study design at St. Mary\u0026apos;s Hospital Lacor, a 482-bed private non-profit Catholic referral hospital located in Gulu City, Northern Uganda. This facility mainly caters to patients from the Acholi, Lango, West Nile, and Karamoja subregions, plus South Sudan. The Maternity unit, within the Department of Obstetrics and Gynaecology, handles approximately 6,000 births yearly, including roughly 1800 CS, with nearly 600 classified as emergency CS (21).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Maternity unit employs three obstetricians, four medical officers, 28 midwives, and auxiliary support staff. Emergency CS deliveries are executed by either junior doctors (interns) or senior doctors (medical officers or obstetricians). A team of 14 anaesthetists with varying credentials provide both spinal and general anaesthesia in both operating theatres. Maternal and foetal monitoring during labour utilises WHO labour care guides and cardiotocography conducted by midwives and doctors. As a fee-based service, payment for emergency CS is remitted by the patient or family members following procedure completion.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively extracted data for women at \u0026ge;24 weeks of gestation admitted to St. Mary\u0026rsquo;s Hospital Lacor\u0026rsquo;s maternity unit, who required emergency CS as determined by a doctor. Indications comprised foetal distress, cord prolapse, placenta previa, placental abruption, eclampsia, obstructed labour, failed vacuum extraction, or previous CS scars in active labour. \u0026nbsp;We excluded participants with multiple pregnancies and gestational age \u0026lt;24 weeks.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eResearch data was obtained from the hospital emergency CS records between 6 September 2022 and 1 June 2024. Data access occurred on 2 September 2024 using a standardised extraction tool to ensure consistency across all participants, regardless of exposure status.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOur primary outcome variable was DDI (in minutes), defined as the time from the decision to perform an emergency CS to the time of delivery of the baby. DDI was categorised as prolonged (\u0026ge;60 minutes) or not prolonged (\u0026lt;60 minutes) according to the local performance guidelines(22).\u003c/p\u003e\n\u003cp\u003eThe exposure variables comprised:\u003c/p\u003e\n\u003col style=\"list-style-type: lower-roman;\"\u003e\n \u003cli\u003e\u003cstrong\u003eSurgeon cadre performing the emergency CS -\u0026nbsp;\u003c/strong\u003eJuniors or senior doctors (medical officers or obstetricians). Juniors were defined as intern doctors completing mandatory post-graduate clinical experience before full licensure; medical officers as fully licensed general practitioners; and obstetricians as licensed doctors with specialist training in reproductive health.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOperating theatre -\u0026nbsp;\u003c/strong\u003eEmergency CS were carried out in either the labour-suite theatre (operating 8 hours on weekdays) or a main theatre (105 metres - nearly 3 minutes\u0026rsquo; walk from the labour-suite), functioning continuously with 1-2 tables reserved for emergency CS. The main theatre was preferred for potentially complicated CS due to its proximity to the intensive care unit.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePresence of intern health professionals \u0026ndash;\u0026nbsp;\u003c/strong\u003eIntern doctors, midwives, nurses, and pharmacists, annually by Uganda\u0026rsquo;s Ministry of Health, supplement St. Mary\u0026rsquo;s Hospital Lacor\u0026rsquo;s workforce. Given deployment inconsistencies, we identified periods of their absence (1 April 2023 to 6\u003csup\u003e\u0026nbsp;\u003c/sup\u003eAugust 2023) versus presence (remaining timeframe). \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eCovariates:\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eincluded maternal age, parity, residence, gestational age (determined by last normal menstrual period), referral status, emergency CS indication, operation day, staff shift, and anaesthesia type.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUsing the two-proportion formula, we determined a minimum required sample size of 760 participants. Assuming that 31% of emergency CS performed by senior doctors were prolonged DDI (\u0026gt;75 minutes) according to a previous study in Uganda(4). This sample size could detect a 32% relative difference in the proportion of prolonged DDI for emergency CS done by juniors compared to senior doctors, with a 0.05 significance level and 80% power.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical methods\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted statistical analyses using STATA 18. For descriptive statistics, we calculated means and standard deviations (normally distributions), medians and interquartile ranges (skewed distributions), and frequencies with percentages (categorical variables).\u003c/p\u003e\n\u003cp\u003eUnivariable analysis employed chi-squared tests and logistic regression to assess associations between exposures, covariates, and prolonged DDI, presenting percentages, crude odds ratios (OR), 95% confidence intervals (CI), and likelihood ratio test (LRT) p-values. We conducted a minimal model analysis to identify important confounders, treating maternal age as an a priori confounder.\u0026nbsp;We identified specific confounders for each exposure-outcome relationship: for \u003cem\u003esurgeon cadre\u003c/em\u003e, we considered work shift, operation day, presence of juniors, gestational age, and parity; for \u003cem\u003etheatre location\u003c/em\u003e, we included the above covariates plus area of residence; and for \u003cem\u003epresence of interns\u003c/em\u003e, only maternal age was retained. Pre-operative delay point and anaesthesia type were considered mediators rather than confounders in the surgeon\u0026apos;s cadre-DDI pathway.\u003c/p\u003e\n\u003cp\u003eFor multivariable analysis, we used causal modelling and a forward modelling approach, constructed three final models, each including one primary exposure, age, and identified important confounders. We assessed multicollinearity by comparing natural log standard errors. We examined effect modification by emergency CS indication using LRT, comparing final adjusted models with/without interaction terms. For missing data, we implemented complete case analysis for our primary analysis and examined the impact of additional adjustment for the variables with \u0026gt;5% missing data sensitivity analysis. All statistical tests used a two-sided p\u0026lt;0.05 significance threshold.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eStudy population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom a total of 772 women who underwent emergency CS between 6\u003csup\u003e\u0026nbsp;\u003c/sup\u003eSeptember 2022 and 1\u003csup\u003e\u0026nbsp;\u003c/sup\u003eJune 2024, 760 (98.4%) fulfilled our inclusion criteria and were enrolled in the analysis. We excluded women with gestational age \u0026lt;24 weeks \u0026nbsp;(3/772, 0.4%) \u0026nbsp; and those with multiple pregnancies (9/772, 1.2%). The final study cohort comprised 760 women who were followed up from the time emergency CS was indicated until delivery. All participants completed follow-up with no attrition (Figure 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e. Flow diagram of participant selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDemographic and Clinical Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study population had a mean age of 25 years (standard deviation, SD: 6.0), with most participants (56.7%, n=431) falling within the 20\u0026ndash;29-year age category. The women had a median parity of 1 (interquartile range, IQR: 1-3), with multiparous women constituting 35.3% (n=268) of the cohort. Pregnancies had a median gestation age of 39 weeks (IQR: 38-40), and the majority of deliveries (66.5%, n=410) occurred at term. Most participants (59.6%, n=453) were referred from other health facilities to St. Mary\u0026rsquo;s Hospital Lacor. Participants predominantly resided in non-urban districts of Uganda (70.1%, n=533), and spinal anaesthesia was administered in 83.3% (n=633) of emergency CS. Stillbirths occurred in 24 (3.2%) deliveries, while birth asphyxia occurred in 18.7% (n=142) of the deliveries. The leading indication for emergency CS was previous scar in active labour, 37.9% (n=288) of the emergency CS (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExposure variables and primary outcome\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEmergency CS were predominantly performed by senior doctors (74.9%, n=503) and took place in the hospital\u0026rsquo;s main theatre (76.6%, n=582). The median DDI was 51 minutes (IQR: 36-67), with approximately two-thirds (64.0%, n=486) delivering within 60 minutes of the decision. Most emergency CS were performed during the periods when intern healthcare professionals were available (74.9%, n=569) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Characteristics of women and their newborn outcome who underwent emergency CS (N=760).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSurgeon\u0026rsquo;s cadreꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eJunior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMedical officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eSpecialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eTheatre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e76.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eLabour-suite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePresence of internsꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e74.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePoint of pre-operative delay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eWard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eTheatre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eWard+theatre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDDI (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e36-67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e64.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMaternal age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMean(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eGestational age (weeks)ꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38-40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePreterm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eTerm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e66.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePost-term\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eParityꝉ\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eGrand multiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eReferral status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e59.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eStaff shift**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMorning\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eAfternoon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eOperation dayꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eWeekday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eWeekend/public holiday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNon-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eIndication of emergency CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePrevious CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eFoetal distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eObstructed labour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eType of anaesthesiaꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eSpinal anaesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eGeneral anaesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eNewborn outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eStillbirth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eBirth asphyxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e78.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e DDI, decision to delivery interval; CS, caesarean section; SD, standard deviation; IQR, inter-quartile range.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003eParity refers to previous pregnancies delivered alive or dead after 24 weeks of gestation grouped into nulliparous, primiparous, multiparous, and grand multiparous (0, 1, 2-4 and \u0026ge;5 respectively)\u003c/p\u003e\n\u003cp\u003eꝉMissing data: Gestational age 198 (26.1%), parity 3 (0.4%), type of anaesthesia 89 (11.7), surgeon cadre 88 (11.6%), opeartion day 2 (0.3%) \u0026nbsp;and presence of interns 2 (0.3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003ePercentages may not add up to 100.0% due to rounding and missing data.\u003c/p\u003e\n\u003cp\u003e**Staff shift \u0026ndash; Morning (08:00-13:59 hours), afternoon (14:00-19:59 hours), and night (20:00-07:59 hours).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnadjusted analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRelationship between exposures and DDI:\u003c/p\u003e\n\u003cp\u003eJunior doctors performing emergency CS were associated with higher odds of prolonged DDI compared to senior doctors, with delays occurring in 51.5% (87/169) of the junior-led procedures versus 31.0% (156/503) of senior-led procedures (OR: 2.36, 95% CI: 1.65-3.37; p\u0026lt;0.0001). Operating theatre location showed no significant association with prolonged DDI, with comparable proportions of prolonged DDI in the main theatre (36.1%; 210/582) and labour-suite theatre (36.0%; 64/178) (OR: 0.99, 95% CI: 0.70-1.41;p=0.98). Concerning intern healthcare professional presence, a higher proportion of prolonged DDI was noted when interns were present (38.0%; 216/569) than absent (30.2%; 57/189), though the association was weak (OR:0.71, 95% CI: 0.50-1.01; p=0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003eAssociation between covariates and DDI:\u003c/p\u003e\n\u003cp\u003eWomen experiencing both ward and theatre-related delays had a higher proportion of prolonged DDI than those with delays restricted to one area. Nulliparous participants had a higher proportion of prolonged DDI than primiparous, multiparous, and grand multiparous women. Higher proportions of prolonged DDI were observed during afternoon and night shifts than during morning shifts. Emergency CS performed under spinal anaesthesia had higher proportions of prolonged DDI than those performed under general anaesthesia (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: Factors associated with prolonged DDI in emergency caesarean sections (N=760).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged DDI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eSurgeon\u0026rsquo;s cadreꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSenior doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e503 (74.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e156 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eJunior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e169 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e87 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.36 (1.65-3.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eTheatre\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e582 (76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e210 (36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eLabour-suite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e178 (23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e64 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.99 (0.70-1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePresence of internsꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e569 (74.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e216 (38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e189 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.71 (0.50-1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePoint of pre-operative delay\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eTheatre-related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e186 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e62 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eWard-related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e186 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e69 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.18 (0.77-1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eWard+theatre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e250 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e143 (57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.67 (1.80-3.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eMaternal age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e153 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.01 (0.69-1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e431 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e160 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e176 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.81 (0.56-1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eGestational age (weeks)ꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePreterm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e95 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e42 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.37 (0.87-2.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eTerm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e410 (66.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e150 (36.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePost-term\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e57 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.01 (0.57-1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eParityꝉ\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e176 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e80 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e213 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e66 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.54 (0.36-0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e268 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e100 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.71 (0.49-1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGrand multiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e100 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e27 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.44 (0.26-0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eReferral status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e307 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e111 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e453 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e163 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.99 (0.73-1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eStaff shift**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMorning\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e237 (31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e70 (29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAfternoon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e214 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e78 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.37 (0.92-2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e309 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e126 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.64 (1.15-2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eOperation dayꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eWeekday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e488 (64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e170 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eWeekend/public holiday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e270 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e103 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.15(0.85-1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e227 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e88 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNon-city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e533 (70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e186 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.85 (0.61-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eIndication of emergency CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePrevious CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e288 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e105 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFoetal distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e125 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.24 (0.81-1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eObstructed labour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e148 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e50 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.89 (0.59-1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e199 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e67 (33.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.88 (0.61-1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eType of anaesthesiaꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSpinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e633 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e235 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e38 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8 (21.1))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.45 (0.20-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e DDI, decision to delivery interval; CS, caesarean section; OR, odds ratio; CI, confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eWomen without any delays documented 138 (18.2%) excluded to overcome zero cells when assessing point of delay-prolonged DDI association\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003eParity refers to previous pregnancies delivered alive or dead after 24 weeks of gestation grouped into nulliparous, primiparous, multiparous, and grand multiparous (0, 1, 2-4 and \u0026ge;5 respectively)\u003c/p\u003e\n\u003cp\u003eꝉMissing data: Gestational age 198(26.1%), parity 3(0.4%), type of anaesthesia 89(11.7), surgeon cadre 88(11.6%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003ePercentages may not add up to 100.0% due to rounding and missing data.\u003c/p\u003e\n\u003cp\u003e**Staff shift \u0026ndash; Morning (08:00-13:59 hours), afternoon (14:00-19:59 hours), and night (20:00-07:59 hours).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAdjusted analysis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOn accounting for confounders, emergency CS conducted by junior doctors were still significantly associated with prolonged DDI compared to senior doctors, with adjusted odds just over two (OR: 2.07, 95% CI: 1.38\u0026ndash;3.10; p=0.0004). The operating theatre location showed no statistically significant association with prolonged DDI on adjusting for confounders, with women operated in the labour-suite theatre showing comparable odds of prolonged DDI as those in the main theatre (OR: 0.89, 95% CI: 0.61\u0026ndash;1.28; p=0.52). Regarding the presence of intern healthcare professionals, the adjusted analysis also showed no statistically significant association between their absence and prolonged DDI (OR: 0.71, 95% CI: 0.50\u0026ndash;1.02; p=0.06) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e: Adjusted associations between surgeons\u0026rsquo; cadre, theatre location, and interns\u0026rsquo; presence and prolonged DDI.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-valueꝉ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eSurgeon\u0026rsquo;s cadreꝉ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eSenior doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eJunior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.35 (1.64-3.36)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.07 (1.38-3.10)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eTheatre\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eMain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLabour-suite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.98 (0.69-1.39)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.89 (0.61-1.28)\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePresence of interns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.71 (0.50-1.01)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.71 (0.50-1.02)\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e DDI, decision-to-delivery interval; OR, odds ratio; CI, confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eꝉ\u003c/strong\u003eLikelihood ratio p-values\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eOR adjusted for maternal age\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003eCrude OR\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003eOR adjusted for maternal age, parity group, presence of juniors, operation day of the week, and staff shift (N=667).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ed\u003c/sup\u003eOR adjusted for maternal age, parity group, indication of emergency caesarean section, area of residence, and calendar day of the week (N=755).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ee\u003c/sup\u003eOR adjusted for age (N=670).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEffect modification by indication of emergency CS\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant evidence to suggest that the association between surgeon\u0026rsquo;s cadre, choice of operating theatre, and the presence of intern healthcare professionals and the odds of prolonged DDI differed by the indications of the emergency CS (p=0.83, p=0.47, and p=0.88, respectively) as in Table 4 [see Additional file 1]\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSensitivity analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccounting for gestational age in the final model (in addition to confounders in the primary analysis) the adjusted association between surgeon\u0026rsquo;s cadre and choice of operating theatre and the odds of prolonged DDI association produced comparable findings to the primary analysis (OR: 2.00, 95% CI: 1.30-3.09, p=0.002, N=487, and OR: 0.91, 95% CI: 0.59-1.41, p=0.67, N=559 respectively) as in Table 5 [see Additional file 1].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings demonstrate that emergency CS performed by \u003cstrong\u003ejunior doctors\u003c/strong\u003e were associated with significantly increased odds of having prolonged DDI compared to those performed by senior doctors. We found no statistically significant evidence of association between the operating theatre location and the odds of prolonged DDI. Similarly, the presence of \u003cstrong\u003eintern healthcare professionals\u003c/strong\u003e was not significantly associated with prolonged DDI. Furthermore, there was no statistically significant evidence that the associations between surgeon\u0026rsquo;s cadre, operating theatre location, and intern presence and prolonged DDI differed by the indication for emergency CS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe observed association between emergency caesarean sections performed by junior doctors and a prolonged decision-to-delivery interval underscores the critical role of surgical expertise in delivering prompt emergency obstetric interventions. This finding is consistent with previous studies that have reported that inexperienced surgeons are more prone to procedural delays during emergencies (20,23). It emphasises the importance of improving education, guidance, and oversight provided to junior doctors to refine their ability to make timely decisions and effectively perform emergency CS (24). \u0026nbsp;The lack of a significant association between operating theatre location and prolonged DDI is a novel contribution to the literature. Despite the main theatre at St. Mary\u0026rsquo;s Hospital Lacor being situated 105 metres away from the labour suite, our findings may suggest that efficient coordination and systematic organisation at the hospital could mitigate the potential delays caused by this spatial separation. Elements such as the readiness of surgical teams, prompt accessibility of anaesthetic services, and general operational effectiveness may play a more significant role in influencing the decision-to-delivery interval than the theatre\u0026apos;s physical location. However, as no previous studies have specifically examined this dynamic, further studies across diverse settings are necessary to substantiate this observation. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe absence of significant evidence of association between the presence of intern healthcare professionals and the prolonged DDI may suggest that while interns support the healthcare workforce, their presence alone does not markedly impact the timeliness of emergency CS. This finding may imply that other elements, such as the specific roles assigned to interns, the quality of supervision provided, and the cohesion within the surgical team, may be more decisive in ensuring efficiency during emergency CS. Additionally, no studies to date have specifically examined this relationship in contexts such as Uganda\u0026rsquo;s healthcare system, where a shortage of senior doctors necessitates reliance on interns deployed by the Ministry of Health. Further investigation across similar resource-limited settings is warranted to confirm and expand upon this finding. In addition, we found no evidence that the associations between surgeon cadre, operating theatre location, or presence of intern healthcare professionals and DDI varied according to the indication for emergency caesarean section. This may suggest that the factors influencing delays are broadly similar across different clinical scenarios. Nevertheless, it remains possible that subtle differences by indication could exist but were not detected due to limited statistical power for some subgroups. Future studies with larger sample sizes could explore this further to clarify whether certain indications may be more susceptible to DDI delays in specific contexts.\u003c/p\u003e\n\u003cp\u003eOur study had many strengths. First, the high completeness of data for most key variables strengthens the internal validity of our findings. Second, the cohort design enabled examination of multiple exposure variables and adjustment for potential confounders in the assessment of factors associated with DDI. Importantly, our study addresses an underexplored area by investigating whether the proximity of the operating theatre to the labour suite and the presence of intern healthcare professionals influence DDI, aspects not examined in previous research. However, some limitations must be acknowledged. Our study may have lacked sufficient power to identify nuanced effect modification, and the absence of statistically significant interactions could reflect a Type II error rather than a true lack of differential effects. Furthermore, as a single-centre investigation conducted in a private tertiary hospital, the generalisability of our findings to primary healthcare facilities or public sector hospitals may be limited. Finally, while DDI is a critical clinical metric, we did not directly evaluate maternal or neonatal outcomes in relation to the intervals observed.\u003c/p\u003e\n\u003cp\u003eOur findings highlight the need to enhance emergency obstetric care in resource-limited settings by prioritising structured training, mentorship, and supervision for junior doctors. Structured mentorship schemes or simulation-based training may help reduce delays and improve DDI for emergency CS (25,26). Future research should explore the direct relationship between prolonged DDI and maternal and neonatal outcomes and evaluate interventions such as mentorship or simulation training aimed at reducing DDI delays in this setting.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study demonstrates that emergency caesarean sections performed by junior doctors are associated with significantly increased odds of a prolonged decision-to-delivery interval compared to those performed by senior doctors. In contrast, no significant association was found between operating theatre location or the presence of intern healthcare professionals and prolonged decision-to-delivery intervals. These findings emphasise the importance of structured training, mentorship, and supervision to support junior doctors in delivering timely emergency obstetric care. While our results suggest that efficient coordination may mitigate spatial challenges between labour wards and theatres, further research across diverse settings is warranted. Strengthening surgical capacity at all levels remains critical to improving the quality of emergency obstetric services, particularly in resource-limited settings (27).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCI:\u003c/strong\u003e Confidence intervals\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCS:\u003c/strong\u003e Caesarean section\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDDI:\u003c/strong\u003e Decision-to-Delivery Interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmOC:\u003c/strong\u003e Emergency obstetric care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIQR:\u003c/strong\u003e\u0026nbsp; Interquartile range\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLRT:\u003c/strong\u003e Likelihood ratio test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOR:\u003c/strong\u003e Odds ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO:\u003c/strong\u003e World Health Organisation\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the St. Mary\u0026rsquo;s Hospital Lacor Research Ethics Committee on 31 January 2024, reference number LACOR-2023-272. Approval was attained before any analysis or use of the clinical data for research purposes commenced on 2 September 2024. The permission to conduct the study at St. Mary\u0026rsquo;s Hospital Lacor was obtained from the hospital administration. Owing to the retrospective design of the study, the ethics committee waived the requirement for informed consent. Throughout the research process, strict measures were taken to ensure the confidentiality of patient information.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed for this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any external funding. The resources and support for this work were provided by St. Mary\u0026rsquo;s Hospital Lacor, where the research was conducted. The authors declare no commercial funding related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHeO, RO,PB, EAO, OO, RKa, EO, NA, HA, JPA, DE, JN, DM, EL, HO, ML, MG, EW, OC, RKo, JO, and SO contributed to the conception and design of the study. HeO, EW, OC, EO, JO, and RKo performed formal data analysis. HeO, SO, DE, DM, RKa, EW, OC, EO, JO, and RKo contributed to drafting the manuscript. OB and OMA contributed to study implementation and data acquisition. HeO, RO,PB, EAO, OO, RKa, EO, NA, HA, JPA, DE, JN, DM, EL, HO, ML, MG, EW, OC, RKo, JO, and SO critically reviewed and revised the manuscript for key content. HeO prepared the final manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to express our profound appreciation to the participants. We extend our heartfelt gratitude to the doctors, nursing and midwifery staff, anaesthesia team, and non-clinical team of St. Mary\u0026rsquo;s Hospital Lacor for their assistance and teamwork during the study period. Our sincere appreciation also goes to the hospital administration for allowing us to carry out this research and for their unwavering support. This study owes its success to the general contributions of all those involved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSoltanifar S, Russell R. The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. International Journal of Obstetric Anesthesia. 2012 Jul;21(3):264\u0026ndash;72.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBlack R, Laxminarayan R, Temmerman M, Walker N, editors. Disease Control Priorities, Third Edition (Volume 2): Reproductive, Maternal, Newborn, and Child Health [Internet]. 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Health Science Reports. 2023 Jan;6(1):e1050.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWorld Health Organization, United Nations Population Fund, Mailman School of Public Health. Averting Maternal Death and Disability, United Nations Children\u0026rsquo;s Fund (UNICEF). Monitoring emergency obstetric care : a handbook. Surveillance des soins obst\u0026eacute;tricaux d\u0026rsquo;urgence : manuel d\u0026rsquo;utilisation. 2009;152.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDegu Ayele A, Getnet Kassa B, Nibret Mihretie G, Yenealem Beyene F. Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020. IJWH. 2021 Apr;Volume 13:395\u0026ndash;403.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKitaw TM, Tsegaw Taye B, Tadese M, Getaneh T. Effect of decision to delivery interval on perinatal outcomes during emergency cesarean deliveries in Ethiopia: A prospective cohort study. Garzon S, editor. PLoS ONE. 2021 Nov 8;16(11):e0258742.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKm O, Ao O, Ajao Ht B, Ma A, Ta A. Determinants of Decision to Delivery Interval (DDI) in Emergency Caesarean Sections in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Nigeria. Clinics Mother Child Health [Internet]. 2018 [cited 2023 Sep 2];15(2). Available from: https://www.omicsonline.org/open-access/determinants-of-decision-to-delivery-interval-ddi-in-emergency-caesarean-sections-in-ladoke-akintola-university-of-technology-teac-2090-7214-1000294-102283.html\u003c/li\u003e\n \u003cli\u003eBidon C, Desgranges FP, Riegel AC, Allaouchiche B, Chassard D, Bouvet L. Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France. Anaesthesia Critical Care \u0026amp; Pain Medicine. 2019 Dec;38(6):623\u0026ndash;30.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKinsella SM. A 20‐minute decision‐delivery interval at emergency caesarean section using general anaesthesia: a clinically‐relevant target. Anaesthesia. 2021 Aug;76(8):1021\u0026ndash;5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKamotho D, Pertet AM, Ogwayo I. Decision to incision interval for emergency caesarean section and postoperative outcomes in a resource limited rural Kenyan public hospital. Int J Reprod Contracept Obstet Gynecol. 2018 Jun 27;7(7):2573.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eQadir Khan M, Afridi F, S.Ghayur M. To Determine the Decision to Delivery Interval in Category I Emergency Caesarean Sections in A Tertiary Care Hospital of Peshawar. J Gandhara Med Dent Sci. 2023 Jan 1;10(1):62\u0026ndash;5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePrawitasari S, Widyandana D, Hakimi M, Utarini A. Decision to Delivery Interval in Emergency Cesarean Section at Two Academic Hospitals in Yogyakarta and Central Java, Indonesia. Bali Med J. 2021 Apr 1;10(1):266\u0026ndash;72.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBoriboonhirunsarn D, Sunsaneevithayakul P. A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section. Journal of Obstetrics and Gynaecology. 2022 Jul 4;42(5):999\u0026ndash;1003.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIgwe PC, Egede JO, Ogah EO, Anikwe CC, Nwali MI, Lawani LO. Association and Determinants of Decision-Delivery Interval of Emergency Caesarean Sections and Perinatal Outcome in a Tertiary Institution. JCDR [Internet]. 2021 [cited 2023 Sep 2]; Available from: https://jcdr.net/article_fulltext.asp?issn=0973-709x\u0026amp;year=2021\u0026amp;volume=15\u0026amp;issue=3\u0026amp;page=QC01\u0026amp;issn=0973-709x\u0026amp;id=14596\u003c/li\u003e\n \u003cli\u003eK DrR, E DrG. A prospective observational study on decision to delivery interval and perinatal outcome in emergency caesarean section in tertiary care hospital. Int J Clin Obstet Gynaecol. 2021 Jan 1;5(1):19\u0026ndash;25.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGupta S, Naithani U, Madhanmohan C, Singh A, Reddy P, Gupta A. Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2017;33(1):64.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNair VV, Nair SS, Venugopalan P. Decision to delivery interval in emergency LSCS and its impact on fetal outcome. Int J Reprod Contracept Obstet Gynecol. 2019 Aug 26;8(9):3679.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNelson JP. Indications and appropriateness of caesarean sections performed in a tertiary referral centre in Uganda: a retrospective descriptive study. Pan Afr Med J [Internet]. 2017 [cited 2023 Dec 21];26. Available from: http://www.panafrican-med-journal.com/content/article/26/64/full/\u003c/li\u003e\n \u003cli\u003eSt Mary\u0026rsquo;s Hospital Lacor. Annual Hospital Report - Financial year July 2021 - June 2022 [Internet]. 2022 Jun p. 25\u0026ndash;7. Available from: https://www.lacorhospital.org/wp-content/uploads/2023/08/FY-2021-22-Annual-Report-Fin.pdf\u003c/li\u003e\n \u003cli\u003eLulgi G, Ochola E, Omona V. Intervention to strengthen the quality of care and empowerment of health personnel in the Acholi region, Northern Uganda: 2018-2021 [Internet]. 2021 Sep p. 29\u0026ndash;30. Available from: https://fondazionecorti.it/wp-content/uploads/2014/07/RBF-study-2021.pdf\u003c/li\u003e\n \u003cli\u003eApako T, Wani S, Oguttu F, Nambozo B, Nahurira D, Nantale R, et al. Decision to delivery interval for emergency caesarean section in Eastern Uganda: A cross-sectional study. Alwy Al-beity F, editor. PLoS ONE. 2023 Sep 27;18(9):e0291953.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMannella P, Pancetti F, Giannini A, Russo E, Montt-Guevara M, Simoncini T. Five actions for five people: emergency cesarean section protocol. BMC Pregnancy Childbirth. 2023 Apr 20;23:272.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDraycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, et al. Does training in obstetric emergencies improve neonatal outcome? BJOG. 2006 Feb;113(2):177\u0026ndash;82.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBerghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery. American Journal of Obstetrics and Gynecology. 2005 Nov;193(5):1607\u0026ndash;17.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKnight HE, Self A, Kennedy SH. Why Are Women Dying When They Reach Hospital on Time? A Systematic Review of the \u0026lsquo;Third Delay\u0026rsquo;. PLOS ONE. 2013 May 21;8(5):e63846.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Emergency caesarean section, decision-to-delivery interval, surgeon cadre, low-resource setting, Northern Uganda","lastPublishedDoi":"10.21203/rs.3.rs-6491008/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6491008/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground:\u003c/em\u003e Emergency caesarean sections (CS) are critical to avert adverse maternal and neonatal outcomes. The Decision-to-Delivery Interval (DDI), the interval between making the decision and achieving delivery of a newborn in an emergency CS, impacts maternal and neonatal outcomes. Although the World Health Organisation recommends achieving a DDI of \u0026lt;30 minutes, this is often difficult in resource-constrained areas. This study assessed the influence of the surgeon’s cadre, operating theatre location, and presence of intern healthcare professionals on DDI and whether these relationships differed by CS indication.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods:\u003c/em\u003e We conducted a historical cohort study at St. Mary’s Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. We also assessed effect modification by CS indication.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults:\u003c/em\u003e Of the 760 participants enrolled (median DDI was 51 minutes (IQR: 36-67)), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to senior doctors (adjusted OR: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (OR: 0.89; 95% CI: 0.61-1.28) and (OR: 0.71; 95% CI: 0.51-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions:\u003c/em\u003e Emergency CS performed by junior doctors is associated with increased odds of prolonged DDI compared to those performed by senior doctors, emphasising the need to strengthen training, supervision, and mentorship for inexperienced surgeons. While theatre location and intern presence were not significantly associated with DDI, further research across diverse settings is warranted.\u003c/p\u003e","manuscriptTitle":"Impact of Surgeon cadre, theatre location, and presence of intern healthcare professionals on decision-to-delivery interval in women undergoing emergency caesarean section in Northern Uganda: a historical cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:56:56","doi":"10.21203/rs.3.rs-6491008/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4381cb71-593e-4a89-96cf-f980e69c700b","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T05:24:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:56:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6491008","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6491008","identity":"rs-6491008","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}