Background: The decision-to-delivery time is the interval between the decision and the child birth by emergency caesarean delivery. The Royal College of Obstetricians and Gynecologists and American College of Obstetricians and Gynecologists recommended that decision to delivery time interval is to be less than 30 minutes. Additionally, the decision to delivery time is vary across the instutions and countiries. 

Objective: The aim of this study was to determine decision to delivery time and its predictors among women underwent emergency cesarean delivery at selected Hospitals of north west Ethiopia, 2023.

Method: institutional based prospective cohort study was conducted at selected hospitals of North west Ethiopia, among women underwent emergence cesarean delivery from November 1 to January 30, 2023. around 285 participants were enrolled, and collected using structured and pre-tested questionnaire. A systematic sampling technique was used.  Data entered into epi-data version 4.6 then exported to STATA 15 for further analysis. The log rank test was utilized to compare group differences. The time is estimated by using Kaplan Meier curve and Cox proportional-hazard regression analysis was carried out to determine the predictors. 

Result: From 285, 56(21.8%) women delivered within the recommended 30 minutes. The overall median survival time was undetermined and the restricted mean survival time was 48.9minute (95% CI: 47.4, 50.5). The average decision to delivery time is affected among women who hesitate to accept consent (AHR: 0.17, 95% CI: 0.02-1.25), Cord prolapses (AHR: 1.36, 0.46-3.94), Rank of surgeon (AHR: 0.42 95% CI: 0.42-1.08), No free operation room table (AHR: 0.27, 95% CI: 0.28, 0.94), Regional ansthesia (AHR: 0.56, 95% CI: 0.25-1.28), Use of bladder flap (AHR: 0.33, 95% CI: 0.16-0.85).

Conclusion: Overall decision to delivery time among women underwent emergency cesarean section at selected Hospitals were longer than the recommended time. 

Keywords: Decision time, Emergency cesarean delivery