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Decision-to-Incision Times and Maternal and Infant Outcomes

Bloom, Steven L. MD1; Leveno, Kenneth J. MD1; Spong, Catherine Y. MD2; Gilbert, Sharon MS3; Hauth, John C. MD4; Landon, Mark B. MD5; Varner, Michael W. MD6; Moawad, Atef H. MD7; Caritis, Steve N. MD8; Harper, Margaret MD9; Wapner, Ronald J. MD10; Sorokin, Yoram MD11; Miodovnik, Menachem MD12; O’Sullivan, Mary J. MD13; Sibai, Baha M. MD14; Langer, Oded MD15; Gabbe, Steven G. MD16

doi: 10.1097/01.AOG.0000224693.07785.14
Original Research

OBJECTIVE: To measure decision-to-incision intervals and related maternal and neonatal outcomes in a cohort of women undergoing emergency cesarean deliveries at multiple university-based hospitals comprising the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network.

METHODS: All women undergoing a primary cesarean delivery at a Network center during a 2-year time span were prospectively ascertained. Emergency procedures were defined as those performed for umbilical cord prolapse, placental abruption, placenta previa with hemorrhage, nonreassuring fetal heart rate pattern, or uterine rupture. Detailed information regarding maternal and neonatal outcomes, including the interval from the decision time to perform cesarean delivery to the actual skin incision, was collected.

RESULTS: Of the 11,481 primary cesarean deliveries, 2,808 were performed for an emergency indication. Of these, 1,814 (65%) began within 30 minutes of the decision to operate. Maternal complication rates, including endometritis, wound infection, and operative injury, were not related to the decision-to-incision interval. Measures of newborn compromise including umbilical artery pH less than 7 and intubation in the delivery room were significantly greater when the cesarean delivery was commenced within 30 minutes, likely attesting to the need for expedited delivery. Of the infants with indications for an emergency cesarean delivery who were delivered more than 30 minutes after the decision to operate, 95% did not experience a measure of newborn compromise.

CONCLUSION: Approximately one third of primary cesarean deliveries performed for emergency indications are commenced more than 30 minutes after the decision to operate, and the majority were for nonreassuring heart rate tracings. In these cases, adverse neonatal outcomes were not increased.

LEVEL OF EVIDENCE: II-2

Approximately one third of all primary cesarean deliveries performed in labor for an emergency indication are commenced more than 30 minutes after the decision to operate.

From the 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; 2National Institute of Child Health and Human Development, Bethesda, Maryland; 3George Washington University Biostatistics Center, Rockville, Maryland; 4Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama; 5Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio; 6Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; 7Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; 8Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania; 9Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, North Carolina; 10Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania; 11Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan; 12Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio; 13Department of Obstetrics and Gynecology, University of Miami, Miami, Florida; 14Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee; 15Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, Texas; and 16Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.

See related editorial on page 2.

* For members of the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, see the Appendix.

Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, and HD36801).

Presented at the 22nd Annual Meeting of the Society for Maternal–Fetal Medicine, January 14-19, 2002, New Orleans, LA.

Corresponding author: Steven L. Bloom, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX; e-mail: steven.bloom@utsouthwestern.edu.

© 2006 The American College of Obstetricians and Gynecologists