OBJECTIVE: To compare incision-to-delivery intervals and related maternal and neonatal outcomes by skin incision in primary and repeat emergent cesarean deliveries.
METHODS: From 1999 to 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 hospitals comprising the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Maternal–Fetal Medicine Units Network. This secondary analysis was limited to emergent procedures, defined as those performed for cord prolapse, abruption, placenta previa with hemorrhage, nonreassuring fetal heart rate tracing, or uterine rupture. Incision-to-delivery intervals, incision-to-closure intervals, and maternal outcomes were compared by skin-incision type (transverse compared with vertical) after stratifying for primary compared with repeat singleton cesarean delivery. Neonatal outcomes were compared by skin-incision type.
RESULTS: Of the 37,112 live singleton cesarean deliveries, 3,525 (9.5%) were performed for emergent indications of which 2,498 (70.9%) were performed by transverse and the remaining 1,027 (29.1%) by vertical incision. Vertical skin incision shortened median incision-to-delivery intervals by 1 minute (3 compared with 4 minutes, P<.001) in primary and 2 minutes (3 compared with 5 minutes, P<.001) in repeat cesarean deliveries. Total median operative time was longer after vertical skin incision by 3 minutes in primary (46 compared with 43 minutes, P<.001) and 4 minutes in repeat cesarean deliveries (56 compared with 52 minutes, P<.001). Neonates delivered through a vertical incision were more likely to have an umbilical artery pH of less than 7.0 (10% compared with 7%, P=.02), to be intubated in the delivery room (17% compared with 13%, P=.001), or to be diagnosed with hypoxic ischemic encephalopathy (3% compared with 1%, P<.001).
CONCLUSION: In emergency cesarean deliveries, neonatal delivery occurred more quickly after a vertical skin incision, but this was not associated with improved neonatal outcomes.
LEVEL OF EVIDENCE: II
Performing emergency cesarean delivery by vertical skin incision is slightly faster than delivery by transverse incision, but this is not associated with improved neonatal outcomes.
From the Departments of Obstetrics and Gynecology, Columbia University, New York, New York; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Utah, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University Health Sciences, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; the University of Cincinnati, Cincinnati, Ohio; the University of Miami, Miami, Florida; the University of Tennessee, Memphis, Tennessee; the University of Texas at San Antonio, San Antonio, Texas; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
*For a list of other members of the NICHD MFMU, see the Appendix online at http://links.lww.com/AOG/A177.
Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD36801).
The authors thank Francee Johnson, BSN, for protocol development and coordination between clinical research centers; Elizabeth Thom, PhD, for protocol and data management and statistical analysis; and John C. Hauth, MD, for protocol development and oversight.
Presented at the 53rd Annual Scientific Meeting of the Society for Gynecologic Investigation, March 22–25, 2006, Toronto, Canada.
Dr. Spong, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.
Corresponding author: Blair J. Wylie, MD, MPH, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail: firstname.lastname@example.org.
Financial Disclosure Dr. Landon received honoraria for doing grand rounds at various institutions and travel and accommodation expenses covered or reimbursed for grand rounds. Dr. Leveno received royalties for the Williams Obstetrics textbook. Dr. Varner received grants or grants pending from the National Institute of Child Health and Human Development (NICHD) for research conducted with funding from the NICHD Maternal–Fetal Medicine Units Network. Dr. Miodovnik received a grant, NIH-NICHD HD-27905-05 (until 2003). Dr. O'Sullivan was reimbursed for travel expenses related to this study by the NICHD; participated in the data monitoring committee after no longer a member of the study group and the compensation for travel and hotel was reimbursed by the NICHD; received a grant or has grants pending from the National Heart, Lung and Blood Institute for The Women's Health Initiative (WHI; The National Children's Study, sponsored by the National Institutes of Health); travel and accommodation expenses were reimbursed by NHLBI for the WHI annual meeting. The other authors did not report any potential conflicts of interest.