Amer J Perinatol
DOI: 10.1055/s-0037-1606641
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes

William A. Grobman1, Jennifer Bailit2, Grecio Sandoval3, Uma M. Reddy4, Ronald J. Wapner5, Michael W. Varner6, John M. Thorp Jr.7, Steve N. Caritis8, Mona Prasad9, Alan T. N. Tita10, George R. Saade11, Yoram Sorokin12, Dwight J. Rouse13, Sean C. Blackwell14, Jorge E. Tolosa15, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network, *
  • 1Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
  • 2Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
  • 3Biostatistics Center, George Washington University, Washington, District of Columbia
  • 4Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
  • 5Department of Obstetrics and Gynecology, Columbia University, New York, New York
  • 6Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
  • 7Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • 8Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 9Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
  • 10Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
  • 11Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
  • 12Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
  • 13Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
  • 14Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas
  • 15Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
Further Information

Publication History

05 July 2017

21 August 2017

Publication Date:
15 September 2017 (eFirst)


Objective The objective of this study was to estimate whether the decision-to-incision (DTI) time for cesarean delivery (CD) is associated with differences in maternal and neonatal outcomes.

Methods This analysis is of data from women at 25 U.S. medical centers with a term, singleton, cephalic nonanomalous gestation and no prior CD, who underwent an intrapartum CD. Perinatal and maternal outcomes associated with DTI intervals of ≤ 15, 16 to 30, and > 30 minutes were compared.

Results Among 3,482 eligible women, median DTI times were 46 and 27 minutes for arrest and fetal indications for CD, respectively (p < 0.01). Women with a fetal indication whose DTI interval was > 30 minutes had similar odds to the referent group (DTI of 16–30 minutes) for the adverse neonatal and maternal composites (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.40–1.71 and OR: 0.89, 95% CI: 0.63–1.27). For arrest disorders, the odds of the adverse neonatal composite were lower among women with a DTI of > 30 minutes (OR: 0.25, 95% CI: 0.08–0.77), and the adverse maternal composite was no different (OR: 1.15, 95% CI: 0.81–1.63).

Conclusion In this analysis, DTI times longer than 30 minutes were not associated with worse maternal or neonatal outcomes.

* See Appendix for a list of other members of the NICHD MFMU Network.