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

William A. Grobman; Jennifer Bailit; Grecio Sandoval; Uma M. Reddy; Ronald J. Wapner; Michael W. Varner; John M. Thorp Jr.; Steve N. Caritis; Mona Prasad; Alan T. N. Tita; George R. Saade; Yoram Sorokin; Dwight J. Rouse; Sean C. Blackwell; Jorge E. Tolosa; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

doi:10.1055/s-0037-1606641

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(03): 247-253
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. Grobman

¹Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

,

Jennifer Bailit

²Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio

,

Grecio Sandoval

³Biostatistics Center, George Washington University, Washington, District of Columbia

,

Uma M. Reddy

⁴Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

Ronald J. Wapner

⁵Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Michael W. Varner

⁶Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah

,

John M. Thorp Jr.

⁷Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Steve N. Caritis

⁸Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania

,

Mona Prasad

⁹Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

,

Alan T. N. Tita

¹⁰Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

George R. Saade

¹¹Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Yoram Sorokin

¹²Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

,

Dwight J. Rouse

¹³Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island

,

Sean C. Blackwell

¹⁴Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas

,

Jorge E. Tolosa

¹⁵Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon

,

for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

› Author Affiliations

Abstract

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.

Keywords

cesarean delivery - decision-to-incision interval - perinatal outcomes - maternal outcomes

Full Text

References

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