Comparison of transverse and vertical skin incision for emergency cesarean delivery

Blair J. Wylie, Sharon Gilbert, Mark B. Landon, Catherine Y. Spong, Dwight J. Rouse, Kenneth J. Leveno, Michael W. Varner, Steve N. Caritis, Paul J. Meis, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1134-1140
Number of pages7
JournalObstetrics and Gynecology
Volume115
Issue number6
DOIs
StatePublished - Jun 1 2010
Externally publishedYes

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Emergencies
Skin
Mothers
National Institute of Child Health and Human Development (U.S.)
Delivery Rooms
Uterine Rupture
Placenta Previa
Brain Hypoxia-Ischemia
Fetal Heart Rate
Umbilical Arteries
Prolapse
Operative Time
Cohort Studies
Medicine
Prospective Studies
Hemorrhage

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Wylie, B. J., Gilbert, S., Landon, M. B., Spong, C. Y., Rouse, D. J., Leveno, K. J., ... Langer, O. (2010). Comparison of transverse and vertical skin incision for emergency cesarean delivery. Obstetrics and Gynecology, 115(6), 1134-1140. https://doi.org/10.1097/AOG.0b013e3181df937f

Comparison of transverse and vertical skin incision for emergency cesarean delivery. / Wylie, Blair J.; Gilbert, Sharon; Landon, Mark B.; Spong, Catherine Y.; Rouse, Dwight J.; Leveno, Kenneth J.; Varner, Michael W.; Caritis, Steve N.; Meis, Paul J.; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded.

In: Obstetrics and Gynecology, Vol. 115, No. 6, 01.06.2010, p. 1134-1140.

Research output: Contribution to journalArticle

Wylie, BJ, Gilbert, S, Landon, MB, Spong, CY, Rouse, DJ, Leveno, KJ, Varner, MW, Caritis, SN, Meis, PJ, Wapner, RJ, Sorokin, Y, Miodovnik, M, O'Sullivan, MJ, Sibai, BM & Langer, O 2010, 'Comparison of transverse and vertical skin incision for emergency cesarean delivery', Obstetrics and Gynecology, vol. 115, no. 6, pp. 1134-1140. https://doi.org/10.1097/AOG.0b013e3181df937f
Wylie BJ, Gilbert S, Landon MB, Spong CY, Rouse DJ, Leveno KJ et al. Comparison of transverse and vertical skin incision for emergency cesarean delivery. Obstetrics and Gynecology. 2010 Jun 1;115(6):1134-1140. https://doi.org/10.1097/AOG.0b013e3181df937f
Wylie, Blair J. ; Gilbert, Sharon ; Landon, Mark B. ; Spong, Catherine Y. ; Rouse, Dwight J. ; Leveno, Kenneth J. ; Varner, Michael W. ; Caritis, Steve N. ; Meis, Paul J. ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Langer, Oded. / Comparison of transverse and vertical skin incision for emergency cesarean delivery. In: Obstetrics and Gynecology. 2010 ; Vol. 115, No. 6. pp. 1134-1140.
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abstract = "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.",
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T1 - Comparison of transverse and vertical skin incision for emergency cesarean delivery

AU - Wylie, Blair J.

AU - Gilbert, Sharon

AU - Landon, Mark B.

AU - Spong, Catherine Y.

AU - Rouse, Dwight J.

AU - Leveno, Kenneth J.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Meis, Paul J.

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Langer, Oded

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N2 - 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.

AB - 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.

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