Decision-to-incision times and maternal and infant outcomes

Steven L. Bloom, Kenneth J. Leveno, Catherine Y. Spong, Sharon Gilbert, John C. Hauth, Mark B. Landon, Michael W. Varner, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, Steven G. Gabbe

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)6-11
Number of pages6
JournalObstetrics and Gynecology
Volume108
Issue number1
DOIs
StatePublished - Jul 1 2006
Externally publishedYes

Fingerprint

Emergencies
Mothers
National Institute of Child Health and Human Development (U.S.)
Newborn Infant
Delivery Rooms
Uterine Rupture
Placenta Previa
Abruptio Placentae
Endometritis
Fetal Heart Rate
Umbilical Arteries
Umbilical Cord
Prolapse
Wound Infection
Intubation
Heart Rate
Medicine
Hemorrhage
Skin
Wounds and Injuries

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Bloom, S. L., Leveno, K. J., Spong, C. Y., Gilbert, S., Hauth, J. C., Landon, M. B., ... Gabbe, S. G. (2006). Decision-to-incision times and maternal and infant outcomes. Obstetrics and Gynecology, 108(1), 6-11. https://doi.org/10.1097/01.AOG.0000224693.07785.14

Decision-to-incision times and maternal and infant outcomes. / Bloom, Steven L.; Leveno, Kenneth J.; Spong, Catherine Y.; Gilbert, Sharon; Hauth, John C.; Landon, Mark B.; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Gabbe, Steven G.

In: Obstetrics and Gynecology, Vol. 108, No. 1, 01.07.2006, p. 6-11.

Research output: Contribution to journalArticle

Bloom, SL, Leveno, KJ, Spong, CY, Gilbert, S, Hauth, JC, Landon, MB, Varner, MW, Moawad, AH, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, O'Sullivan, MJ, Sibai, BM, Langer, O & Gabbe, SG 2006, 'Decision-to-incision times and maternal and infant outcomes', Obstetrics and Gynecology, vol. 108, no. 1, pp. 6-11. https://doi.org/10.1097/01.AOG.0000224693.07785.14
Bloom SL, Leveno KJ, Spong CY, Gilbert S, Hauth JC, Landon MB et al. Decision-to-incision times and maternal and infant outcomes. Obstetrics and Gynecology. 2006 Jul 1;108(1):6-11. https://doi.org/10.1097/01.AOG.0000224693.07785.14
Bloom, Steven L. ; Leveno, Kenneth J. ; Spong, Catherine Y. ; Gilbert, Sharon ; Hauth, John C. ; Landon, Mark B. ; Varner, Michael W. ; Moawad, Atef H. ; Caritis, Steve N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Langer, Oded ; Gabbe, Steven G. / Decision-to-incision times and maternal and infant outcomes. In: Obstetrics and Gynecology. 2006 ; Vol. 108, No. 1. pp. 6-11.
@article{7bde8ef0d4844277a3078767fc4845e5,
title = "Decision-to-incision times and maternal and infant outcomes",
abstract = "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.",
author = "Bloom, {Steven L.} and Leveno, {Kenneth J.} and Spong, {Catherine Y.} and Sharon Gilbert and Hauth, {John C.} and Landon, {Mark B.} and Varner, {Michael W.} and Moawad, {Atef H.} and Caritis, {Steve N.} and Margaret Harper and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Oded Langer and Gabbe, {Steven G.}",
year = "2006",
month = "7",
day = "1",
doi = "10.1097/01.AOG.0000224693.07785.14",
language = "English",
volume = "108",
pages = "6--11",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Decision-to-incision times and maternal and infant outcomes

AU - Bloom, Steven L.

AU - Leveno, Kenneth J.

AU - Spong, Catherine Y.

AU - Gilbert, Sharon

AU - Hauth, John C.

AU - Landon, Mark B.

AU - Varner, Michael W.

AU - Moawad, Atef H.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Gabbe, Steven G.

PY - 2006/7/1

Y1 - 2006/7/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=33746882840&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33746882840&partnerID=8YFLogxK

U2 - 10.1097/01.AOG.0000224693.07785.14

DO - 10.1097/01.AOG.0000224693.07785.14

M3 - Article

C2 - 16816049

AN - SCOPUS:33746882840

VL - 108

SP - 6

EP - 11

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 1

ER -