Leslie Moroz1, Marianne DiNapoli2, Mary D'Alton2, Cynthia Gyamfi-Bannerman2. 1. Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY. Electronic address: lm3000@cumc.columbia.edu. 2. Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
Abstract
OBJECTIVE: The purpose of this study was to determine whether surgical speed is associated with maternal outcomes in women who have a history of previous cesarean delivery (CD) and who require emergent delivery. STUDY DESIGN: This is a secondary analysis of a multicenter, prospective observational study of women with a history of previous CD. Women who attempted a vaginal birth after CD and required emergent CD were dichotomized into those with a skin incision-to-fetal delivery time of ≤2 min (I-D ≤2) or >2 min (I-D >2), based on the mode I-D. Rates of composite maternal complications and specific surgical complications were compared. RESULTS: Seven hundred ninety-three women had an emergency repeat CD: 108 women (13.6%) had I-D ≤2, and 685 women (86.4%) had I-D >2. The composite of maternal morbidity occurred in 36% of women with I-D≤2 and 23% with I-D>2 (P < .01). Women with I-D ≤2 had higher odds of intraoperative transfusion, uterine artery ligation, and broad ligament hematoma. In a multivariable regression model, the only variable that remained associated with maternal outcome was I-D (relative risk, 1.66; 95% confidence interval, 1.23-2.23). There was no difference in the incidence of neonatal acidemia between groups. CONCLUSION: Among women who underwent emergent repeat cesarean delivery, surgical speed was associated with an increased risk for maternal complications.
OBJECTIVE: The purpose of this study was to determine whether surgical speed is associated with maternal outcomes in women who have a history of previous cesarean delivery (CD) and who require emergent delivery. STUDY DESIGN: This is a secondary analysis of a multicenter, prospective observational study of women with a history of previous CD. Women who attempted a vaginal birth after CD and required emergent CD were dichotomized into those with a skin incision-to-fetal delivery time of ≤2 min (I-D ≤2) or >2 min (I-D >2), based on the mode I-D. Rates of composite maternal complications and specific surgical complications were compared. RESULTS: Seven hundred ninety-three women had an emergency repeat CD: 108 women (13.6%) had I-D ≤2, and 685 women (86.4%) had I-D >2. The composite of maternal morbidity occurred in 36% of women with I-D≤2 and 23% with I-D>2 (P < .01). Women with I-D ≤2 had higher odds of intraoperative transfusion, uterine artery ligation, and broad ligament hematoma. In a multivariable regression model, the only variable that remained associated with maternal outcome was I-D (relative risk, 1.66; 95% confidence interval, 1.23-2.23). There was no difference in the incidence of neonatal acidemia between groups. CONCLUSION: Among women who underwent emergent repeat cesarean delivery, surgical speed was associated with an increased risk for maternal complications.
Authors: William A Grobman; Jennifer Bailit; Grecio Sandoval; Uma M Reddy; Ronald J Wapner; Michael W Varner; John M Thorp; Steve N Caritis; Mona Prasad; Alan T N Tita; George R Saade; Yoram Sorokin; Dwight J Rouse; Sean C Blackwell; Jorge E Tolosa Journal: Am J Perinatol Date: 2017-09-15 Impact factor: 1.862