William A Grobman1, Jennifer Bailit2, Grecio Sandoval3, Uma M Reddy4, Ronald J Wapner5, Michael W Varner6, John M Thorp7, Steve N Caritis8, Mona Prasad9, Alan T N Tita10, George R Saade11, Yoram Sorokin12, Dwight J Rouse13, Sean C Blackwell14, Jorge E Tolosa15. 1. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 2. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. 3. Biostatistics Center, George Washington University, Washington, District of Columbia. 4. Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland. 5. Department of Obstetrics and Gynecology, Columbia University, New York, New York. 6. Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah. 7. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 8. Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio. 10. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama. 11. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. 12. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan. 13. Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island. 14. Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas. 15. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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