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, Steve N. Caritis, Mona Prasad, Alan T.N. Tita, George Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
JournalAmerican Journal of Perinatology
DOIs
StateAccepted/In press - Aug 21 2017

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Mothers
Odds Ratio
Confidence Intervals
Decision Support Techniques
Head
Pregnancy

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Grobman, W. A., Bailit, J., Sandoval, G., Reddy, U. M., Wapner, R. J., Varner, M. W., ... Tolosa, J. E. (Accepted/In press). The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes. American Journal of Perinatology. https://doi.org/10.1055/s-0037-1606641

The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes. / Grobman, William A.; Bailit, Jennifer; Sandoval, Grecio; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Caritis, Steve N.; Prasad, Mona; Tita, Alan T.N.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.

In: American Journal of Perinatology, 21.08.2017.

Research output: Contribution to journalArticle

Grobman, WA, Bailit, J, Sandoval, G, Reddy, UM, Wapner, RJ, Varner, MW, Thorp, JM, Caritis, SN, Prasad, M, Tita, ATN, Saade, G, Sorokin, Y, Rouse, DJ, Blackwell, SC & Tolosa, JE 2017, 'The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes', American Journal of Perinatology. https://doi.org/10.1055/s-0037-1606641
Grobman, William A. ; Bailit, Jennifer ; Sandoval, Grecio ; Reddy, Uma M. ; Wapner, Ronald J. ; Varner, Michael W. ; Thorp, John M. ; Caritis, Steve N. ; Prasad, Mona ; Tita, Alan T.N. ; Saade, George ; Sorokin, Yoram ; Rouse, Dwight J. ; Blackwell, Sean C. ; Tolosa, Jorge E. / The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes. In: American Journal of Perinatology. 2017.
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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.",
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AU - Grobman, William A.

AU - Bailit, Jennifer

AU - Sandoval, Grecio

AU - Reddy, Uma M.

AU - Wapner, Ronald J.

AU - Varner, Michael W.

AU - Thorp, John M.

AU - Caritis, Steve N.

AU - Prasad, Mona

AU - Tita, Alan T.N.

AU - Saade, George

AU - Sorokin, Yoram

AU - Rouse, Dwight J.

AU - Blackwell, Sean C.

AU - Tolosa, Jorge E.

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N2 - 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.

AB - 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.

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KW - perinatal outcomes

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