Time between skin incision and delivery during cesarean

Area of Science:

• Obstetrics and Gynecology
• Surgical Outcomes Research

Background:

• Cesarean delivery is a common surgical procedure with varying operative times.
• Understanding factors influencing surgical duration is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To identify factors affecting skin incision-to-delivery time during cesarean sections.
• To assess the impact of these surgical intervals on immediate neonatal outcomes, specifically the 5-minute Apgar score.

Main Methods:

• Prospective cohort study of 1120 cesarean deliveries at Tygerberg Hospital, South Africa.
• Evaluation of three surgical intervals: skin incision to myometrium, myometrium to delivery, and skin incision to delivery.
• Neonatal outcome assessed using the 5-minute Apgar score.

Main Results:

• Emergency cesarean deliveries were performed significantly faster than elective ones (P<0.01).
• Presence of adhesions (7.4% primary vs. 67.7% repeat procedures, P<0.001) and repeat procedures significantly prolonged skin incision-to-delivery time (P<0.001).
• Increased obesity also correlated with longer operative times (P<0.001), though no interval correlated with a low 5-minute Apgar score (<7) in emergency deliveries.

Conclusions:

• Repeat cesarean deliveries, surgical adhesions, and obesity are significant factors that prolong operative time.
• Despite prolonged surgical times due to these factors, the immediate neonatal outcome, as measured by the 5-minute Apgar score, was minimally affected.
• These findings highlight the need for efficient surgical planning in repeat cesarean deliveries, particularly in cases with adhesions or obesity.