Cesarean deliveries are the most commonly performed surgical procedure in the United States. Several factors can impact surgical times, thereby influencing neonatal outcomes. This study explores the relationship between time-to-delivery in cesarean deliveries and its impact on neonatal outcomes.METHODS:
We used medical record data from all singleton, liveborn, non-anomalous cesarean deliveries from January–July 2010 at Stony Brook University Hospital. The primary outcome was a novel neonatal outcome score (NOS) that was the sum of numerically-weighted neonatal characteristics at birth, including use of resuscitative measures, with higher scores reflecting a poorer neonatal outcome. This score was categorized into three groups: no (NOS=0), minor (NOS=1) and major (NOS greater than 2) morbidity. We performed chi-square tests and multinomial logistic regression analyses.RESULTS:
Controlling for confounders, a uterine incision-to-delivery time of 3-minutes or greater, compared with a 1-minute uterine incision-to-delivery time, was associated with a 1.03 unit increase (CI=0.35, 1.70) in the multinomial log-odds of major neonatal morbidity compared to no morbidity. General anesthesia compared to spinal anesthesia was associated with an increased multinomial log-odds of major neonatal morbidity. Preterm neonates compared to full-term neonates had an increased multinomial log-odds of major morbidity.CONCLUSION:
We found that longer uterine incision-to-delivery times were associated with major neonatal morbidity. There is a need for a tool to immediately evaluate newborn wellbeing in the operating room. Our score incorporates key components to assess the neonate, and provides a simple approach to doing so. Future directions include validating this score and studying it in a larger neonatal population.