LAUSR

OBJECTIVE Timely response to obstetrical emergencies is highly desired. The recommendation for decision-to-incision (DTI) time in cesarean delivery (CD) of not more than 30 minutes was issued to prevent neonatal hypoxic-ischemic morbidities. We analyzed the efficiency with which an institutional-specific CD acuity classification system (emergent case: target DTI≤15min; urgent case: target DTI≤30min) reflected in the actual DTI time, Apgar scores and newborn acid-base status. METHODS Data on all 610 CSs performed over a 14-month period at a tertiary medical center was retrospectively extracted. Cases grouped by target DTI time categories were compared for proportions in low Agar scores and fetal acidosis. Multi-variable regression was used to identify clinical variables associated with need for neonatal resuscitation. RESULTS During the study period, 60 (10%) of CSs were emergent, 296 (49%) urgent and 254 (41%) elective. The target DTI ≤15 min. was achieved in 68% of emergent CSs with 93% having a DTI≤30 min. Among urgent surgeries, the target DTI≤30 min was reached in 48% of cases with 83% having DTI≤45 min. Compared to both urgent and scheduled procedures the incidence of newborn acidosis and Apgar scores ≤4 and ≤7 was highest amongst emergent CSs. The proportion of moderate and severe acidosis for deliveries with DTI≤15 min was significantly higher compared to procedures with DTI 16-30 min. and DTI>30 min. The need for neonatal resuscitation, including intubation were independently associated with fetal acidosis, low gestational age, surgery acuity level, general anesthesia, but not with the actual DTI time. CONCLUSIONS Adherence to tight DTI time targets is pragmatically difficult. The need for neonatal resuscitation varies with the acuity of the procedure but not with the actual DTI interval, implying that within certain time limits, the indication for surgery plays a greater role in the status of the newborn than the speed of the CS.