Time between skin incision and delivery during cesarean.

OBJECTIVE

To investigate factors influencing skin incision-to-delivery time (including sub-divisions thereof) and the effect of these surgical intervals on immediate neonatal outcome.

METHODS

A prospective cohort analysis was conducted of all women undergoing cesarean delivery at Tygerberg Hospital, Cape Town, South Africa, from May 24 to November 2, 2010. Three surgical intervals were evaluated: skin incision to myometrium, myometrium to delivery, and skin incision to delivery. Neonatal outcome was assessed by the 5-minute Apgar score.

RESULTS

Of 1120 cesarean deliveries recorded during the study period, 77.2% were emergency procedures, which were performed more quickly at all surgical planes (P<0.01). Adhesions in the surgical field were present in 7.4% of all primary procedures versus 67.7% of all third procedures (P<0.001). The skin incision-to-delivery time was significantly extended among repeat procedures (P<0.001) and increased progressively with degree of obesity (P<0.001). Although the 3 surgical intervals were calculated individually, none of the median values correlated with a 5-minute Apgar score below 7 for emergency deliveries.

CONCLUSION

Repeat procedures, adhesions, and obesity prolonged the time taken for cesarean delivery. Nevertheless, the effect of these factors on the 5-minute Apgar score was minimal.