A study of factors influencing surgical cesarean delivery times in an academic tertiary center (original) (raw)
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Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2008
To determine the factors that influence caesarean operative time and operative time effects on pregnancy outcomes. Methods: Prospective observational study of women undergoing a caesarean delivery (CD). Multiple antepartum, intrapartum and neonatal outcomes were assessed for their influence on the time of the CD and the time effect of CD on pregnancy outcomes. Results: There were 386 (23%) caesarean deliveries performed ≤ 30 min, 1070 (65%) between 31 and 60 min, and 200 deliveries ≥ 60 min. Women younger than 18 years (P = 0.004) and who had caesarean for fetal labor intolerance were associated with shorter operation time (P < 0.001). Factors associated with an increased operation time were age > 35 years (P = 0.049), body mass index (BMI) ≥ 30 (P < 0.001), pre-existing hypertension (P = 0.001), prior low segment transverse scar (P < 0.001), uterus incision other than transverse (P < 0.001), first-year resident as primary surgeon (P < 0.001) and accompanying sterilisation procedure (P < 0.001). Operation time was significantly related to blood loss (P < 0.001), likelihood of umbilical artery cord gas pH < 7.1 (P < 0.001) and Apgar scores at five minutes < 7 (P = 0.009). Conclusions: Operative time is shortened by age < 18 and delivery for fetal labor intolerance, lengthened by age > 35, BMI > 30, prior caesarean, uterine incision, operating surgeon inexperience and accompanying sterilisation. Increased operative time was linked with an increased blood loss, low five-minute Apgar scores and umbilical arterial pH < 7.1.
Singapore medical journal, 2016
This study aimed to determine the decision-to-delivery intervals (DDIs), total duration of surgery and factors influencing these for caesarean sections (CSs). A retrospective study was conducted of all CSs performed from August 2013 to June 2014 at a single tertiary general hospital. Data collected included maternal demographics, indications for CS, category of urgency, DDI, total duration of surgery, grade of first surgeon and number of previous CSs. In total, 488 CSs (Category 1, n = 28; Category 2, n = 137; Category 3, n = 184; Category 4, n = 139) were studied. Overall mean duration of surgery was 41.7 minutes. Mean DDI was 23.9 minutes and 64.5 minutes for Category 1 and Category 2 CSs, respectively. For Category 1 CSs, deliveries during office hours had a significantly shorter DDI than deliveries during out-of-office hours (p < 0.05). For Category 2 CSs, deliveries during office hours had a significantly longer DDI (p < 0.05). Total duration of surgery for senior surgeon...
Predictive Factors for Cesarean Delivery ? A Retrospective Study
Journal of Pregnancy and Child Health, 2015
Background: Cesarean section rates have risen markedly worldwide. Considering the potential harm caused by this mode of delivery, and the general concern in reducing its incidence, it would be useful to individualize the risk of non-planned cesareans, and if there is any possibility, reduce that risk, and anesthesiologists should take part of this risk evaluation. In recent studies, many factors have been related with a higher risk of cesarean, and controversy still surrounds labor analgesia impact on cesarean risk. The aim of this study was to search for predictive factors for nonplanned cesarean delivery. Methods: Retrospective analysis of all labors occurred in our Obstetric Department during 2014. Maternal related factors, previous obstetric history, birth weight and factors related to labor analgesia and labor progression were studied. Our primary outcome was cesarean delivery. Results: We identified two independent predictive factors for cesarean delivery: birth weight (p=0,007 OR= 1,001 CI 95% [1,0003; 1,002]) and labor length since beginning of analgesia (p<0,0001 OR= 1,00005 CI 95%[1,00003; 1,00007]). Searching correlation between registered variables, maternal body mass index was positively associated with newborn birth weight (p<0.0001, R=0.157). Conclusion: Our study showed that birth weight and labor length since beginning of epidural analgesia are independent predictor factors of non-planned cesarean delivery. Furthermore, birth weight was associated with maternal body mass index, providing health professionals a modifiable factor in which we can intervene to improve outcome. As labor progression to cesarean is of major obstetric and anesthetic concern, multidisciplinary initiatives are warranted to clearly identify important variables concurring to operative delivery.
International journal of obstetric anesthesia, 1998
Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calendar years (1990-1995) at our busy tertiary center, to determine patient demographics, indications for cesarean section, indications for general anesthesia, time of day, and complications related to airway management. From 1990 through 1995, cesarean sections under general anesthesia decreased from 7.2% to 3.6% (P=0.0001), however, they were performed on parturients w...
Medical Journal of Pokhara Academy of Health Sciences, 2018
Background: Regional anesthesia is being utilized as the preferred anesthetic technique for cesarean delivery worldwide. This study was performed to review cesarean delivery anesthetic practice in our institute which represents a tertiary care regional hospital. Methods: Data was collected regarding the number of cesarean delivery performed during the period of six months from January 2017 to June 2017 at Western Regional Hospital. Number of elective versus emergency cesarean delivery, mode of anesthesia and the reason for general anesthesia and complications was recorded. Results: The number of cesarean delivery was found to be 1174(26.41%) of total deliveries during the study period. Out of which, 64.82% were for emergency indication and 35.18% were elective cesarean delivery. Spinal anesthesia was utilized in 99.03% of elective cesarean section and 97.63% of emergency cesarean section. The percentage of cases performed under general anesthesia was 1.87%. Reasons for general anest...
F1000Research, 2017
One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or "top-up" of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden. A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday - Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were ...
Indications for cesarean deliveries during a 7-year period in a tertiary hospital
Acta médica portuguesa
To analyze the cesarean section rate evolution in a tertiary hospital and the main indications for cesarean section. A retrospective study was conducted at a major academic hospital and included 5 751 women who had a cesarean section from 2005 to 2011. The rates of overall, primary and repeat cesarean sections were analyzed. A linear regression and adjusted R-square were used to access the relative contribution of each indication to the variation in primary cesarean section. During the 7-year period of the study the cesarean section rate decreased from 30.9% to 27.6%. This was due to a decrease in primary cesarean section (21.9% to 18.2%), although an increase in repeat cesarean section was observed (9.0% to 9.4%). Among the indications for primary cesarean section, maternal-fetal indications and malpresentation were the ones that decreased the most with adjusted R-square of 0.70 and 0.55, respectively. The collected data identified that the decrease in the cesarean section rate at ...
Romanian Journal of Anaesthesia and Intensive Care, 2020
Objective The choice of anesthesia for emergency cesarean delivery (CD) is one of the most important choices to make in obstetric anesthesia. In this study, we examine which type of anesthesia was used for emergency CD in our hospital, and how the choice affected the time from entry to the operation room until incision (TTI), time until delivery (TTD), and maternal/neonatal outcomes. Methods Retrospectively, we examined all emergency CD’s performed in Shaare Zedek Medical Center between January–December 2018. Results: 1059 patients met the inclusion criteria, of which 7.7% underwent general anesthesia (GA), 36.2% – conversion from labor epidural analgesia to surgical anesthesia, 52% – spinal anesthesia and 4.1% – combined spinal epidural. We did not find a significant difference between the GA and conversion epidural groups in terms of TTI or TTD. Nevertheless, GA was found to be correlated to a high rate of blood-products requirement and ICU admission. The rate of newborns with an ...
International Journal of Gynecology & Obstetrics, 2010
Objectives: To measure 3 intervals of time-induction of regional anesthesia to delivery (I-D), initial skin incision to delivery (S-D), and uterine incision to delivery (U-D)-in elective cesareans and to evaluate the impact of the duration of these 3 components on short-term neonatal outcome. Methods: We reviewed retrospective data on the duration of the components from the computerized database of the obstetrics operation room at the Sheba Medical Center, Tel Aviv, Israel, and from the medical records of term neonates. Results: Sufficient data were available in 933 cases. The parameters associated with longer time to delivery at any stage were epidural rather than spinal anesthesia, maternal diabetes, previous cesarean delivery, antihypertensive treatment, higher birth weight (3456 g and 3285 g for U-D interval longer than 2 minutes and U-D interval up to 2 minutes, respectively; P = 0.02), and male fetus. The duration of the I-D, S-D, and U-D intervals had no significant impact on any of the measured neonatal parameters. Conclusion: With regard to neonatal wellbeing, obstetricians have a relatively large safety margin in the time taken for inducing regional anesthesia and making the first and uterine incisions.