| Comparison of transverse and vertical skin incision for emergency cesarean delivery. | |
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MedLine Citation:
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PMID: 20502282 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To compare incision-to-delivery intervals and related maternal and neonatal outcomes by skin incision in primary and repeat emergent cesarean deliveries. METHODS: From 1999 to 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 hospitals comprising the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network. This secondary analysis was limited to emergent procedures, defined as those performed for cord prolapse, abruption, placenta previa with hemorrhage, nonreassuring fetal heart rate tracing, or uterine rupture. Incision-to-delivery intervals, incision-to-closure intervals, and maternal outcomes were compared by skin-incision type (transverse compared with vertical) after stratifying for primary compared with repeat singleton cesarean delivery. Neonatal outcomes were compared by skin-incision type. RESULTS: Of the 37,112 live singleton cesarean deliveries, 3,525 (9.5%) were performed for emergent indications of which 2,498 (70.9%) were performed by transverse and the remaining 1,027 (29.1%) by vertical incision. Vertical skin incision shortened median incision-to-delivery intervals by 1 minute (3 compared with 4 minutes, P<.001) in primary and 2 minutes (3 compared with 5 minutes, P<.001) in repeat cesarean deliveries. Total median operative time was longer after vertical skin incision by 3 minutes in primary (46 compared with 43 minutes, P<.001) and 4 minutes in repeat cesarean deliveries (56 compared with 52 minutes, P<.001). Neonates delivered through a vertical incision were more likely to have an umbilical artery pH of less than 7.0 (10% compared with 7%, P=.02), to be intubated in the delivery room (17% compared with 13%, P=.001), or to be diagnosed with hypoxic ischemic encephalopathy (3% compared with 1%, P<.001). CONCLUSION: In emergency cesarean deliveries, neonatal delivery occurred more quickly after a vertical skin incision, but this was not associated with improved neonatal outcomes. LEVEL OF EVIDENCE: II. |
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Authors:
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Blair J Wylie; Sharon Gilbert; Mark B Landon; Catherine Y Spong; Dwight J Rouse; Kenneth J Leveno; Michael W Varner; Steve N Caritis; Paul J Meis; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Mary J O'Sullivan; Baha M Sibai; Oded Langer; |
Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Obstetrics and gynecology Volume: 115 ISSN: 1873-233X ISO Abbreviation: Obstet Gynecol Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-26 Completed Date: 2010-07-01 Revised Date: 2011-12-21 |
Medline Journal Info:
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Nlm Unique ID: 0401101 Medline TA: Obstet Gynecol Country: United States |
Other Details:
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Languages: eng Pagination: 1134-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Obstetrics, Columbia University, New York, New York, USA. bwylie@partners.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cesarean Section / methods* Cesarean Section, Repeat / methods Emergencies Female Hospitals, Teaching Humans Infant, Newborn Length of Stay Pregnancy Pregnancy Outcome Prospective Studies Skin / surgery Time Factors Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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HD21410/HD/NICHD NIH HHS; HD21414/HD/NICHD NIH HHS; HD27860/HD/NICHD NIH HHS; HD27861/HD/NICHD NIH HHS; HD27869/HD/NICHD NIH HHS; HD27905/HD/NICHD NIH HHS; HD27915/HD/NICHD NIH HHS; HD27917/HD/NICHD NIH HHS; HD34122/HD/NICHD NIH HHS; HD34136/HD/NICHD NIH HHS; HD34208/HD/NICHD NIH HHS; HD34210/HD/NICHD NIH HHS; HD36801/HD/NICHD NIH HHS; U10 HD040485-01/HD/NICHD NIH HHS |
| Investigator | |
Investigator/Affiliation:
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M Belfort / ; F Porter / ; B Oshiro / ; K Anderson / ; A Guzman / ; S Bloom / ; J Gold / ; D Bradford / ; M Cotroneo / ; D Fischer / ; M Luce / ; G Burkett / ; J Gilles / ; J Potter / ; F Doyle / ; S Chandler / ; M Byrne / ; A Sciscione / ; M DiVito / ; M Talucci / ; M Pollock / ; M Harper / ; M Swain / ; C Moorefield / ; K Lanier / ; L Steele / ; J Iams / ; F Johnson / ; S Meadows / ; H Walker / ; T Siddiqi / ; H How / ; N Elder / ; M Dombrowski / ; G Norman / ; A Millinder / ; C Sudz / ; B Steffy / ; J Hauth / ; A Northen / ; S Tate / ; A Moawad / ; J Hibbard / ; P Jones / ; M Ramos-Brinson / ; M Moran / ; D Scott / ; B Mabie / ; H How / ; R Ramsey / ; D Conway / ; S Barker / ; M Rodriguez / ; E Thom / ; H Juliussen-Stevenson / ; M Fischer / ; L Leuchtenburg / ; D McNellis / ; K Howell / ; S Tolivaisa / ; S Gabbe / |
| Comments/Corrections | |
Comment In:
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Obstet Gynecol. 2010 Sep;116(3):773; author reply 773
[PMID:
20733469
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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