Decision-to-incision time and neonatal outcomes

A systematic review and meta-analysis

Mary C. Tolcher, Rebecca L. Johnson, Sherif A. El-Nashar, Colin Patrick West

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

OBJECTIVE:: To systematically review the literature on the proportion of emergent cesarean deliveries accomplished within 30 minutes, the mean time from decision-to-incision or delivery, and differences in neonatal outcomes in deliveries accomplished within 30 minutes compared to beyond 30 minutes. DATA SOURCES:: Electronic databases (Ovid MEDLINE and EMBASE and www.clinicaltrials. gov) were searched from inception to January 2013. METHODS OF STUDY SELECTION:: Eligible studies reported decision-to-incision time or delivery time intervals for nonelective cesarean deliveries. Both emergent and urgent deliveries (also known as category 1 and category 2 deliveries) were included. Two reviewers independently identified studies for inclusion. TABULATION, INTEGRATION, AND RESULTS:: Out of 737 reports identified in the primary search, 34 studies (22,936 women) met eligibility criteria. Seventy-nine percent (95% confidence interval [CI] 61-97%) of category 1 deliveries and 36% (95% CI 24-48%) of category 2 deliveries were achieved within 30 minutes, with significantly shorter time in category 1 compared to category 2 deliveries (21.2 compared with 42.6 minutes; P<.001). In the 13 studies that included neonatal outcomes, there was a higher risk of overall 5-minute Apgar score less than 7 (odds ratio [OR] 3.10; 95% CI 1.93-4.96) and umbilical artery pH level less than 7.10 (OR 3.40; 95% CI 2.38-4.87) in cases involving shorter delivery intervals. However, analyses limited to category 1 deliveries did not show a statistically greater risk of Apgar score less than 7 (OR 0.69; 95% CI 0.11-4.51) or umbilical artery pH level less than 7.10 (OR 1.10; 95% CI 0.28-4.40) with shorter delivery intervals. There was no difference by delivery interval in admission to neonatal intensive care units or special newborn units (OR 1.23; 95% CI 0.90-1.68). CONCLUSION:: Delivery within 30 minutes was not achieved in a substantial proportion of cases. The clinical significance of failing to achieve this standard remains uncertain.

Original languageEnglish (US)
Pages (from-to)536-548
Number of pages13
JournalObstetrics and Gynecology
Volume123
Issue number3
DOIs
StatePublished - 2014

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Meta-Analysis
Confidence Intervals
Odds Ratio
Umbilical Arteries
Apgar Score
Neonatal Intensive Care Units
MEDLINE
Newborn Infant
Databases

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Decision-to-incision time and neonatal outcomes : A systematic review and meta-analysis. / Tolcher, Mary C.; Johnson, Rebecca L.; El-Nashar, Sherif A.; West, Colin Patrick.

In: Obstetrics and Gynecology, Vol. 123, No. 3, 2014, p. 536-548.

Research output: Contribution to journalArticle

Tolcher, Mary C. ; Johnson, Rebecca L. ; El-Nashar, Sherif A. ; West, Colin Patrick. / Decision-to-incision time and neonatal outcomes : A systematic review and meta-analysis. In: Obstetrics and Gynecology. 2014 ; Vol. 123, No. 3. pp. 536-548.
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abstract = "OBJECTIVE:: To systematically review the literature on the proportion of emergent cesarean deliveries accomplished within 30 minutes, the mean time from decision-to-incision or delivery, and differences in neonatal outcomes in deliveries accomplished within 30 minutes compared to beyond 30 minutes. DATA SOURCES:: Electronic databases (Ovid MEDLINE and EMBASE and www.clinicaltrials. gov) were searched from inception to January 2013. METHODS OF STUDY SELECTION:: Eligible studies reported decision-to-incision time or delivery time intervals for nonelective cesarean deliveries. Both emergent and urgent deliveries (also known as category 1 and category 2 deliveries) were included. Two reviewers independently identified studies for inclusion. TABULATION, INTEGRATION, AND RESULTS:: Out of 737 reports identified in the primary search, 34 studies (22,936 women) met eligibility criteria. Seventy-nine percent (95{\%} confidence interval [CI] 61-97{\%}) of category 1 deliveries and 36{\%} (95{\%} CI 24-48{\%}) of category 2 deliveries were achieved within 30 minutes, with significantly shorter time in category 1 compared to category 2 deliveries (21.2 compared with 42.6 minutes; P<.001). In the 13 studies that included neonatal outcomes, there was a higher risk of overall 5-minute Apgar score less than 7 (odds ratio [OR] 3.10; 95{\%} CI 1.93-4.96) and umbilical artery pH level less than 7.10 (OR 3.40; 95{\%} CI 2.38-4.87) in cases involving shorter delivery intervals. However, analyses limited to category 1 deliveries did not show a statistically greater risk of Apgar score less than 7 (OR 0.69; 95{\%} CI 0.11-4.51) or umbilical artery pH level less than 7.10 (OR 1.10; 95{\%} CI 0.28-4.40) with shorter delivery intervals. There was no difference by delivery interval in admission to neonatal intensive care units or special newborn units (OR 1.23; 95{\%} CI 0.90-1.68). CONCLUSION:: Delivery within 30 minutes was not achieved in a substantial proportion of cases. The clinical significance of failing to achieve this standard remains uncertain.",
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N2 - OBJECTIVE:: To systematically review the literature on the proportion of emergent cesarean deliveries accomplished within 30 minutes, the mean time from decision-to-incision or delivery, and differences in neonatal outcomes in deliveries accomplished within 30 minutes compared to beyond 30 minutes. DATA SOURCES:: Electronic databases (Ovid MEDLINE and EMBASE and www.clinicaltrials. gov) were searched from inception to January 2013. METHODS OF STUDY SELECTION:: Eligible studies reported decision-to-incision time or delivery time intervals for nonelective cesarean deliveries. Both emergent and urgent deliveries (also known as category 1 and category 2 deliveries) were included. Two reviewers independently identified studies for inclusion. TABULATION, INTEGRATION, AND RESULTS:: Out of 737 reports identified in the primary search, 34 studies (22,936 women) met eligibility criteria. Seventy-nine percent (95% confidence interval [CI] 61-97%) of category 1 deliveries and 36% (95% CI 24-48%) of category 2 deliveries were achieved within 30 minutes, with significantly shorter time in category 1 compared to category 2 deliveries (21.2 compared with 42.6 minutes; P<.001). In the 13 studies that included neonatal outcomes, there was a higher risk of overall 5-minute Apgar score less than 7 (odds ratio [OR] 3.10; 95% CI 1.93-4.96) and umbilical artery pH level less than 7.10 (OR 3.40; 95% CI 2.38-4.87) in cases involving shorter delivery intervals. However, analyses limited to category 1 deliveries did not show a statistically greater risk of Apgar score less than 7 (OR 0.69; 95% CI 0.11-4.51) or umbilical artery pH level less than 7.10 (OR 1.10; 95% CI 0.28-4.40) with shorter delivery intervals. There was no difference by delivery interval in admission to neonatal intensive care units or special newborn units (OR 1.23; 95% CI 0.90-1.68). CONCLUSION:: Delivery within 30 minutes was not achieved in a substantial proportion of cases. The clinical significance of failing to achieve this standard remains uncertain.

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