Exploring factors influencing skin incision to the delivery time and their impact on neonatal outcomes among emergency cesarean deliveries indicated for non-reassured fetal heart rate status

Abstract

BackgroundThe time interval between skin incision and delivery (S-D) is crucial in determining neonatal outcome; however, little is known about the influencing factors and their impact on neonatal outcomes, particularly among emergency cesarean deliveries (ECD) indicated for fetal distress. This study investigated the factors influencing S-D time and their effects on neonatal outcomes among mothers who underwent ECD for non-reassured fetal heart rate status.MethodsThis retrospective cohort study involved 426 mother-infant pairs over four years. We retrieved data from the medical records, including baseline characteristics, perioperative data, and neonatal outcomes. Using multivariable logistic regression analysis, adjusted odd ratios, and a 95% confidence interval, potential factors influencing S-D time and their impacts on neonatal outcomes were assessed. A p-value of less than 0.05 was considered statistically significant.ResultsFactors independently associated with longer S-D time (>8 min) were mothers who had previous CD (AOR 5.9: 95% CI 2.2–16.1), obese mothers (AOR 6.2: 95% CI 1.6–24.5), and the second stage of labor (AOR 5.3: 95% CI 2.4–11.7). Adverse neonatal outcomes, including a 5th minute Apgar score of less than 7, the need for NICU admission, and neonatal death, were significantly higher in the longer S-D time interval [47.7% vs. 8.9%; p-value 0.001], [21.9% vs. 9.1%; p-value 0.001], and [32% vs. 11.8%; p-value = 0.004], respectively. Obese mothers and the second stage of labor, but not previous CD, adversely impact neonatal outcomes.ConclusionLonger S-D times are significantly associated with adverse neonatal outcomes. Factors that prolong the time interval between skin incision and delivery may or may not necessarily be associated with adverse neonatal outcomes. Considering surgical techniques that shorten the incision-delivery time and preparation for advanced neonatal care for risky subjects would help reduce detrimental neonatal consequences.

Neonatal outcomes in the surgical management of placenta accreta spectrum disorders: a retrospective single-center observational study from 468 Vietnamese pregnancies beyond 28 weeks of gestation

“…Although the cut-off of the APGAR score at 1 min less than 3 pts is required for neonatal intervention, some documents have demonstrated that the APGAR score at 1 min is not related to the adverse long-term outcomes, even at 1 pt or 3 pts [ 31 ]. Regarding the 5-min APGAR score, a total score of fewer than 7 pts relates significantly to poor neonatal outcomes and increases tenfold NICU admission despite non-PASDs cesarean delivery [ 32 – 34 ]. In our study, using the APGAR score of less than 7 pts as the adverse neonatal outcome, the study found that the neonatal requirement of intervention after birth, NICU admission, and the length of stay (LOS) at NICU admission of more than 7 days were significantly greater in emergency group versus planned surgery.…”

Association between the stage of labour during caesarean delivery with adverse maternal and neonatal outcomes among referred mothers to tertiary centres in resource-limited settings

“…Thus, providing equitable obstetric surgical access and strengthening obstetric surgical and intensive neonatal care in low-income countries need immediate attention to improve maternal and perinatal outcomes. 26–29 …”

“…We retrospectively collected data from the maternal and neonatal medical records, including maternal and neonatal baseline characteristics, perioperative data, and adverse maternal and neonatal outcomes of all study participants using a checklist adapted from prior studies. 26 …”