Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery

Moroz, Leslie; DiNapoli, Marianne; D’Alton, Mary E.; Gyamfi-Bannerman, Cynthia

doi:10.1016/j.ajog.2015.06.055

Cited by 16 publications

(10 citation statements)

References 12 publications

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“…Moroz and colleagues, for example, studied incision-to-decision times among women who were undergoing a trial of labor after cesarean and found that particularly short times (i.e., ≤ 2 minutes) were associated with an increased risk of maternal complications. 13 In contrast, in the analysis by Bloom et al, maternal complications did not appear to increase at DTI times of more than 30 minutes. 11…”

Section: Commentmentioning

confidence: 78%

The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes

Grobman¹,

Bailit

Sandoval

et al. 2017

Amer J Perinatol

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Section: Commentmentioning

confidence: 78%

The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes

Grobman¹,

Bailit

Sandoval

et al. 2017

Amer J Perinatol

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“…We recognized that in umbilical cord prolapse, the fetal heart may present with persistent bradycardia (29.8%) or recurrent de- esthesia is an option as general anesthesia usually carries a higher risk of maternal complications in an emergent setting. [31][32][33] On the other hand, once vasospasm has occurred resulting in persistent bradycardia, delivery in a short time is critical to prevent adverse perinatal outcome. Cord arterial pH drops at 0.009 per minute, which is similar to our previously reported rate of 0.011 per minute in other irreversible causes such as abruptio placentae and shoulder dystocia.…”

Section: Discussionmentioning

confidence: 99%

Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse

Wong

Tse

Lai

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision‐to‐delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia‐to‐delivery or decision‐to‐delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse. Material and methods This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia‐to‐delivery, deceleration‐to‐delivery, and decision‐to‐delivery were performed for the different groups with Spearman test. Results There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision‐to‐delivery interval in any of the groups, but they were inversely correlated with bradycardia‐to‐delivery interval in Group 1 (Spearman’s ρ = −.349; P = .043 and Spearman's ρ = −.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia‐to‐delivery interval in Group 1 (95% CI 0.0180‐0.0003). The risk of significant acidosis (pH < 7) was 80% when bradycardia‐to‐delivery interval was >20 minutes, and 17.2% when the interval was <20 minutes. Conclusions There is significant correlation between bradycardia‐to‐delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations.

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“…49 Surgery-related parameters such as the urgency of delivery, the duration of surgery, and the interval from uterine incision to delivery, are known to influence neonatal outcomes. 50 Maternal inhaled oxygen concentration, minute ventilation, intravenous fluid volume, blood pressure, vasopressor administration and extent of sympathetic block may be more important than the nature of the anesthetic agents. 42 The dose of local anesthetic used for spinal anesthesia and the extent of the spinal block influence maternal hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis

Kim

Hur

Park

et al. 2019

International Journal of Obstetric Anesthesia

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Background: This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery. Methods: An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included: Apgar score at 1-or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2-4 hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and s 2. Quality of evidence was assessed using the GRADE approach. Results: Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score 6 at 1 min between spinal versus general anesthesia (odds ratio 0.27, 95% confidence interval [CI] 0.13 to 0.55: moderate quality evidence) and Apgar scores at 1-and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95% CI 0.001 to 0.020: moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score 6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3). Conclusions: Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.

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Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery

Cited by 16 publications

References 12 publications

The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes

The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes

Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse

Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis

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