Question: What should be the optimal time interval for delivery of baby (uterine incision to delivery) during caesarean section? After what time interval U-D(uterine incision to delivery) do acidosis or low APGARS occur in general and regional anaesthesia?
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Answer: The following studies of the relationship between the time from uterine incision to delivery during caesarean section and neonatal outcome were identified, with varying conclusions:
A retrospective review of 855 cases in which U-D intervals were documented (Maayan-Metzger et al) compared women with intervals of at least 2 minutes with those with shorter U-D intervals. There were more feeding problems and later hospital discharge in intervals of 2 minutes or longer. Other neonatal complications were similar.
In 130 healthy parturients undergoing elective cesarean section under epidural anesthesia,(Zhou) U-D of more than 150 sec was associated with significantly higher UVPCO2, UAPCO2, lower UVpH, UApH, UVPO2, and UAPO2. (UV = umbilical venous, UA = umbilical arterial). The only two newborns with low 1-minute Apgar scores (6 and 3) in the present study both had prolonged U-DI (> 150 sec)
Andersen et al studied 204 patients undergoing cesarean delivery, and found that, after correction for various factors (labor complications (fetal distress, meconium, and pre-eclampsia), infant weight, type of cesarean delivery (primary vs. repeat), and type of anesthesia), uterine incision to delivery intervals did not significantly contribute to Apgar scores nor umbilical cord blood gases.
Haruta et al studied 60 healthy parturients undergoing elective cesarean section under spinal anesthesia. Acid-base states in cases of long and excessively long U-DI (greater than 90 sec and greater than 150 sec, respectively) were more acidotic than those of short U-DI groups (less than 90 sec). Both 1 and 5 minute Apgar scores were 8 or more in all neonates.
The relationship of uterine incision-to-delivery intervals to neonatal outcome was studied in 105 parturient women undergoing cesarean section with either general or spinal anesthesia. (Datta) U-D intervals of more than three minutes were associated with the following outcomes: under general anaesthesia - significantly more instances of neonatal acidosis (umbilical artery pH 7.31 versus 7.22) and a greater incidence of low 1-min Apgar scores (4% versus 73%). under spinal anaesthesia - an increased acidosis (umbilical artery pH 7.30 versus 7.18) and depressed Apgar scores (0% versus 62%).
(Evidence level III)
References:
- Andersen HF. Auster GH. Marx GF. Merkatz IR. Neonatal status in relation to incision intervals, obstetric factors, and anesthesia at cesarean delivery. American Journal of Perinatology. 4(4):279-83, 1987 Oct. Abstract. Full text available to RCOG Fellows, Members and Trainees only.
- Datta S. Ostheimer GW. Weiss JB. Brown WU Jr. Alper MH. Neonatal effect of prolonged anesthetic induction for cesarean section. Obstetrics & Gynecology. 58(3):331-5, 1981 Sep. Abstract
- Haruta M. Funato T. Naka Y. Saeki N. Shinkai T. [Neonatal effects of the delivery interval during cesarean section under spinal anesthesia]. [Japanese] Nippon Sanka Fujinka Gakkai Zasshi - Acta Obstetrica et Gynaecologica Japonica. 38(12):2207-13, 1986 Dec. Abstract
- Maayan-Metzger A. Schushan-Eisen I. Todris L. Etchin A. Kuint J. The effect of time intervals on neonatal outcome in elective cesarean delivery at term under regional anesthesia. International Journal of Gynaecology & Obstetrics. 111(3):224-8, 2010 Dec. Abstract
- Zhao H. [Neonatal effects of uterine incision-to-delivery interval during elective cesarean section under epidural anesthesia]. [Chinese] Chung-Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics & Gynecology]. 28(2):67-9, 121, 1993 Feb. Abstract
Search date: September 2011
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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