title: Cesarean delivery for suspected fetal distress among preterm parturients.
abstract: OBJECTIVE
  Among preterm parturients (< 37 weeks) who underwent cesarean delivery for suspected fetal distress, to determine the factors associated with decision-incision time (DIT) of < or = 30 minutes and to assess if umbilical arterial pH < 7.10 is more common with DIT < or = 30 or > 30 minutes.
  
  
  METHODS
  The peripartum course of all patients who had cesareans for suspected fetal distress over three years was reviewed. The inclusion criteria were reliable gestational age < 37 weeks and a single indication for cesarean delivery, suspected fetal distress. Twenty antepartum and intrapartum factors were used in a univariate analysis.
  
  
  RESULTS
  The mean DIT among the 84 parturients was 30.5 +/- 21.2 minutes, and 63% of patients had surgery started within 30 minutes. The incidence of pH < 7.10 was 20%. Multivariate analysis indicated that the two factors significantly associated with prolonged time to surgery were tachycardia with decreased variability (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.6-21.6) and use of spinal anesthesia (OR 6.2, 95% CI 1.1-35.0). Though none of the 20 variables had significant univariate associations with neonatal acidosis at alpha = .05, those with P < .20 were considered in multiple logistic regression analysis. None of the 20 factors were associated with pH < 7.10, including DIT of > or = 30 minutes (OR 0.26, 95% CI 0.06-1.03).
  
  
  CONCLUSIONS
  DIT is likely to be > 30 minutes if cesarean delivery is due to decreased fetal heart variability or if spinal anesthesia is utilized; neonatal acidosis, however, is not significantly associated with a prolonged interval.
authors.affiliation: Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Chauhan
authors.forename: J A
authors.initials: JA
authors.lastname: Mobley
authors.forename: N W
authors.initials: NW
authors.lastname: Hendrix
authors.forename: E F
authors.initials: EF
authors.lastname: Magann
authors.forename: L D
authors.initials: LD
authors.lastname: Devoe
authors.forename: J N
authors.initials: JN
authors.lastname: Martin
mesh_terms: D000138:Acidosis; D000328:Adult; D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008499:Medical Records; D007744:Obstetric Labor Complications / Q000175:diagnosis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors