Emergent (crash) cesarean delivery: indications and outcomes.
OBJECTIVE
The purpose of this study was to define the indications and outcomes of emergent cesarean deliveries.


METHODS
We analyzed prospectively collected singleton maternal and neonatal data from January 1, 1998, to December 31, 2004 of all such cesarean deliveries that were performed. A case-control analysis was performed by matching emergent cesarean deliveries with the next 2 acute cesarean deliveries.


RESULTS
There were 126 emergent cesarean deliveries (1:159 deliveries). There were no significant differences in identifiable obstetric or chronic medical risk factors between the 2 groups. Compared with the control subjects, the subjects with emergent cesarean deliveries had an increased risks of cesarean delivery for non-reassuring fetal heart rate (P < .0001; odds ratio, 12.0), cord prolapse (P < .0001), and suspected uterine rupture (P < .0001); in addition, greater risk of a low 1-minute Apgar score (P < .001; odds ratio, 19.5) and low 5-minute Apgar score (P < .001; odds ratio, 10.4), acute respiratory distress of infant (P < .001; odds ratio, 4.21), and infant intubations (P < .0001; odds ratio, 8.1).


CONCLUSIONS
These data demonstrate that most emergent cesarean deliveries develop during labor in low-risk women and cannot be anticipated by prelabor factors. The outcomes demonstrate that infants are at risk in these clinical situations and suggest that strategies to improve performance in these clinical situations are important.
Lagrew
David C
DC
Women's Hospital, Saddleback Memorial Medical Center, Laguna Hills, CA, USA. dlagrew@memorialcare.org
Bush
Melissa C
MC
McKeown
Anna M
AM
Lagrew
Nancy G
NG
D001034:Apgar Score; D016022:Case-Control Studies; D002585:Cesarean Section; D004632:Emergency Medical Services; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007440:Intubation; D011247:Pregnancy; D011391:Prolapse; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn; D012307:Risk Factors; D014470:Umbilical Cord; D014597:Uterine Rupture