Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes.
OBJECTIVE
To determine the factors that influence caesarean operative time and operative time effects on pregnancy outcomes.


METHODS
Prospective observational study of women undergoing a caesarean delivery (CD). Multiple antepartum, intrapartum and neonatal outcomes were assessed for their influence on the time of the CD and the time effect of CD on pregnancy outcomes.


RESULTS
There were 386 (23%) caesarean deliveries performed < or = 30 min, 1070 (65%) between 31 and 60 min, and 200 deliveries > or = 60 min. Women younger than 18 years (P= 0.004) and who had caesarean for fetal labor intolerance were associated with shorter operation time (P < 0.001). Factors associated with an increased operation time were age > 35 years (P = 0.049), body mass index (BMI) > or = 30 (P < 0.001), pre-existing hypertension (P = 0.001), prior low segment transverse scar (P < 0.001), uterus incision other than transverse (P < 0.001), first-year resident as primary surgeon (P < 0.001) and accompanying sterilisation procedure (P < 0.001). Operation time was significantly related to blood loss (P < 0.001), likelihood of umbilical artery cord gas pH < 7.1 (P < 0.001) and Apgar scores at five minutes < 7 (P= 0.009).


CONCLUSIONS
Operative time is shortened by age < 18 and delivery for fetal labor intolerance, lengthened by age > 35, BMI > 30, prior caesarean, uterine incision, operating surgeon inexperience and accompanying sterilisation. Increased operative time was linked with an increased blood loss, low five-minute Apgar scores and umbilical arterial pH < 7.1.
School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia.
Dorota A
DA
Doherty
Everett F
EF
Magann
Suneet P
SP
Chauhan
Amy L
AL
O'Boyle
Jeanne M
JM
Busch
John C
JC
Morrison
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D014768:Virginia