Comparison of transverse and vertical skin incision for emergency cesarean delivery.
OBJECTIVE
To compare incision-to-delivery intervals and related maternal and neonatal outcomes by skin incision in primary and repeat emergent cesarean deliveries.


METHODS
From 1999 to 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 hospitals comprising the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network. This secondary analysis was limited to emergent procedures, defined as those performed for cord prolapse, abruption, placenta previa with hemorrhage, nonreassuring fetal heart rate tracing, or uterine rupture. Incision-to-delivery intervals, incision-to-closure intervals, and maternal outcomes were compared by skin-incision type (transverse compared with vertical) after stratifying for primary compared with repeat singleton cesarean delivery. Neonatal outcomes were compared by skin-incision type.


RESULTS
Of the 37,112 live singleton cesarean deliveries, 3,525 (9.5%) were performed for emergent indications of which 2,498 (70.9%) were performed by transverse and the remaining 1,027 (29.1%) by vertical incision. Vertical skin incision shortened median incision-to-delivery intervals by 1 minute (3 compared with 4 minutes, P<.001) in primary and 2 minutes (3 compared with 5 minutes, P<.001) in repeat cesarean deliveries. Total median operative time was longer after vertical skin incision by 3 minutes in primary (46 compared with 43 minutes, P<.001) and 4 minutes in repeat cesarean deliveries (56 compared with 52 minutes, P<.001). Neonates delivered through a vertical incision were more likely to have an umbilical artery pH of less than 7.0 (10% compared with 7%, P=.02), to be intubated in the delivery room (17% compared with 13%, P=.001), or to be diagnosed with hypoxic ischemic encephalopathy (3% compared with 1%, P<.001).


CONCLUSIONS
In emergency cesarean deliveries, neonatal delivery occurred more quickly after a vertical skin incision, but this was not associated with improved neonatal outcomes.


METHODS
II.
Wylie
Blair J
BJ
From the Departments of Obstetrics and Gynecology, Columbia University, New York, New York; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Utah, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University Health Sciences, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; the University of Cincinnati, Cincinnati, Ohio; the University of Miami, Miami, Florida; the University of Tennessee, Memphis, Tennessee; the University of Texas at San Antonio, San Antonio, Texas; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Gilbert
Sharon
S
Landon
Mark B
MB
Spong
Catherine Y
CY
Rouse
Dwight J
DJ
Leveno
Kenneth J
KJ
Varner
Michael W
MW
Caritis
Steve N
SN
Meis
Paul J
PJ
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D017604:Cesarean Section, Repeat / Q000379:methods; D062109:Dermatologic Surgical Procedures; D004630:Emergencies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult