title: Time between skin incision and delivery during cesarean.
abstract: OBJECTIVE
  To investigate factors influencing skin incision-to-delivery time (including sub-divisions thereof) and the effect of these surgical intervals on immediate neonatal outcome.
  
  
  METHODS
  A prospective cohort analysis was conducted of all women undergoing cesarean delivery at Tygerberg Hospital, Cape Town, South Africa, from May 24 to November 2, 2010. Three surgical intervals were evaluated: skin incision to myometrium, myometrium to delivery, and skin incision to delivery. Neonatal outcome was assessed by the 5-minute Apgar score.
  
  
  RESULTS
  Of 1120 cesarean deliveries recorded during the study period, 77.2% were emergency procedures, which were performed more quickly at all surgical planes (P<0.01). Adhesions in the surgical field were present in 7.4% of all primary procedures versus 67.7% of all third procedures (P<0.001). The skin incision-to-delivery time was significantly extended among repeat procedures (P<0.001) and increased progressively with degree of obesity (P<0.001). Although the 3 surgical intervals were calculated individually, none of the median values correlated with a 5-minute Apgar score below 7 for emergency deliveries.
  
  
  CONCLUSIONS
  Repeat procedures, adhesions, and obesity prolonged the time taken for cesarean delivery. Nevertheless, the effect of these factors on the 5-minute Apgar score was minimal.
authors: Department of Obstetrics and Gynecology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa. jnrossouw@yahoo.com
authors: Jana N
authors: JN
authors: Rossouw
authors: David
authors: D
authors: Hall
authors: Justin
authors: J
authors: Harvey
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000379:methods*; D017604:Cesarean Section, Repeat / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D061646:Operative Time; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013019:South Africa; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology; D055815:Young Adult