title: Factors that influence the incision-delivery interval at caesarean section and the impact on the neonate: a prospective cohort study.
abstract: OBJECTIVE
  To determine the range of, and influences on, the incision-delivery interval (IDI) and the impact on neonatal condition at delivery.
  
  
  METHODS
  Analysis of prospectively collected cohort data from all women delivered by caesarean section over 12 months in an obstetric unit delivering 6000 women per year. Prospective data were collected from clinical records, with factors that influence IDI and relationship to neonatal condition at birth as the main outcome measures.
  
  
  RESULTS
  IDI was recorded for 1379 (93%) caesarean sections and ranged between 1 and 37min; median (IQR) was 6 (5-8)min, and for 3% the interval was longer than 15min. Category 1 and 2 caesarean sections had shorter IDI than categories 3 and 4 and intrapartum operations had significantly shorter IDI at 5 (3-8)min than antepartum at 7 (5-9)min (P<0.0001). Factors associated with longer IDI included previous delivery by caesarean section, increased maternal body mass index (BMI), regional anaesthesia, larger neonatal birthweight and technical problems including intraperitoneal adhesions, but did not include fetal malpresentation, multiple pregnancy, grade of surgeon or stage of labour. IDI had no impact on neonatal condition at birth.
  
  
  CONCLUSIONS
  Prolonged IDI does not adversely affect neonatal outcome, but factors associated with prolonged IDI should be acknowledged when assessing decision-to-delivery interval target times.
authors.affiliation: Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. greg.pearson@doctors.org.uk
authors.forename: Greg A
authors.initials: GA
authors.lastname: Pearson
authors.forename: Ian Z
authors.initials: IZ
authors.lastname: MacKenzie
mesh_terms: D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn / Q000097:blood*; D007745:Labor Onset; D011247:Pregnancy; D011446:Prospective Studies
keywords: Acidosis; Apgar score; Caesarean section; Emergency; Incision to delivery interval (IDI)