title: Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries.
abstract: OBJECTIVE
  To compare the uterine incision-to-delivery interval and neonatal and maternal complications in vertical versus transverse uterine incisions in preterm cesarean births.
  
  
  METHODS
  This is a retrospective cohort study of singleton cesarean deliveries from 2002 to 2009 between 23 and 34 weeks of gestation. Statistical analysis utilized Wilcoxon rank-sum test and multivariable logistic regression.
  
  
  RESULTS
  Of the 773 singleton cesarean deliveries, 586 (75.8%) had a transverse uterine incision and 187 (24.2%) had vertical uterine incision (classical = 134 and low vertical incision = 53). After adjusting for confounders, there was no significant difference in incision-to-delivery interval between the two types of incisions. The risk for maternal transfusion was higher among those with a vertical incision (odds ratio: 2.17; 95% confidence interval: 1.00, 4.67) than those with a transverse incision. Incision type was not associated with any neonatal outcomes studied, including intraventricular hemorrhage, Apgar scores and neonatal mortality.
  
  
  CONCLUSIONS
  We observed no difference in Uterine Incision-to-Delivery interval and neonatal complications between vertical and transverse incision. Performance of a vertical uterine incision for the sole reason of facilitating a more rapid delivery is not justified. Development of methods to better determine transverse incision feasibility may facilitate a decrease in vertical uterine incisions.
authors.affiliation: Division of Maternal Fetal Medicine, Baystate Medical Center and Tufts University School of Medicine , Springfield, MA , USA .
authors.forename: Gauri
authors.initials: G
authors.lastname: Luthra
authors.forename: Prasad
authors.initials: P
authors.lastname: Gawade
authors.forename: Roman
authors.initials: R
authors.lastname: Starikov
authors.forename: Glenn
authors.initials: G
authors.lastname: Markenson
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014599:Uterus / Q000601:surgery*; D055815:Young Adult