title: Time from uterine incision to delivery and hypoxic neonatal outcomes.
abstract: OBJECTIVE
  The objective of this study was to estimate the association between time from uterine incision to delivery and hypoxic neonatal outcomes in nonanomalous term infants.
  
  
  METHODS
  All women undergoing in-labor term cesarean deliveries (CDs) in the first 2 years of an ongoing prospective cohort study were included. The primary exposure was time in seconds from uterine incision to delivery. The primary outcome was a composite of hypoxia-associated neonatal outcomes, defined as at least one of: seizures, hypoxic ischemic encephalopathy, need for hypothermia treatment, and death within 7 days.
  
  
  RESULTS
  Of 812 patients who underwent in-labor CD, the composite hypoxia outcome occurred in 18 (2.2%) neonates. There was no significant difference in the rate of hypoxic morbidity with increasing increments of 60 seconds from uterine incision to delivery (p = 0.35). There was a significantly increased risk of hypoxic morbidity in those delivered in the highest quintile (>240 seconds) compared with those in the lowest quintile (≤ 60 seconds) in cesareans performed for an indication other than nonreassuring fetal status (relative risk, 5.58; 95% confidence interval, 1.30-23.91).
  
  
  CONCLUSIONS
  Overall, duration from uterine incision to delivery for in-labor cesareans of nonanomalous term infants was not associated with an increase in risk of hypoxia-associated morbidities.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Janine E
authors.initials: JE
authors.lastname: Spain
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Methodius
authors.initials: M
authors.lastname: Tuuli
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Stout
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005316:Fetal Distress / Q000209:etiology*; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D020883:Hysterotomy; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D047929:Term Birth; D013997:Time Factors; D055815:Young Adult