title: Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery.
abstract: OBJECTIVE
  The purpose of this study was to determine whether surgical speed is associated with maternal outcomes in women who have a history of previous cesarean delivery (CD) and who require emergent delivery.
  
  
  METHODS
  This is a secondary analysis of a multicenter, prospective observational study of women with a history of previous CD. Women who attempted a vaginal birth after CD and required emergent CD were dichotomized into those with a skin incision-to-fetal delivery time of ≤2 min (I-D ≤2) or >2 min (I-D >2), based on the mode I-D. Rates of composite maternal complications and specific surgical complications were compared.
  
  
  RESULTS
  Seven hundred ninety-three women had an emergency repeat CD: 108 women (13.6%) had I-D ≤2, and 685 women (86.4%) had I-D >2. The composite of maternal morbidity occurred in 36% of women with I-D≤2 and 23% with I-D>2 (P < .01). Women with I-D ≤2 had higher odds of intraoperative transfusion, uterine artery ligation, and broad ligament hematoma. In a multivariable regression model, the only variable that remained associated with maternal outcome was I-D (relative risk, 1.66; 95% confidence interval, 1.23-2.23). There was no difference in the incidence of neonatal acidemia between groups.
  
  
  CONCLUSIONS
  Among women who underwent emergent repeat cesarean delivery, surgical speed was associated with an increased risk for maternal complications.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY. Electronic address: lm3000@cumc.columbia.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Moroz
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
authors.forename: Marianne
authors.initials: M
authors.lastname: DiNapoli
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
authors.forename: Mary
authors.initials: M
authors.lastname: D'Alton
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gyamfi-Bannerman
mesh_terms: D000291:Adnexal Diseases / Q000453:epidemiology*; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001956:Broad Ligament; D017604:Cesarean Section, Repeat; D004630:Emergencies; D005260:Female; D006406:Hematoma / Q000453:epidemiology*; D006801:Humans; D008026:Ligation / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D061646:Operative Time; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors; D014219:Trial of Labor; D055988:Uterine Artery / Q000601:surgery; D016064:Vaginal Birth after Cesarean; D055815:Young Adult
keywords: cesarean delivery; complication; emergent cesarean delivery; maternal morbidity; trial of labor after cesarean delivery