title: Emergency Caesarean Section in Obese Parturients: Is a 30-Minute Decision-to-Incision Interval Feasible?
abstract: OBJECTIVE
  To determine the effect of obesity on decision-to-incision and decision-to-delivery time intervals in emergency Caesarean section.
  
  
  METHODS
  We performed a retrospective study of emergency Caesarean sections performed between 2005 and 2009. Indications for emergency Caesarean section were defined as those posing an immediate threat to the life of the mother or fetus. The primary outcomes were the time intervals from decision for emergency delivery to skin incision, and decision to delivery of the infant. The secondary outcome was a composite of poor neonatal outcomes comprising umbilical cord artery pH lt; 7.20, Apgar score lt; 7 at five minutes, admission to NICU, or neonatal death.
  
  
  RESULTS
  A total of 232 women underwent emergency Caesarean section, and 140 of these met the inclusion criteria. At the time of delivery, 78/140 (55.7%) patients were categorized as obese (BMI ≥ 30kg/m2). The median decision-to-incision and decision-to-delivery intervals were significantly longer in the obese group, with a median delay of 4.5 minutes in both time intervals. Time-to-event analysis demonstrated prolongation of the decision-to-incision interval in the obese group (hazard ratio 0.71, P lt; 0.05). There was no difference in the neonatal composite outcome, but there was a significant reduction in median five-minute Apgar score in the obese group (P = 0.02).
  
  
  CONCLUSIONS
  Obesity is associated with prolonged decision-to-incision and decision-to-delivery intervals, without associated neonatal morbidity, in a tertiary hospital setting. Further studies are required to assess the specific factors limiting expedient delivery in this population.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Pulman
authors.affiliation: Department of Obstetrics and Gynaecology, Queen's University, Kingston ON.
authors.forename: Mina
authors.initials: M
authors.lastname: Tohidi
authors.affiliation: Department of Obstetrics and Gynaecology, Queen's University, Kingston ON.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pudwell
authors.affiliation: Department of Obstetrics and Gynaecology, Queen's University, Kingston ON.
authors.forename: Gregory A L
authors.initials: GA
authors.lastname: Davies
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003657:Decision Making; D004420:Dystocia / Q000453:epidemiology* / Q000601:surgery; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009767:Obesity, Morbid; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013997:Time Factors
keywords: Caesarean section; decision-to-delivery interval (DDI); emergency; obesity