Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes

• Published in: Australian & New Zealand journal of obstetrics & gynaecology Vol. 48; no. 3; pp. 286 - 291
• Main Authors: DOHERTY, Dorota A., MAGANN, Everett F., CHAUHAN, Suneet P., O'BOYLE, Amy L., BUSCH, Jeanne M., MORRISON, John C.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-06-2008
• Subjects: Adolescent; Adult; caesarean delivery; Cesarean Section - statistics & numerical data; Female; Humans; operative blood loss; operative time; perinatal outcome; Pregnancy; Pregnancy Outcome; Prospective Studies; Time Factors; Virginia; Virginia
• ISSN: 0004-8666; 1479-828X
• DOI: 10.1111/j.1479-828X.2008.00862.x

Aim:  To determine the factors that influence caesarean operative time and operative time effects on pregnancy outcomes.
Methods:  Prospective observational study of women undergoing a caesarean delivery (CD). Multiple antepartum, intrapartum and neonatal outcomes were assessed for their influence on the time of the CD and the time effect of CD on pregnancy outcomes.
Results:  There were 386 (23%) caesarean deliveries performed ≤ 30 min, 1070 (65%) between 31 and 60 min, and 200 deliveries ≥ 60 min. Women younger than 18 years (P= 0.004) and who had caesarean for fetal labor intolerance were associated with shorter operation time (P < 0.001). Factors associated with an increased operation time were age > 35 years (P= 0.049), body mass index (BMI) ≥ 30 (P < 0.001), pre‐existing hypertension (P= 0.001), prior low segment transverse scar (P < 0.001), uterus incision other than transverse (P < 0.001), first‐year resident as primary surgeon (P < 0.001) and accompanying sterilisation procedure (P < 0.001). Operation time was significantly related to blood loss (P < 0.001), likelihood of umbilical artery cord gas pH < 7.1 (P < 0.001) and Apgar scores at five minutes < 7 (P= 0.009).
Conclusions:  Operative time is shortened by age < 18 and delivery for fetal labor intolerance, lengthened by age > 35, BMI > 30, prior caesarean, uterine incision, operating surgeon inexperience and accompanying sterilisation. Increased operative time was linked with an increased blood loss, low five‐minute Apgar scores and umbilical arterial pH < 7.1.