Emergent primary cesarean delivery and maternal operative morbidity

Background: It is unknown how variations in surgical entry time in primary cesarean delivery (CD) may affect operative outcomes and maternal morbidity. Objective: Determine whether performing a primary CD in labor emergently (“stat”) is associated with adverse maternal outcomes. Study design: Retrospective cohort study of patients who underwent primary CD at The Mount Sinai Hospital during the years of 2011–2016. Women with a singleton pregnancy and without a prior uterine scar attempting a trial of labor were included. An emergent CD was defined as a skin-to-uterine incision (I-U) time of ≤3 minutes. Subjects were dichotomized into those with an I-U time of ≤3 minutes or ≥5 minutes. Results: 1722 patients underwent primary CD and met eligibility criteria. 72 patients with an I-U time of 4 minutes were removed from the analysis. 196 patients (11.9%) had an I-U time ≤3 minutes and 1454 patients (88.1%) had an I-U time ≥5 minutes. There were no differences in any outcomes between groups. The likelihood of transfusion, hysterectomy, or admission to the intensive care unit (ICU) was 1.5% in the emergent group and 1.0% in the control group (p =.334). Postpartum length of stay was also similar between the groups (3.3 versus 3.2 days, p =.259). When 384 patients with I-U times >10 minutes were excluded, surgical outcomes remained similar between groups. Among the subgroup of patients who reached the second stage of labor, surgical outcomes were also similar between groups. Conclusions: Emergent primary CD is not associated with increased maternal morbidity.