{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:53:53Z","timestamp":1787748833802,"version":"build-2784847793"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"S 01","funder":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003Timely response to obstetrical emergencies is highly desired. The recommendation for decision-to-incision (DTI) time in cesarean delivery (CD) of not more than 30\u2009minutes was issued to prevent neonatal hypoxic\u2013ischemic morbidities. We analyzed the efficiency with which an institutional-specific CD acuity classification system (emergent case: target DTI \u2264 15\u2009minutes; urgent case: target DTI \u2264 30\u2009minutes) reflected in the actual DTI time, Apgar scores, and newborn acid\u2013base status.<\/jats:p><jats:p>\n            Study Design\u2003Data on all 610 cesarean sections (CSs) performed over a 14-month period at a tertiary medical center were retrospectively extracted. Cases grouped by target DTI time categories were compared for proportions in low Agar scores and fetal acidosis. Multivariable regression was used to identify clinical variables associated with the need for neonatal resuscitation.<\/jats:p><jats:p>\n            Results\u2003During the study period, 60 (10%) of CSs were emergent, 296 (49%) urgent, and 254 (41%) elective. The target DTI \u2264 15\u2009minutes was achieved in 68% of emergent CSs with 93% having a DTI \u2264 30\u2009minutes. Among urgent surgeries, the target DTI \u2264 30\u2009minutes was reached in 48% of cases with 83% having DTI \u2264 45\u2009minutes. Compared with both urgent and scheduled procedures the incidence of newborn acidosis and Apgar scores \u22644 and \u22647 was the highest among emergent CSs. The proportion of moderate and severe acidosis for deliveries with DTI \u2264 15\u2009minutes was significantly higher compared with procedures with DTI 16 to 30 and &gt;30\u2009minutes. The need for neonatal resuscitation, including intubation, was independently associated with fetal acidosis, low gestational age, surgery acuity level, general anesthesia, but not with the actual DTI time.<\/jats:p><jats:p>\n            Conclusion\u2003Adherence to tight DTI time targets is pragmatically difficult. The need for neonatal resuscitation varies with the acuity of the procedure but not with the actual DTI interval, implying that within certain time limits, the indication for surgery plays a greater role in the status of the newborn than the speed of the CS.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2088-5393","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T23:56:55Z","timestamp":1683590215000},"page":"e1925-e1934","source":"Crossref","is-referenced-by-count":2,"special_numbering":"S","title":["Is Faster Better? Relationships of Cesarean Acuity with Risk of Low Apgar Scores and Fetal Acidemia"],"prefix":"10.1055","volume":"41","author":[{"given":"Gian","family":"Diaz-Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"},{"name":"University of Illinois Hospital and Health Sciences (UI Health), Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Braverman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"},{"name":"University of Illinois Hospital and Health Sciences (UI Health), Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria G.","family":"Elam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"},{"name":"University of Illinois Hospital and Health Sciences (UI Health), Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Norris-Stojak","sequence":"additional","affiliation":[{"name":"University of Illinois Hospital and Health Sciences (UI Health), Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Harmon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hartwig","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiana","family":"Dunlap","sequence":"additional","affiliation":[{"name":"University of Illinois Hospital and Health Sciences (UI Health), Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Nixon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phornphat","family":"Rasamimari","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina A.","family":"Buhimschi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1701-1326","authenticated-orcid":false,"given":"Catalin S.","family":"Buhimschi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois"},{"name":"University of Illinois Hospital and Health Sciences (UI Health), Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"key":"ref1","volume-title":"To Err is Human: Building a Safer Health System","author":"Institute of Medicine (US) Committee on Quality of Health Care in America","year":"2000"},{"key":"ref2","volume-title":"Risk management event evaluation and responsibilities","author":"J McGowan","year":"2022"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1001\/jama.2021.7510","article-title":"Rapid response teams as a patient safety practice for failure to rescue","volume":"326","author":"C P 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