{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:04:04Z","timestamp":1789772644298,"version":"4.0.1"},"reference-count":7,"publisher":"Georg Thieme Verlag KG","funder":[{"name":"National Institutes of Health","award":["HD007203-42"],"award-info":[{"award-number":["HD007203-42"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Prior studies showing an inverse association between time from spinal anesthesia to delivery and umbilical artery (UA) pH were relatively small cohorts or included only spinal anesthesia. In a large cohort of unlabored cesarean deliveries, we further investigated this association.<\/jats:p>\n                  <jats:p>This is a secondary analysis of a retrospective cohort study of singleton, term, non-anomalous pregnancies delivered by non-labor cesarean with neuraxial anesthesia, inclusive of spinal, epidural, or combined spinal\u2013epidural. We assessed outcomes with time intervals from neuraxial placement to delivery: &lt;\u200920, 20\u201339, 40\u201359, and \u2265\u200960\u2009minutes. The primary outcome was UA pH &lt;\u20097.1. We further analyzed the time intervals for surgical procedural steps among neonatal UA pH cohorts: \u2264\u20097.00, 7.01\u20137.10, 7.11\u20137.20, 7.21\u20137.30, and \u2265\u20097.31. Multivariable logistic regression adjusting for baseline confounders was used to determine the strength of association.<\/jats:p>\n                  <jats:p>Of the 5,255 cesarean deliveries, 645 (12.3%) delivered within 20\u2009minutes, 4,067 (77.4%) delivered between 20 and 39\u2009minutes, 468 (8.9%) delivered between 40 and 59\u2009minutes, and 75 (1.4%) delivered in \u2265\u200960\u2009minutes from neuraxial anesthesia. Increased time from neuraxial placement to delivery was associated with UA pH &lt;\u20097.1 and &lt;\u20097.2, UA base deficit &gt;\u20098, and meconium-stained amniotic fluid (all p\u2009&lt;\u20090.05). After adjusting for confounders and using &lt;\u200920\u2009minutes as the reference, increased time from neuraxial placement to delivery was no longer associated with adverse outcomes. There was an inverse relationship with pH and time from neuraxial placement to delivery, skin incision to uterine incision, and uterine incision to delivery (all p\u2009&lt;\u20090.01).<\/jats:p>\n                  <jats:p>Our study suggests that although increased time from neuraxial anesthesia to delivery is associated with lower UA pH, these findings are significantly affected by clinical factors such as body mass index (BMI), hypertension, or diabetic disorders, type of neuraxial anesthesia, number of prior cesarean deliveries, and surgical factors such as duration of procedural steps.<\/jats:p>","DOI":"10.1055\/a-2957-5324","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:08:56Z","timestamp":1789189736000},"source":"Crossref","is-referenced-by-count":0,"title":["Adverse Outcomes Associated with Time from Neuraxial Anesthesia to Delivery among Non-Labor Cesarean"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-3023","authenticated-orcid":false,"given":"Minhazur","family":"Sarker","sequence":"additional","affiliation":[{"name":"University of California San Diego, California, United States","place":["San Diego"],"department":["Department of Obstetrics, Gynecology and Reproductive Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Canfield","sequence":"additional","affiliation":[{"name":"University of Washington, Washington, United States","place":["Seattle"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys A.","family":"Ramos","sequence":"additional","affiliation":[{"name":"University of California San Diego, California, United States","place":["San Diego"],"department":["Department of Obstetrics, Gynecology and Reproductive Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela T.","family":"Bianco","sequence":"additional","affiliation":[{"name":"Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, United States","place":["New York"],"department":["Department of Obstetrics, Gynecology and Reproductive Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-4109","authenticated-orcid":false,"given":"Chelsea A.","family":"DeBolt","sequence":"additional","affiliation":[{"name":"Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, United States","place":["New York"],"department":["Department of Obstetrics, Gynecology and Reproductive Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"S 01","key":"ref1","first-page":"90","article-title":"Spinal anaesthesia-induced hypotension in obstetrics: prevention and therapy","volume":"58","author":"I \u0160klebar","year":"2019","journal-title":"Acta Clin Croat"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S1521-6896(02)00114-3","article-title":"Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia","volume":"17","author":"F V Salinas","year":"2003","journal-title":"Best Pract Res Clin Anaesthesiol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"389.e1","DOI":"10.1016\/j.ajog.2019.01.006","article-title":"Time from neuraxial anesthesia placement to delivery is inversely proportional to umbilical arterial cord pH at scheduled cesarean delivery","volume":"220","author":"R R Rimsza","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12884-022-04536-y","article-title":"Impact of interval between induction of spinal anesthesia to delivery on umbilical arterial cord ph of neonates delivered by elective cesarean section","volume":"22","author":"A S Hassanin","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1097\/AOG.0000000000004968","article-title":"Association between obesity and fetal acidosis at scheduled cesarean delivery","volume":"140","author":"C A DeBolt","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/j.1471-0528.2012.03335.x","article-title":"The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51,519 consecutive validated samples","volume":"119","author":"P Yeh","year":"2012","journal-title":"BJOG"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"c1471","DOI":"10.1136\/bmj.c1471","article-title":"Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis","volume":"340","author":"G L Malin","year":"2010","journal-title":"BMJ"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2957-5324.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:58:28Z","timestamp":1789772308000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2957-5324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":7,"URL":"https:\/\/doi.org\/10.1055\/a-2957-5324","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9,11]]},"published":{"date-parts":[[2026,9,11]]}}}