{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:53:54Z","timestamp":1787748834516,"version":"build-2784847793"},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health","award":["K08HD082287"],"award-info":[{"award-number":["K08HD082287"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Objective\u2003This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery.<\/jats:p><jats:p>Study Design\u2003This unplanned secondary analysis of the Maternal\u2013Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH \u22647.0, and Apgar score \u22644 at 5\u2009minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as &lt;10\u2009minutes, 10 to &lt;20\u2009minutes, 20 to &lt;30\u2009minutes, 30 to &lt;50\u2009minutes, or \u226550\u2009minutes. As secondary outcomes umbilical cord pH \u22647.1, umbilical artery pH \u22647.0, and Apgar score \u22645 at 5\u2009minutes were analyzed.<\/jats:p><jats:p>Results\u2003Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval \u226410\u2009minutes, 20.2% 11 to 20\u2009minutes, 14.9% 21 to 30\u2009minutes, 18.2% 31 to 50\u2009minutes, and 16.5% &gt;50\u2009minutes. Risk for umbilical cord pH \u22647.0 was highest at \u226410 and 11 to 20\u2009minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30\u2009minutes (3.9%), 31 to 50\u2009minutes (3.9%), and &gt;50\u2009minutes (3.5%) (p\u2009&lt;\u20090.01). Risk for Apgar scores \u22644 at 5\u2009minutes was also higher with decision-to-incision intervals \u226410 and 11 to 20\u2009minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30\u2009minutes (1.7%), 31 to 50\u2009minutes (2.1%), and &gt;50\u2009minutes (2.0%) (p\u2009&lt;\u20090.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of \u226410 and 11 to 20\u2009minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30\u2009minutes and 31 to 50\u2009minutes (p\u2009=\u20090.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals.<\/jats:p><jats:p>Conclusion\u2003Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean.<\/jats:p><jats:p>Key Points<\/jats:p>","DOI":"10.1055\/s-0040-1717068","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T22:55:26Z","timestamp":1600728926000},"page":"416-424","source":"Crossref","is-referenced-by-count":7,"title":["Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy"],"prefix":"10.1055","volume":"39","author":[{"given":"Sabine","family":"Bousleiman","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwight J.","family":"Rouse","sequence":"additional","affiliation":[{"name":"Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gyamfi-Bannerman","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongmei","family":"Huang","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"D'Alton","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Siddiq","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"ref1","volume-title":"Standards for obstetric-gynecologic services","author":"American 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