Decision-To-Delivery Interval in Obese Patients Undergoing Emergent Cesarean Birth

Abstract

Objective: To examine how increased body mass index (BMI) class impacts time to delivery interval in the setting of emergent cesarean birth. Study Design: A cohort study of all emergent cesarean births at our institution from 2012-2018. Three comparison groups were divided by BMI category: Primary outcomes were time interval from decision-to-delivery interval and from skin-incision-to-delivery interval. Results: The mean time interval (minutes +/- standard deviation (SD)) from arrival at the OR to delivery was 25.1 ± 9.7, 26.1 ± 10.6 and 30.2 ±12.2, highlighting that as patient BMI class increased, the interval time to arrival to the OR and to delivery increased (beta coefficient 95% CI 5.15 (1.01,9,30) p=0.037). The mean time interval (minutes +/- SD) from skin incision to delivery was 8.7 ± 5.6, 9.0 ± 6.4 and 11.7 ±7.0, again showing a positive correlation between time interval and increasing BMI class (beta coefficient 95% CI 3.02 (0.65,5.40) p=0.025). Conclusion: This study describes the challenge of urgent cesarean births in obese patients, manifested in longer decision-to-delivery and skin-to-delivery intervals as BMI class increases. These findings support prior literature that describe a longer transport and surgical times in obese patients undergoing cesarean birth.