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Do Emergent Cesarean Deliveries Have Worse Neonatal Outcomes When Performed After “Normal” Business Hours?
Abstract Number: F-31
Abstract Type: Original Research
Our hypothesis was that neonates delivered via emergent Cesarean delivery after hours will have a higher proportion of low APGARs (5 or less), NICU admissions, and lower cord pH and BE, compared to neonates delivered between 7AM and 5PM. Our study methodology was a retrospective chart review (November 2012-January 2015) analyzing markers consistent with poor neonatal outcomes in patients who underwent an emergent Cesarean delivery. Other variables we considered included: time of delivery, maternal parity, gestational age, type of anesthesia, OB fellowship trained vs. generalist anesthesia staff, maternal BMI, interval between decision to actual delivery, indication for emergent delivery, and primary vs. repeat Cesarean. Our statistical methodology included chi-squared testing, t-test, ANOVA and regression analysis.
Our results included a sample size of 124 patients, 57 during business hours and 67 after business hours, to fulfill a power of 80%. The primary indication for emergent cesarean delivery was non-reassuring fetal heart tones (FHT’s). Category 2 FHT’s comprised 31.4% of deliveries, followed by Category 3 FHT’s at 14.6% and terminal decelerations also at 14.6%. Other indications included placental abruption, cord prolapse, malpresentation and uterine rupture. Our primary outcome revealed that there was no statistical difference in outcomes during business hours compared to after hours when analyzing APGARs, cord pH, cord BE, and NICU admissions. The secondary results regarding anesthetic concerns include modality of anesthesia and staff training. The most used anesthetic for these patients was an epidural, which made up more than 50% in both arms of the study. This finding is most likely due to the high percentage of laboring patients receiving an epidural, that was then able to be converted to an anesthetic for surgery.
Our study revealed that fellowship training for anesthesiologists did not affect neonatal outcomes. Only the type of anesthetic showed a statistical difference. Patients that had general anesthesia or spinals for an emergent cesarean delivery had lower APGARS at 1 minute and more NICU admissions. This is likely due to the level of acuity of the presenting patient; for example, a uterine rupture presenting urgently to the hospital receiving a general anesthetic as compared to a category 2 FHT that is emergently brought to the OR with a working epidural.
This study shows that at our institution neonatal outcomes do not differ based on time or day of delivery. Our data have encouraged us to counsel patients that are at higher risk for emergent cesarean delivery to receive an epidural as neonates delivered with this anesthetic have better outcomes than if general or spinal anesthesia is induced.