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

Author(s): Itamar D. Futterman, Liel Navi, Hae-Young Kim, Roni Mendonca, Michael Girshin, Alexander Shilkrut

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: 1. Non obese; 30 kg/cm2 (n=55) 2. Class I obesity; 31-34 kg/cm2 (n=75) 3. Class II and III Obesity; =35 kg/cm2 (n=51) 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.