The Witching Hours

Abstract

INTRODUCTION: Primary outcome: determine whether there is a higher incidence of APGAR scores five or less in neonates delivered via emergent Cesarean section performed after business hours (5 PM–7 AM and weekends) versus those performed during business hours (weekdays 7 AM–5 PM). Secondary outcomes: umbilical cord pH, base excess, and NICU admissions. METHODS: A retrospective chart review analyzing markers consistent with poor neonatal outcomes in patients who underwent an emergent Cesarean delivery. Variables collected: time/day of delivery, APGARs at one and five minutes, umbilical cord pH and base excess, NICU admission, maternal age, gravidity, parity, delivery gestational age, time from decision until delivery, anesthesia type, staff anesthesiologist with OB fellowship training, maternal BMI, indication for emergent delivery. RESULTS: 124 patients (57 during business hours, 67 after business hours) delivered November 2012–January 2015. All results listed as during-hours, after-hours, respectively. APGAR five or less at one minute 35.59%, 40% (P=.61); APGAR five or less at five minutes 9.2%, 6.8% (P=.62); cord pH 7.18, 7.19 (P=.68); cord base excess −5.7, −4.9 (P=.3); NICU admissions 64.4%, 63% (P=.87). Anesthesia outcomes: APGAR five or less at 1 minute 27.3% epidural, 53.9% general, 46.9% spinal (P=.03); APGAR five or less at 5 minutes 6.1% epidural, 19.2% general, 3.1% spinal (P=.06); NICU admissions 18.2% epidural, 57.7% general, 56.2% spinal (P<.0001). CONCLUSION: Markers consistent with poor neonatal outcomes have not been well studied. There was no significant difference in patients delivered emergently after-hours. Patients who received epidural anesthesia had significantly better neonatal outcomes than those who underwent general or spinal anesthesia.