The association between indications for cesarean delivery and surgery time

Daniel Gabbai*, Anat Lavie, Yariv Yogev, Emmanuel Attali

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: We aimed to determine risk factors for prolonged surgery time of cesarean delivery (CD). Methods: We conducted a retrospective cohort study in a single tertiary university–affiliated medical center (2011–2022). The study group consisted of all women who underwent CD that lasted >90 min (representing the 95th percentile of CD length in our cohort). Data were compared with CDs with an operation time of <90 min. Demographic, obstetric, and surgical characteristics, as well as indications for surgery and urgency (in labor vs. elective surgery), were compared. Results: Overall, during the study period, 31 660 CDs were performed in our center. Of them, 1397 (4.4%) lasted >90 min. After applying a multivariate analysis, abnormal placentation (relative risk [RR] 1.5 [95% confidence interval (CI), 1.3–1.8]), previous uterine scar (RR, 2.15 [95% CI, 1.5–3.0]), general anesthesia (RR, 3.5 [95% CI, 2.9–4.4]) and preterm delivery (RR, 2.06 [95% CI, 1.78–2.4]) were found to be associated with prolonged surgical time. CD due to malpresentation (RR, 0.57 [95% CI, 0.46–0.7]), multiple gestations (RR, 0.72 [95% CI, 0.6–0.9]), and patient request (RR, 0.56 [95% CI, 0.38–0.84]) were found to be protective factors. Conclusion: The main risk factors associated with additional surgery time in CD are general anesthesia, abnormal placentation, previous uterine scar, and preterm delivery.

Original languageEnglish
Pages (from-to)693-698
Number of pages6
JournalInternational Journal of Gynecology and Obstetrics
Issue number2
StatePublished - Feb 2024


  • abnormal placentation
  • cesarean delivery
  • preterm delivery
  • previous uterine scar
  • prolonged surgery
  • risk factors


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