الفهرس 
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Abstract
A Caesarean section is usually performed when a vaginal
delivery would put the baby’s or mother’s life or health at risk,although in recent times it has been also performed
upon request for childbirths that could otherwise have been natural, which known as elective cesarean section, or cesarean section on maternal request.
Cesarean section is associated with increased risks for
adverse obstetric and perinatal outcomes. Many factors may contribute in the unfavorable neonatal outcome during cesarean section.
With an ever increasing number of cesarean section
performed in Egypt, and whole world, the necessity of
understanding the influence of operative time on perinatal
morbidity is important, as operative time may be one of the factors contribute in the unfavorable neonatal outcome during cesarean section.
The present study was carried out through 9 months to
highlight the effect of operative time on the immediate neonatal
outcome, which was assessed by well trained pediatricians,
using a simplified scoring system, Apgar score.
The study included 100 women with singleton
pregnancy, full term, undergoing cesarean section, with no medical disorder (uncomplicated pregnancy), fetal distress or
neonatal congenital anomalies.
Among the studied group, the duration from initiation of
spinal anesthesia, till clamping the cord was ranged between 3.5 – 25.5 minutes with mean of 11.02 ± 4.8 minutes. While the duration form incision of the uterus till clamping of the cord ranged between one minute and 4.5 minutes.
The neonates were assessed and evaluated through Apgar
score. Apgar 1 min ranged between 2/10 - 8 /10 with median of 5/10, while Apgar 5 min ranged between 6/10 – 10/10 with median of 8/10.
The current study showed no significant correlation
between Apgar score of the neonates, either after 1 minute or 5 minutes, and the I-C interval up to 25.5 minutes (P-value between Apgar 1 min and I-C interval = 0.575, while P-value between Apgar 5 min and I-C interval = 0.674) for all cesarean sections done under spinal anesthesia.
The present study showed no significant correlation
between Apgar score of the neonates, either after 1 minute or 5 minutes, and the U-C interval up to 4.5 minutes (P-value between Apgar 5 min and U-C interval = 0.329, while P-value
between Apgar 5 min and U-C interval = 0.237). for all
cesarean sections done under spinal anesthesia.
Among the studied group, 57 of the cases (57%)
undergoing through cesarean section for the 1st time, while 43 of them (43%) with history of previous cesarean section. Therewas no significant correlation between multiple cesarean sections and Apgar score (Apgar 1 min, P-value = 0.091, and Apgar 5 min, P-value = 0.256).
There are numbers of factors that affect caesarean
operative time. Operative time is affected either by modifiable or non-modifiable factors. Modifiable factors such as hand skills of the surgeon and timing of sterilization after initiation
of Spinal anesthesia, which affect the operative time interval.
Non-modifiable factors, such as; history of undergoing cesarean section before (history of previous cesarean section),presentation of the fetus may have a rule in the cesarean operative time.
In the current study, pregnant women with history of
previous cesarean section increased the duration of the I-C interval, with highly significant correlation (P-value = <0.001).
It was noticed that absence of significant correlation
between the I-C interval and the neonatal respiratory rate
(P-value = 0.817), or the occurrence of TTN (P-value = 0.437),for all cesarean sections done under spinal anesthesia.
History of doing Previous cesarean section before
showed no significant correlation with the U-C interval (Pvalue = 0.829).
It was noticed that 7 neonates (7%) developed Transient
Tachypnea of Newborn (TTN) and transferred to NICU. .