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A Cesarean delivery may be critical to the health and wellbeing of a newborn. The time required to extract an infant from a hostile in utero environment is a frequent issue in medical negligence cases. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics suggest a time guideline of 30 minutes from decision for Cesarean delivery to the beginning (incision) of the procedure. This time frame is based on survey data from hospitals throughout the United States and is not based on clinical outcomes or the pathophysiology of obstetric events. This review focuses on specific Cesarean indications as noted by the specialty groups and analyzes them from an outcome point of view. The authors conclude that specific high-risk factors do indeed warrant delivery in as expedient a fashion as possible; however, compliance with the 30-minute guideline does not necessarily lead to a difference in outcome as far as the neonate is concerned.

Thirty-seven patients who delivered singleton pregnancies were followed by serial sonograms during the first 2 weeks of the puerperal period to evaluate uterine involution. Significant correlation was found between birthweight and uterine size during this period. No correlation was found between regressing uterine size and route of delivery, parity, or method of infant feeding. Variations in normal uterine, endometrial, and adnexal appearance are described as knowledge of these changes is necessary to appreciate pathologic conditions.