Effect of Anesthetic Modality on Decision-to-Delivery Interval and Maternal–Neonatal Outcomes in Category 2 and 3 Cesarean Deliveries

<b>Background/Objectives:</b> The optimal anesthetic technique for category 2 and 3 cesarean deliveries remains debated, with concerns about impacts on decision-to-delivery interval (DDI) and perinatal outcomes. This study examined the influence of epidural, spinal, and general anesthesia on DDI, surgical and postoperative complications, and neonatal outcomes. <b>Methods</b>: This prospective cohort study at a tertiary perinatology center enrolled parturient women undergoing category 2 and 3 cesarean deliveries. Three DDI phases were assessed for each anesthetic modality: transfer time (decision for cesarean section to admission in the operation room), anesthetic time (admission to incision), and delivery time (incision to delivery of the neonate). The surgical procedure time (incision to closure), neonatal (5 min Apgar score, umbilical artery pH/base excess, neonatal intensive care unit (NICU) admission) and maternal (blood loss, surgical and postoperative complications) outcomes were also analyzed for each group. <b>Results</b>: There were 215 women (122 category 2 and 93 category 3) included. The use of epidural and general anesthesia was associated with significantly shortened DDI compared to spinal anesthesia (<i>p</i> < 0.001). This difference was due prolonged transfer (<i>p</i> < 0.05) and anesthetic times (<i>p</i> < 0.001), respectively. No cases of umbilical artery pH below 7 were observed in any group. No significant differences were observed in the incidence of umbilical artery pH between 7 and 7.10 or in base excess below -12 nmol/L (<i>p</i> = 0.416 and <i>p</i> = 0.865, respectively). NICU admission was higher with both general and spinal anesthesia (<i>p</i> = 0.021), but mainly due to a higher proportion of preterm births, both before the 32nd week (<i>p</i> = 0.033) and between the 32nd and 37th week of pregnancy (<i>p</i> < 0.001). General anesthesia was associated with higher maternal blood loss (<i>p</i> = 0.026) and a higher rate of postoperative complications (<i>p</i> = 0.006). <b>Conclusions</b>: In category 2 and 3 cesarean deliveries, general and epidural anesthesia were associated with shorter DDI compared to spinal anesthesia with no differences in neonatal outcomes. General anesthesia was associated with a higher risk of maternal complications compared to neuraxial anesthetic techniques.