Tan W C, Tan L K, Tan H K, Tan A S
Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, Singapore 169608.
Ann Acad Med Singap. 2003 Sep;32(5):638-41.
The objective was to audit 'crash' emergency caesarean sections (CS) with respect to response time (the diagnosis to delivery interval [DDI]) and perinatal outcome.
The computerised database at the Singapore General Hospital (SGH) delivery suite was used to identify all cases of 'crash' emergency CS activated for the diagnosis of cord prolapse from 1992 to 2002. Patients' case notes and neonatal charts were reviewed and the following variables were evaluated: parity, gestational age at the time of delivery and the DDI. Neonatal outcome was measured by Apgar scores at 1 and 5 minutes, cord pH and admission to the neonatal intensive care unit (NICU).
A total of 34 cases of umbilical cord prolapse were identified from 29,867 deliveries, giving an incidence of 0.11% (1 in 900). The median gestational age was 38.5 weeks (range, 25 to 41 weeks). The median time from diagnosis to delivery was 20 minutes (range, 10 to 40 minutes). Seventy-six percent (19/30) were delivered within 30 minutes. The time of diagnosis was not recorded for 5 cases. Sixty-three percent of neonates had an Apgar score < or = 7 at 1 minute of life, increasing to 97% at 5 minutes. There were 3 NICU admissions for reasons of prematurity. There was no perinatal mortality. Cord pH was not performed for 47% of (14/30) neonates. Among the remaining 16 neonates, an umbilical cord pH of < or = 7.20 was found in 62% (10/16). There was poor correlation between the DDI and umbilical cord pH.
Three-quarters of our 'crash' emergency CS for cord prolapse were performed within 30 minutes with a good perinatal outcome. However, we have identified areas for improvement to optimise further the operational efficiency of 'crash' emergency CS.
旨在审核“紧急”剖宫产手术，评估其反应时间（诊断至分娩间隔时间[DDI]）及围产期结局。
利用新加坡总医院（SGH）产房的计算机化数据库，识别1992年至2002年间因诊断脐带脱垂而启动的所有“紧急”剖宫产病例。查阅患者病历和新生儿图表，并评估以下变量：产次、分娩时的孕周及DDI。通过1分钟和5分钟时的阿氏评分、脐带血pH值及新生儿重症监护病房（NICU）收治情况来衡量新生儿结局。
在29867例分娩中，共识别出34例脐带脱垂病例，发生率为0.11%（900例中有1例）。中位孕周为38.5周（范围为25至41周）。从诊断到分娩的中位时间为20分钟（范围为10至40分钟）。76%（19/30）的产妇在30分钟内分娩。有5例未记录诊断时间。63%的新生儿出生1分钟时阿氏评分≤7分，5分钟时增至97%。因早产有3例新生儿入住NICU。无围产期死亡。47%（14/30）的新生儿未进行脐带血pH值检测。在其余16例新生儿中，62%（10/16）的脐带血pH值≤7.20。DDI与脐带血pH值之间相关性较差。
我们实施的四分之三的因脐带脱垂而进行的“紧急”剖宫产手术在30分钟内完成，围产期结局良好。然而，我们已确定有待改进的方面，以进一步优化“紧急”剖宫产手术的操作效率。
