Kawano Shoko, Amano Kan, Unno Nobuya, Okutomi Toshiyuki
Department of Obstetrics and Gynecology, Kitasato University Hospital, Sagamihara 252-0375.
Masui. 2012 Sep;61(9):917-23; discussion 923-4.
There are abundant cases of obstetric emergencies demanding prompt intervention. Emergency cesarean sections are classified into stable, urgent and immediate surgeries, although there is significant overlap between three groups. Stable emergency cesarean sections are performed in patients with stable maternal and fetal physiology, but who need surgery before unstability occurs. Urgent cesarean sections refer to situations in which maternal and/or fetal physiology is unstable, whereas the immediate cesarean section is used for life-threatening condition such as sustained fetal bradycardia, maternal cardiopulmonary arrest. In most cases the key to proper management is the prompt communication between obstetricians and anesthesiologists. Anesthesiologists must have a clear understanding of certain obstetric emergencies. In the event of sustained fetal bradycardia caused by placental abruption, cord prolapse, uterine rupture etc, delivery by immediate cesarean section within 25 minutes improve long-term neonatal neurologic outcome. Although cardiopulmonary arrest in pregnancy is very uncommon, peripartum cesarean section should be considered within 5 minutes not only for maternal resuscitation but for neonatal survival. Only a well-coordinated teamwork of all involved specialities will guarantee optimal prognosis of mother and fetus.
产科急症需要迅速干预的情况屡见不鲜。急诊剖宫产分为择期、限期和急症手术，尽管这三组之间存在显著重叠。择期急诊剖宫产适用于母婴生理状况稳定，但需要在病情不稳定之前进行手术的患者。限期剖宫产是指母婴生理状况不稳定的情况，而急症剖宫产则用于危及生命的状况，如持续性胎儿心动过缓、产妇心跳呼吸骤停。在大多数情况下，妥善处理的关键是产科医生和麻醉医生之间的迅速沟通。麻醉医生必须清楚了解某些产科急症。在因胎盘早剥、脐带脱垂、子宫破裂等导致持续性胎儿心动过缓的情况下，在25分钟内急症剖宫产分娩可改善新生儿长期神经学预后。尽管妊娠期间心跳呼吸骤停非常罕见，但应在5分钟内考虑进行围产期剖宫产，这不仅有利于产妇复苏，也有利于新生儿存活。只有所有相关专业人员的密切协作，才能确保母婴获得最佳预后。
