Departments of Obstetrics and Gynecology, Anesthesiology, Medicine, and Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Obstet Gynecol. 2014 Mar;123(3):536-548. doi: 10.1097/AOG.0000000000000132.
To systematically review the literature on the proportion of emergent cesarean deliveries accomplished within 30 minutes, the mean time from decision-to-incision or delivery, and differences in neonatal outcomes in deliveries accomplished within 30 minutes compared to beyond 30 minutes.
Electronic databases (Ovid MEDLINE and EMBASE and www.clinicaltrials.gov) were searched from inception to January 2013.
Eligible studies reported decision-to-incision time or delivery time intervals for nonelective cesarean deliveries. Both emergent and urgent deliveries (also known as category 1 and category 2 deliveries) were included. Two reviewers independently identified studies for inclusion.
TABULATION, INTEGRATION, AND RESULTS: Out of 737 reports identified in the primary search, 34 studies (22,936 women) met eligibility criteria. Seventy-nine percent (95% confidence interval [CI] 61-97%) of category 1 deliveries and 36% (95% CI 24-48%) of category 2 deliveries were achieved within 30 minutes, with significantly shorter time in category 1 compared to category 2 deliveries (21.2 compared with 42.6 minutes; P<.001). In the 13 studies that included neonatal outcomes, there was a higher risk of overall 5-minute Apgar score less than 7 (odds ratio [OR] 3.10; 95% CI 1.93-4.96) and umbilical artery pH level less than 7.10 (OR 3.40; 95% CI 2.38-4.87) in cases involving shorter delivery intervals. However, analyses limited to category 1 deliveries did not show a statistically greater risk of Apgar score less than 7 (OR 0.69; 95% CI 0.11-4.51) or umbilical artery pH level less than 7.10 (OR 1.10; 95% CI 0.28-4.40) with shorter delivery intervals. There was no difference by delivery interval in admission to neonatal intensive care units or special newborn units (OR 1.23; 95% CI 0.90-1.68).
Delivery within 30 minutes was not achieved in a substantial proportion of cases. The clinical significance of failing to achieve this standard remains uncertain.
系统地回顾文献中关于在 30 分钟内完成紧急剖宫产的比例、从决定手术到切开子宫或分娩的平均时间，以及在 30 分钟内完成与超过 30 分钟完成分娩的新生儿结局差异。
从开始到 2013 年 1 月，电子数据库（Ovid MEDLINE 和 EMBASE 以及 www.clinicaltrials.gov）进行了搜索。
纳入的研究报告了非选择性剖宫产的决定到切开子宫或分娩的时间间隔。包括紧急和紧急（也称为 1 类和 2 类分娩）分娩。两名审查员独立确定了纳入的研究。
表格、综合和结果：在初步搜索中确定的 737 份报告中，有 34 项研究（22936 名女性）符合入选标准。79%（95%置信区间[CI]61-97%）的 1 类分娩和 36%（95%CI 24-48%）的 2 类分娩在 30 分钟内完成，1 类分娩的时间明显短于 2 类分娩（21.2 分钟比 42.6 分钟；P<.001）。在纳入新生儿结局的 13 项研究中，5 分钟 Apgar 评分小于 7 的总风险更高（比值比[OR]3.10；95%CI 1.93-4.96）和脐动脉 pH 值小于 7.10（OR 3.40；95%CI 2.38-4.87）的风险更高。然而，仅针对 1 类分娩的分析并未显示较短分娩间隔的 Apgar 评分小于 7 的风险（OR 0.69；95%CI 0.11-4.51）或脐动脉 pH 值小于 7.10 的风险（OR 1.10；95%CI 0.28-4.40）统计学上更大。较短的分娩间隔在新生儿重症监护病房或特殊新生儿病房的入院率方面没有差异（OR 1.23；95%CI 0.90-1.68）。
在很大一部分情况下，未能在 30 分钟内完成分娩。未能达到这一标准的临床意义仍不确定。
