Hillemanns P, Hepp H, Rebhan H, Knitza R
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ludwig-Maximilians-Universität, München.
Geburtshilfe Frauenheilkd. 1996 Aug;56(8):423-30. doi: 10.1055/s-2007-1023258.
The German Society of Gynaecology and Obstetrics has published standards for obstetrical services concerning equipment, personnel and organisation. All obstetrical services must be able to perform an emergency Caesarean section with a 20 minutes interval from decision to delivery (D-D time). This study represents an analysis of the 75 emergency Caesarean sections performed at the University hospital Grosshadern of Munich during the interval from 1987 to 1994. This being a level III hospital, there is a 24 hour obstetrical, anaesthesia and neonatal service, and personnel is readily available. The operation can and has been done in each delivery room. 1. The incidence of emergency Caesarean sections was 0.6% compared to a total Caesarean rate of 21.5% in a high risk population having a preterm rate of 19% during the period of the study. 55% of the patients who had emergency Caesarean sections presented with a gestational age of less than 37 weeks and 35% of less than 32 weeks. 2. The mean time elapsed between decision and delivery (D-D time) was 12.8 minutes; however, the 90 percentile was 22 minutes and exceeded the recommended D-D time of 20 minutes. The mean decision to incision interval represented 9.1 minutes, and 3.6 minutes were needed between incision and delivery. 3. There was a significantly higher frequency of emergency Caesarean sections, performed during daytime and evening hours compared to early morning (0-8 a.m.). However, the D-D time intervals examined for these three time periods showed only minor, non-significant differences. In conclusion, an efficient emergency Caesarean delivery requires a coordinated team effort with excellent cooperation between obstetrics, anaesthesia and neonatology. Our study demonstrates that even in this optimal setting a decision to delivery time within the 20-minute interval can not always be achieved. Based upon our results and other studies, we recommend a D-D time of 30 minutes.
德国妇产科学会已发布了有关产科服务在设备、人员和组织方面的标准。所有产科服务都必须能够在从决定手术到分娩（D-D时间）间隔20分钟内完成急诊剖宫产。本研究对1987年至1994年间在慕尼黑大学格罗斯哈登医院进行的75例急诊剖宫产进行了分析。这是一家三级医院，提供24小时产科、麻醉和新生儿服务，人员随时可用。手术可以且已经在每个产房进行。1. 急诊剖宫产的发生率为0.6%，而在研究期间，高危人群的总剖宫产率为21.5%，早产率为19%。接受急诊剖宫产的患者中，55%的孕周小于37周，35%的孕周小于32周。2. 决定手术到分娩之间的平均时间（D-D时间）为12.8分钟；然而，第90百分位数为22分钟，超过了建议的20分钟D-D时间。决定到切开的平均间隔时间为9.1分钟，切开到分娩需要3.6分钟。3. 与凌晨（0-8点）相比，白天和晚上进行急诊剖宫产的频率明显更高。然而，对这三个时间段检查所得的D-D时间间隔仅显示出微小的、无显著差异。总之，高效的急诊剖宫产需要产科、麻醉科和新生儿科之间密切协作的团队努力。我们的研究表明，即使在这种最佳环境下，也并非总能在20分钟的间隔内实现决定到分娩的时间。根据我们的研究结果和其他研究，我们建议D-D时间为30分钟。
