Notsectio - Organisation und E-E-Zeit

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.