Notsectio - Organisation und E-E-Zeit

Abstract

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.

Anaesthesia for caesarean section — a German survey

“…For most emergency situations rapid-sequence induction of general anaesthesia is the method of choice. Altogether, these indications are rare and amount to 0.6% of all caesarean deliveries in a German investigation (19). However, in the majority of non-scheduled cases these arguments against regional anaesthesia do not apply.…”

“…On the other hand, emergency CS makes immediate delivery necessary. A maximum response time of 20 to 30 min from decision to delivery is recommended (18,19). The question arises as to which anaesthetic procedure is appropriate and safe for an emergency CS.…”

Aktuelle Praxis der Anästhesie zur Sectio caesarea an den deutschen Universitätsklinika

“…Inwieweit dieser Trend zur Regionalanästhesie auch in der Bundesrepublik Deutschland eingetreten ist, kann schwerlich beantwortet werden. Letzte Umfragen zur geburtshilflichen Anäs-thesie an deutschsprachigen Universitätsklinika stammen -soweit ersichtlich -aus den Jahren 1977 und 1982 [8,10]. Um einen Überblick über die gegenwärtige Situation der geburtshilflichen Anästhesie in Deutschland geben zu können, wurden Fragebögen zur geburtshilflichen Anästhesie an die Universitätsinstitute in der Bundesrepublik versandt.…”

“…Hier sollte bei vitaler Gefähr-dung von Mutter und/oder Kind die E-E Zeit (Entschluß-Entwicklungs-Zeit) so kurz wie irgend möglich gehalten werden. Als Mindestanforderung gilt eine E-E Zeit von 20 min [8]. In dieser Situation führt jede Verzögerung potentiell zu gravierenden Folgen für Leben und Gesundheit.…”

Anästhesieverfahren bei operativer Entbindung

“…Aus[17]) Tagen in der Woche. Unabhängig von der Geburtenfrequenz muû gewährlei-stet sein, daû ein Anästhesist innerhalb von 10 min zur Verfügung steht und eine E-E-Zeit von 20 min realisiert werden kann (s. Vereinbarungen der Berufsverbände, Stellungnahme der DGGG,[9]). Diese Forderung erschien im Jahr 1996 noch nicht überall erfüllt zu sein (Tabelle 7).…”