EMERGENCY CESAREAN-SECTION - ORGANIZATION AND D-D TIME

The German Society of Gynaecology and Obstetrics has published standar ds for obstetrical services concerning equipment, personnel and organi sation. 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 Cae sarean sections performed at the University hospital Grosshadern of Mu nich during the interval from 1987 to 1994. This being a level III hos pital, there is a 24 hour obstetrical, anaesthesia and neonatal servic e, and personnel is readily available. The operation can and has been done in each delivery room. 1. The incidence of emergency Caesarean se ctions 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 presen ted 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 fr equency 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 C aesarean delivery requires a coordinated team effort with excellent co operation between obstetrics, anaesthesia and neonatology. Our study d emonstrates that even in this optimal setting a decision to delivery t ime within the 20-minute interval can not always be achieved. Based up on our results and other studies, we recommend a DD time of 30 minutes .