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Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retrospective analysis of emergency cesareans from 2004 (introduction of the new SOP) to 2009 in a Swiss Level 3 perinatal center. Primary endpoints were the DDI, the pathology-to-decision interval (PDI), the 5 year learning curve, and neonatal and maternal outcome. Results: In the emergency cesarean group (175 women and 188 infants), mean DDI decreased over the observation period from 15 to 9 minutes (mean 10 minutes 41 seconds), and mean PDI from 11 to 6 minutes (mean 8 minutes). Not only did the DDI not exceed 15 minutes in over 90% of cases during the 5 years, but it fell consistently below 10 minutes in the latter stages of the learning curve. Only 2/188 infants had an umbilical artery pH < 7.00 and 19/188 had an Apgar score <5 at 5 minutes. Maternal morbidity comprised three cases of superficial wound infection. Conclusion: Logistic prerequisites comprise a surgical capability directly within the delivery suite, a standby surgical and anesthetic team, a crash call system, and clear duty allocation. International guideline target times are readily achievable at no additional significant fetal or maternal cost.
In this paper a numerical study of a turbulent, natural convection
problem is performed with a compressible Large-Eddy simulation. In a natural
convection the fluid is accelerated by local density differences and a
resulting pressure gradient. Directly at the heated walls the temperature
distribution is determinate by increasing temperature gradients. In the centre
region convective mass exchange is dominant. Density changes due to temperature
differences are considered in the numerical model by a compressible coupled model. The obtained numerical results of this
study are compared to an analogue experimental setup. The fluid properties
profiles, e.g. temperature and velocity, show an asymmetry which is caused by
the non-Boussinesq effects of the fluid. The investigated Rayleigh number of
this study lies at Ra = 1.58 × 109.