Editors' ChoicePediatric presence at cesarean section: Justified or not?
Section snippets
Methods
Royal Prince Alfred Hospital (RPAH), Sydney, Australia, is the major obstetric tertiary referral center for Central Sydney Area Health Service (CSAHS). It covers an inner city, multicultural population of approximately 500,000 people.18 Within the CSAHS population, 39.6 % of residents are born overseas and 41.3% speak a language other than English at home, compared with 18.7% in NSW as a whole.18 Of mothers giving birth, 41.4% were born in a non-English speaking country, with Chinese, Arabic,
Results
There were a total of 44,938 eligible singleton term deliveries during the study period. This comprised 79% of all deliveries at RPAH. There was a trend to increasing CS rates throughout the 13 years with an average rate of 21.2% (range 18.3%-27.8%). There were 35,753 spontaneous vaginal deliveries, 4698 emergency CS, and 4,487 elective CS. The demographic, presentation, and resuscitation details are shown in Table I. Women delivered by elective CS were older than the emergency CS or vaginal
Comment
This study was performed to assess the need for resuscitation at CS with particular regard to type of anesthetic, elective or emergency procedures, presence of fetal distress, and fetal presentation. This was primarily to determine whether the need for an advanced skills practitioner was justified for all CS. Previous studies and international guidelines have indicated that the need for resuscitation in term infants delivered by elective CS under regional anesthesia is not significantly
Conclusions
The results of this study suggest that an advanced skills practitioner need not be present at uncomplicated elective CS under regional anesthesia provided there are no other risk factors, namely, fetal distress and noncephalic presentation. Conversely, an advanced skills practitioner is required at emergency CS, CS under general anesthesia, and in the presence of fetal distress and noncephalic presentation.
Acknowledgments
We acknowledge the help of Dr Phillip Beeby, Neonatologist, for data retrieval from the Obstetric Information Systems Database.
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Cited by (34)
European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth
2021, ResuscitationCitation Excerpt :There is no universally applicable model to predict risk for resuscitation or need of support during transition, and the list of risk factors in the guidelines is not exhaustive. Elective caesarean delivery at term, in the absence of other risk factors, does not increase the risk of needing newborn resuscitation.18,27,28 Following the review of evidence, ILCOR recommendations are unchanged: When an infant is delivered at term by caesarean delivery under regional anaesthesia a provider capable of performing assisted ventilation should be present at the delivery.
European Resuscitation Council Guidelines for Resuscitation 2015. Section 7. Resuscitation and support of transition of babies at birth
2015, ResuscitationCitation Excerpt :Furthermore, caesarean delivery is associated with an increased risk of problems with respiratory transition at birth requiring medical interventions especially for deliveries before 39 weeks gestation.10–13 However, elective caesarean delivery at term does not increase the risk of needing newborn resuscitation in the absence of other risk factors.14–17 Although it is sometimes possible to predict the need for resuscitation or stabilisation before a baby is born, this is not always the case.
Part 11: Neonatal resuscitation: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :The number needed to treat equals 35 (LOE 4159,160). Five retrospective studies showed that delivery by Caesarean section at term under regional anaesthesia did not increase the risk of requirement for intubation during neonatal resuscitation compared with unassisted vaginal birth (LOE 4161,162). There is no evidence addressing this question in babies born at 34–36 weeks’ gestation.
Editorial: Perils for the term infant born by elective caesarean section!
2010, Gynecologie Obstetrique et FertiliteNeonatal Resuscitation in Delivery Room: Current Trends and Guidelines in 2022
2023, Current Anesthesiology Reports
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