Editors' Choice
Pediatric presence at cesarean section: Justified or not?

https://doi.org/10.1016/j.ajog.2005.06.013Get rights and content

Objectives

This study was undertaken to determine the incidence and type of resuscitation required for infants delivered by both elective and emergency cesarean section relative to spontaneous vaginal delivery.

Study design

A hospital-based cohort study from 1990 to 2002. Information was extracted from a prospectively collected database on term (≥37 weeks) singleton infants delivered by cesarean section and spontaneous vaginal delivery. Analysis was performed on type of cesarean section, type of anesthetic, fetal presentation, and evidence of fetal distress. Outcomes assessed were resuscitation and Apgar scores.

Results

There were 44,938 eligible deliveries. There was no significant difference in need for resuscitation between infants born by elective cesarean section under regional anesthetic compared with spontaneous vaginal delivery (χ2 = 0.998; df = 1; P = .318). General anesthesia, fetal distress, and noncephalic presentation increase the need for resuscitation.

Conclusion

An advanced skills practitioner does not need to be present at elective cesarean sections under regional anesthesia provided there are no additional risk factors.

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.

References (18)

There are more references available in the full text version of this article.

Cited by (34)

View all citing articles on Scopus

Reprints not available from the author.

View full text