Attendance of paediatricians at elective Caesarean sections performed under regional anaesthesia: Is it warranted?

Abstract

Elective CSs performed under regional anaesthesia are low-risk deliveries. The slight increased requirement for bag and mask ventilation is not practically significant. Such deliveries do not require the routine attendance of experienced paediatric medical staff.

Non-urgent caesarean delivery increases the need for ventilation at birth in term newborn infants

“…The results in the present study can be compared to those presented by Gordon et al 20 and Atherton et al ,19 both of whom enrolled term singleton gestations and evaluated a subset of patients born by elective caesarean section under regional anaesthesia. In these studies, the frequency of bag and mask ventilation varied between 5% and 8% for the caesarean section newborns and 4% for the vaginally delivered infants and intubation was needed, respectively, in 0.08–0.3% and 0.06–0.2% of infants.…”

“…Annibale et al 17 evaluated 11 702 term gestations in two American hospitals and found a higher incidence of bag and mask ventilation and intubation in all caesarean sections compared to vaginal deliveries, but indications for caesarean section, the presence of fetal distress and the type of anaesthesia were not specified. Parsons et al 18 and Atherton et al 19 compared resuscitative procedures between vaginal and caesarean deliveries for term, singleton gestations in Australia, using population-based studies. In a subgroup analysis of non-instrumental spontaneous vaginal deliveries versus elective repeat caesarean sections under regional anaesthesia without fetal distress, the authors did not find an increase in the need for neonatal tracheal intubation at birth.…”

Part 15: Neonatal Resuscitation

“…6 Several studies have demonstrated that a cesarean section performed under regional anesthesia at 37 to 39 weeks, without antenatally identified risk factors, versus a similar vaginal delivery performed at term, does not increase the risk of the baby requiring endotracheal intubation. [7][8][9][10] With careful consideration of risk factors, the majority of newborns who will need resuscitation can be identified before birth. If the possible need for resuscitation is anticipated, additional skilled personnel should be recruited and the necessary equipment prepared.…”

Part 11: Neonatal Resuscitation

“…The number needed to treat equals 35 (LOE 4 159,160 ). Five retrospective studies showed that delivery by cesarean section at term under regional anesthesia did not increase the risk of requirement for intubation during neonatal resuscitation compared with unassisted vaginal birth (LOE 4 161,162 ).…”