Levine E M, Ghai V, Barton J J, Strom C M
Department of Obstetrics and Gynecology, Illinois Masonic Medical Center, Chicago 60657, USA.
Obstet Gynecol. 1999 Mar;93(3):338-40. doi: 10.1016/s0029-7844(98)00410-4.
To determine whether it is necessary for a pediatrician to attend all cesarean deliveries.
We analyzed a database of 17,867 consecutive deliveries to determine the rates of low Apgar scores in the following three groups of patients: those with vaginal delivery, cesarean delivery using regional anesthesia without fetal indication, and cesarean delivery for fetal indications or using general anesthesia.
There was a significantly higher rate of low Apgar scores in the fetal indications or general anesthesia group when compared with vaginal deliveries. Specifically, 35 (5.8%) of 596 cesareans for fetal heart rate abnormality or using general anesthesia had 1-minute Apgars under 4 in contrast to 115 of 10,270 (1.1%) of vaginal deliveries. There was no significantly increased risk for low Apgar scores in the group of cesareans using regional anesthesia for nonfetal indications (33 of 2057, 1.6%). Results were similar for Apgar scores under 7 at 5 minutes.
Because there is no higher incidence of low Apgar scores in cesarean deliveries using regional anesthesia for nonfetal indications compared with vaginal deliveries, there is no convincing need for pediatrician attendance at such deliveries.
确定儿科医生是否有必要参与所有剖宫产手术。
我们分析了一个包含17867例连续分娩病例的数据库，以确定以下三组患者中Apgar评分低的发生率：阴道分娩患者、采用非胎儿指征区域麻醉的剖宫产患者以及因胎儿指征或采用全身麻醉的剖宫产患者。
与阴道分娩相比，胎儿指征或全身麻醉组的Apgar评分低的发生率显著更高。具体而言，596例因胎儿心率异常或采用全身麻醉进行剖宫产的患者中，有35例（5.8%）1分钟Apgar评分低于4分，而10270例阴道分娩患者中有115例（1.1%）。采用非胎儿指征区域麻醉进行剖宫产的患者中，Apgar评分低的风险没有显著增加（2057例中有33例，1.6%）。5分钟时Apgar评分低于7分的结果相似。
由于与阴道分娩相比，采用非胎儿指征区域麻醉进行剖宫产时Apgar评分低的发生率没有更高，因此没有令人信服的理由让儿科医生参与此类分娩。
