Atherton Neil, Parsons Simon J, Mansfield Peter
Department of Paediatrics, Royal Hobart Hospital, Tasmania, Australia.
J Paediatr Child Health. 2006 Jun;42(6):332-6. doi: 10.1111/j.1440-1754.2006.00886.x.
Whether or not a paediatric registrar or consultant paediatrician trained in advanced neonatal resuscitation is needed at elective Caesarean section (CS) deliveries remains controversial. The objective of this study was to provide recent population-based data comparing the need for resuscitation of babies born at >or=37 weeks gestation by elective CS under regional anaesthesia with those born by spontaneous, unassisted vertex vaginal delivery.
We performed a population-based cohort study in Tasmania using data collected between January 1998 and December 2003 inclusive. Data on all singleton births>or=37 weeks gestation was analysed from the Tasmanian Obstetric and Neonatal Audit database to determine the number and type of resuscitations, and the number of low 1-min Apgar scores for each mode of delivery.
There were 31 820 singleton deliveries born at >or=37 weeks gestation over the 6-year period. Of these 21 733 (68.3%) were spontaneous unassisted vertex vaginal deliveries and 2918 (9.2%) were elective CSs performed under regional anaesthesia (2620 spinal and 298 epidural). The incidence of a 1-min Apgar score of <4 and a 1-min Apgar score of >or=4 and <7 for elective sections under spinal was significantly lower when compared with unassisted, spontaneous, vertex vaginal delivery at 0.57% and 11.8% respectively. The relative risks when compared with unassisted, spontaneous, vertex vaginal delivery were 0.36 (95% confidence interval (CI) 0.21-0.60, P<0.05) and 0.73 (95% CI 0.65-0.81, P<0.05), respectively. There was a small but statistically significant difference between unassisted, spontaneous, vertex vaginal delivery and elective CSs performed under regional anaesthesia in the requirement for resuscitation in the form of bag and mask ventilation. The relative risk for the need for bag and mask ventilation was 1.33 (95% CI 1.11-1.58, P<0.05) for spinal anaesthesia and 1.99 (95% CI 1.33-2.96, P<0.05) for epidural anaesthesia. There was no difference in the need for bag and mask ventilation or low 1-min Apgar scores between non-cephalic and cephalic presentation at elective CS under regional anaesthesia.
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.
择期剖宫产分娩时是否需要有接受过高级新生儿复苏培训的儿科住院医师或儿科顾问医生仍存在争议。本研究的目的是提供基于近期人群的数据，比较在区域麻醉下择期剖宫产出生的≥37周妊娠婴儿与自然、未辅助的头位阴道分娩出生的婴儿的复苏需求。
我们在塔斯马尼亚进行了一项基于人群的队列研究，使用了1998年1月至2003年12月（含）期间收集的数据。从塔斯马尼亚产科和新生儿审计数据库中分析了所有≥37周妊娠的单胎分娩数据，以确定每种分娩方式的复苏次数和类型，以及1分钟阿氏评分低的次数。
在这6年期间，有31820例≥37周妊娠的单胎分娩。其中21733例（68.3%）是自然、未辅助的头位阴道分娩，2918例（9.2%）是在区域麻醉下进行的择期剖宫产（2620例脊髓麻醉和298例硬膜外麻醉）。与未辅助的自然头位阴道分娩相比，脊髓麻醉下择期剖宫产1分钟阿氏评分<4分以及1分钟阿氏评分≥4分且<7分的发生率显著更低，分别为0.57%和11.8%。与未辅助的自然头位阴道分娩相比，相对风险分别为0.36（95%置信区间（CI）0.21 - 0.60，P<0.05）和0.73（95%CI 0.65 - 0.81，P<0.05）。在以面罩通气形式进行复苏的需求方面，未辅助的自然头位阴道分娩与区域麻醉下择期剖宫产之间存在微小但具有统计学意义的差异。脊髓麻醉下需要面罩通气的相对风险为1.33（95%CI 1.11 - 1.58，P<0.05），硬膜外麻醉下为1.99（95%CI 1.33 - 2.96，P<0.05）。在区域麻醉下择期剖宫产时，非头位与头位分娩在面罩通气需求或1分钟阿氏评分低方面没有差异。
在区域麻醉下进行的择期剖宫产是低风险分娩。面罩通气需求略有增加在实际中并不显著。此类分娩不需要有经验的儿科医务人员常规在场。
