Neonatal Department, Groote Schuur Hospital, Cape Town.
S Afr Med J. 2011 Sep 27;101(10):749-50.
To determine the need for resuscitation at the birth of babies delivered by elective caesarean section (CS) and to record the time spent by doctors attending such deliveries.
Data were collected prospectively on all elective CSs performed at Groote Schuur Hospital over a 3-month period. Data collected included: total time involved for paediatrician from call to leaving theatre, management of infant (requiring any form of resuscitation), Apgar scores and neonatal outcome (e.g. admission to nursery). The CSs were classified as low-risk or high-risk (multiple pregnancy, prematurity, growth restriction, abnormal lie, general anaesthetic or known congenital abnormality).
Data were recorded for 138 deliveries. Three were excluded as they were not elective CS. One hundred and fifteen deliveries were classified as uncomplicated and 20 as high-risk. Only 1 of the babies born from the 115 low-risk CSs needed brief resuscitation, whereas 9 of the 20 high-risk deliveries resulted in newborn resuscitation. The reasons for low-risk CS were: previous CS (81); infant of diabetic mother (IDM) and previous CS (16); IDM alone (6); estimated big baby (10); and other (2).The average time spent at each elective CS by the pediatrician was 37 minutes.
For low-risk CS, the same medical attendance (i.e. a midwife) as for an uncomplicated NVD would be appropriate; this can free a doctor for other duties, and assist in de-medicalising a low-risk procedure.
确定择期剖宫产分娩的婴儿是否需要复苏，并记录主治医生参与此类分娩的时间。
前瞻性收集了 3 个月内在格罗特舒尔医院进行的所有择期剖宫产的数据。收集的数据包括：儿科医生从接到电话到离开手术室的总时间、婴儿的处理（需要任何形式的复苏）、阿普加评分和新生儿结局（例如入新生儿监护室）。剖宫产分为低风险或高风险（多胎妊娠、早产、生长受限、胎位异常、全身麻醉或已知先天性异常）。
记录了 138 次分娩的数据。有 3 次被排除在外，因为它们不是择期剖宫产。115 次分娩被归类为无并发症，20 次为高风险。只有 1 名来自 115 例低风险剖宫产的婴儿需要短暂复苏，而 20 例高风险分娩中有 9 例需要新生儿复苏。低风险剖宫产的原因是：既往剖宫产（81 例）；糖尿病母亲婴儿（IDM）和既往剖宫产（16 例）；单纯 IDM（6 例）；估计胎儿较大（10 例）；和其他（2 例）。儿科医生每次择期剖宫产的平均用时为 37 分钟。
对于低风险剖宫产，与无并发症自然分娩相同的医疗护理（即助产士）即可；这可以让医生有时间去做其他工作，并有助于使低风险的剖宫产过程非医疗化。
