Jacob J, Pfenninger J
Alaska Neonatology Associates, P.C., Anchorage, USA.
Obstet Gynecol. 1997 Feb;89(2):217-20. doi: 10.1016/S0029-7844(96)00430-9.
We evaluated the need for vigorous resuscitation (bag-and-mask ventilation, tracheal intubation, and cardiopulmonary resuscitation) in certain common cesarean deliveries at term to evaluate the need for pediatrician attendance on behalf of the fetus.
Records of singleton cesarean deliveries (repeat, nonprogressive labor, fetal malposition, fetal heart rate abnormality) at term over 2 years were reviewed for the following: need for vigorous resuscitation, Apgar scores, anesthesia used, and the need for newborn intensive care. The next consecutive, uncomplicated singleton vaginal delivery in each case was used to create a control group. Exclusion criteria included the presence of maternal disease (diabetes, pregnancy-induced hypertension, placenta previa) or suspicion of fetal abnormalities (growth restriction, congenital defect, known meconium staining of the amniotic fluid). There were 834 cesarean deliveries and 834 controls (low-risk vaginal deliveries).
Compared with vaginal deliveries, Apgar scores of 6 or less at 1 minute were more frequent in all cesarean deliveries except for the repeat cesarean category. The incidence of needing vigorous resuscitation was as follows: vaginal 1.7%, repeat 3.0%, nonprogressive labor 4.8%, fetal malposition 11.2%, and fetal heart rate abnormality 17.7%. The use of regional anesthesia reduced the need for vigorous resuscitation in cesarean deliveries for the repeat group and the group with nonprogressive labor without fetal heart rate abnormalities to a level similar to that in uncomplicated vaginal deliveries (2.1% repeat; 1.6% nonprogressive labor without fetal heart rate abnormality).
Both repeat cesarean deliveries and cesareans done for nonprogressive labor without signs of fetal heart rate abnormality, when performed under regional anesthesia, may not need a pediatrician in attendance because of minimal fetal risk.
我们评估了足月剖宫产分娩时进行积极复苏（面罩通气、气管插管和心肺复苏）的必要性，以评估代表胎儿的儿科医生到场的必要性。
回顾了两年多来足月单胎剖宫产分娩（重复剖宫产、产程无进展、胎位异常、胎儿心率异常）的记录，内容包括：积极复苏的必要性、阿氏评分、使用的麻醉方法以及新生儿重症监护的必要性。每个病例中接下来连续的、无并发症的单胎阴道分娩作为对照组。排除标准包括存在母体疾病（糖尿病、妊娠高血压、前置胎盘）或怀疑胎儿异常（生长受限、先天性缺陷、已知羊水胎粪污染）。共有834例剖宫产分娩和834例对照（低风险阴道分娩）。
与阴道分娩相比，除重复剖宫产类别外，所有剖宫产分娩中1分钟时阿氏评分≤6分的情况更为常见。需要积极复苏的发生率如下：阴道分娩1.7%，重复剖宫产3.0%，产程无进展4.8%，胎位异常11.2%，胎儿心率异常17.7%。区域麻醉的使用将重复剖宫产组和产程无进展且无胎儿心率异常组剖宫产分娩时积极复苏的需求降低到与无并发症阴道分娩相似的水平（重复剖宫产2.1%；产程无进展且无胎儿心率异常1.6%）。
重复剖宫产以及在区域麻醉下进行的产程无进展且无胎儿心率异常迹象的剖宫产，由于胎儿风险极小，可能不需要儿科医生到场。
