Pediatric presence at cesarean section: justified or not?

OBJECTIVES

This study was undertaken to determine the incidence and type of resuscitation required for infants delivered by both elective and emergency cesarean section relative to spontaneous vaginal delivery.

STUDY

DESIGN

A hospital-based cohort study from 1990 to 2002. Information was extracted from a prospectively collected database on term (>/=37 weeks) singleton infants delivered by cesarean section and spontaneous vaginal delivery. Analysis was performed on type of cesarean section, type of anesthetic, fetal presentation, and evidence of fetal distress. Outcomes assessed were resuscitation and Apgar scores.

RESULTS

There were 44,938 eligible deliveries. There was no significant difference in need for resuscitation between infants born by elective cesarean section under regional anesthetic compared with spontaneous vaginal delivery (chi(2)=0.998; df=1; P=.318). General anesthesia, fetal distress, and noncephalic presentation increase the need for resuscitation.

CONCLUSION

An advanced skills practitioner does not need to be present at elective cesarean sections under regional anesthesia provided there are no additional risk factors.