title: Attendance of paediatricians at elective Caesarean sections performed under regional anaesthesia: is it warranted?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatrics, Royal Hobart Hospital, Tasmania, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Atherton
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Parsons
authors.forename: Peter
authors.initials: P
authors.lastname: Mansfield
mesh_terms: D000765:Anesthesia, Conduction; D000773:Anesthesia, Obstetrical; D001034:Apgar Score; D002585:Cesarean Section; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010372:Pediatrics; D010819:Physician's Role; D011247:Pregnancy; D012151:Resuscitation; D013648:Tasmania