title: Determinants of paediatrician's presence at Caesarian section.
abstract: BACKGROUND
  Paediatricians are required to attend all Caesarian sections, yet most neonates so delivered do not require complex resuscitations necessitating a paediatrician's presence.
  
  
  METHODS
  All Caesarean sections in the University of Benin Teaching Hospital from January to December 2009 were prospectively studied. The socio-demographic characteristics, indication and type of surgery, and the type of anaesthesia were recorded. Neonatal outcome was assessed with Apgar scores at 1 and 5 minutes and the need for a paediatrician determined.
  
  
  RESULTS
  There were 431 cases of caesarean section within the period and 326 (75.6%) of these had antenatal care. About three-quarters of the patients had emergency caesarean section. Indications for caesarean section were foetal in 19% and maternal in 81%. Subarachnoid block was the main anaesthetic technique 392/431 (91.0%). Apgar score in 1 min was less than 7 in 172/431 (39.9%) and was severe (< 4) in 26/ 431 (6.0%). Lack of ante natal care (p < 0.05, RR = 1.3, 95% CI = 1.0 - 1.7 ), foetal indications (p < 0.05, RR = 1.4, 95% CI = 1.1 - 1.8), emergency caesarean section (p < 0.05, RR = 1.4, 95% C1 =1.0 -1.8), general anaesthesia (p = 0.0056, RR = 1.6, 95% CI = 1.2 -2.2) and active resuscitation (p < 0.05, RR = 2.5, 95% CI = 2.1 =3.1) were associated with Apgar scores less 7 in 1 minute.
  
  
  CONCLUSIONS
  Unbooked status, foetal indication (foetal distress, prematurity, abnormal lie), emergency sections, and general anaesthesia may lead to poor Apgar scores and the need for active resuscitation. These settings justify the paediatrician's presence at Caesarean section.
authors.affiliation: Department of Anaesthesiology, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria.
authors.forename: S O
authors.initials: SO
authors.lastname: Tudjegbe
authors.forename: C O
authors.initials: CO
authors.lastname: Imarengiaye
authors.forename: W E
authors.initials: WE
authors.lastname: Sadoh
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D001034:Apgar Score; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods / Q000706:statistics & numerical data; D009549:Nigeria / Q000453:epidemiology; D010348:Patient Care Team / Q000458:organization & administration*; D010372:Pediatrics / Q000379:methods / Q000458:organization & administration; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification / Q000453:epidemiology / Q000601:surgery*; D011256:Pregnancy Outcome / Q000453:epidemiology; D012959:Socioeconomic Factors