Key result
Cesarean deliveries using regional anesthesia for nonfetal indications showed no significantly increased risk of 1-minute Apgar scores under 4 compared with vaginal deliveries (1.6% vs 1.1%).
Why the study?
Does cesarean delivery using regional anesthesia for nonfetal indications increase the risk of low Apgar scores compared to vaginal delivery?
Observational (n=17,867)
Does cesarean delivery using regional anesthesia for nonfetal indications increase the risk of low Apgar scores compared to vaginal delivery?
Pediatrician attendance may not be necessary for cesarean deliveries using regional anesthesia for nonfetal indications, as they do not carry a higher risk of low Apgar scores than vaginal deliveries.
Answers are grounded in this paper and cite their sources.
May support selective pediatric attendance at such cesareans; leaves open need for prospective confirmation before practice change.
OBJECTIVE: To determine whether it is necessary for a pediatrician to attend all cesarean deliveries. METHODS: We analyzed a database of 17,867 consecutive deliveries to determine the rates of low Apgar scores in the following three groups of patients: those with vaginal delivery, cesarean delivery using regional anesthesia without fetal indication, and cesarean delivery for fetal indications or using general anesthesia. RESULTS: There was a significantly higher rate of low Apgar scores in the fetal indications or general anesthesia group when compared with vaginal deliveries. Specifically, 35 (5.8%) of 596 cesareans for fetal heart rate abnormality or using general anesthesia had 1-minute Apgars under 4 in contrast to 115 of 10,270 (1.1%) of vaginal deliveries. There was no significantly increased risk for low Apgar scores in the group of cesareans using regional anesthesia for nonfetal indications (33 of 2057, 1.6%). Results were similar for Apgar scores under 7 at 5 minutes. CONCLUSION: Because there is no higher incidence of low Apgar scores in cesarean deliveries using regional anesthesia for nonfetal indications compared with vaginal deliveries, there is no convincing need for pediatrician attendance at such deliveries.
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Elliot M. Levine (1999) conducted an observational in Deliveries (n=17,867). Cesarean delivery using regional anesthesia without fetal indication vs. Vaginal delivery was evaluated on 1-minute Apgar score under 4. Cesarean deliveries using regional anesthesia for nonfetal indications showed no significantly increased risk of 1-minute Apgar scores under 4 compared with vaginal deliveries (1.6% vs 1.1%).
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