ABSTRACT
OBJECTIVE: To study the relationship between the indication for caesarean section (CS) and the need for resuscitation of the infant. DESIGN: Prospective cohort study. METHODS: During one year the following information was collected for each CS in a secondary teaching hospital (Isala klinieken/Weezenlanden Hospital), Zwolle, the Netherlands: indication for the CS, Apgar scores after 1 and 5 min and measures taken by the attending paediatrician at birth. These measures were divided into two groups: resuscitation (bag and mask ventilation or endotracheal intubation and ventilation) or no resuscitation (stimulation, supplemental oxygen, or no action at all). RESULTS: During the study year 202 CS were carried out. In the 50 CS carried out because of a narrow pelvis or a previous CS and in the 61 CS carried out for non-progressive labour there was little need for resuscitation of the newborn (4 and 3.3%, respectively), similar to resuscitation requirements after vaginal birth. The need for resuscitation of the newborn was significantly greater in the other indication groups, namely in 6/37 (16%) of cases of foetal malposition, in 3/10 (30%) of placental dysfunction, and in 11/44 (25%) of foetal distress. One infant had to be intubated directly after birth. The 1-minute Apgar score was lower in infants born after CS under general anaesthesia than under spinal anaesthesia (p = 0.002), regardless of the indication for the CS. CONCLUSION: Based on the indication for a CS, a paediatrician or physician experienced in neonatal resuscitation is required for a high-risk CS (foetal malposition, placental dysfunction, foetal distress, and general anaesthesia).
