Attendance of paediatricians at elective Caesarean sections performed under regional anaesthesia: is it warranted?

AIM: 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. CONCLUSION: 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.

Free radical processes and loss of seed viability during desiccation in the recalcitrant species Quercus robur L.

Loss of moisture in mature seeds of Quercus robur L. was associated with loss of viability, a rise in lipid peroxidation and build-up of free radicals. Radical-initiated damage was largely confined to the embryonic axes as their moisture contents declined to below 47 %. The accumulation of a stable free radical in axial tissue, detected by electron para-magnetic resonance (EPR), was indistinguishable from the EPR response previously shown in a moss on droughting and maize roots on desiccation. A minor higher-field component appeared to represent an intermediate stage in the sequence of free radical reactions associated with loss of water. Using seeds from freshly abscised fruits dried to different moisture contents, protective mechanisms against activated forms of oxygen were monitored in cotyledons and in embryonic axes. The two tissues exhibit distinctly different molecular defences against oxidative attack; that in the cotyledons being predominantly enzymatic, with relatively high and increasing activities of superoxide dismutase and glutathione reductase; that in the axes being largely through the anti-oxidants, ascorbic acid and alpha-tocopherol. We conclude that a decrease in enzymic protection against oxidative attack in the axes, associated with diminishing concentrations of alpha-tocopherol (and depletion of the precursor gamma-tocopherol) as moisture was lost, was directly linked with lipid peroxidation and free radical formation in the axes and that these events taken together may contribute to loss of viability in these recalcitrant seeds.