On–Table Resuscitation

or partial resuscitation of newborn baby delivered by caesarian section on the operation table

By Dr. M. H. Mohammad

 

  This is a case-control study focused on neonates delivered by caesarian section who are usually deprived from the squeezing effect provided in the normal vaginal delivery where there is compression to the chest of the baby by the birth canal leading to evacuation of most of the lung fluid to out side the body through his mouth and nose.

  Since that the neonates delivered by caesarian section do not subjected to this phenomenon, therefore, they are more susceptible for retaining of lung fluid after delivery leading to ( Wet Lung Syndrome ) which is one of the causes of birth asphyxia.

  Because of this fact, the researcher has been suggest a maneuver of partial resuscitation during the Critical Period which begins just after extrication of the baby from uterus till his first breath or cough and it usually takes few seconds to one minute.

  This maneuver is done by upside-down position of the baby with gentle compression on his chest on lateral sides by one hand accompanied by continuous suction of fluid from nose and mouth, and it must be done BEFORE clamping and cutting the umbilical cord. This maneuver can be stopped once the baby takes first breath or cough.

  The explanation of delay in clamping and cutting the umbilical cord till the first breath or cough is that the placenta normally supplies the fetus with oxygen and nutrients required for the growth of baby by the umbilical cord throughout gestation including the moments just after delivery before detachment of placenta from uterus. Therefore, if we cut the umbilical cord before adequate evacuation of lung fluid, it means we cut the only way of oxygen before preparing the lung to receive the environmental oxygen.

Attention: do not delay the clamping and cut off the umbilical cord for more than one minute even if baby did not take his first breath because this may be risky to the mother due to bleeding from uterus.

  On study of 100 baby (50 case & 50 control) delivered by caesarian section. The 50 case babies who undergo this maneuver, i.e., received partial resuscitation on the operation table; majority of them have been received little or no further resuscitation by suction and oxygen therapy alone except in only minority of cases have required intervention. While the other 50 control babies who do not undergo this maneuver, all are subjected to further resuscitation by suction and oxygen therapy and a significant number who fail to breath after this resuscitation (which is may be due to muscle fatigue after prolonged hypoxia) have required intervention by artificial ventilation and/or resuscitation drugs e.g.; adrenaline, aminophylline, sodium bicarbonate…..etc.

  So, obviously we can conclude the benefit of this maneuver on the baby's respiration and health.

  Finally, the researcher is believe that if this maneuver is applied to an operation of caesarian section and the fetus was in good health and not premature, no need for the attendance of a pediatrician during these operations because the operation staff can do the job instead of him.