The evaluation of cord blood interleukin-1β levels in normal and caesarean deliveries

OBJECTIVE

The aim of this prospective study was to establish the cord blood interleukin 1β (IL-1β) levels and asphyxia enzymes in term newborns and their relationship between delivery modes. We investigated whether cord blood level of IL-1β could be used as a reliable marker for detecting hypoxic stress and to determine the optimal cut-off level for IL-1β.

METHODS

The study was designed prospectively. Cord blood samples were obtained at the time of delivery from 75 noninfected full-term neonates for the purpose of measuring cord blood levels of IL-1β. Women were classified into three groups according to the mode of delivery (20 vaginal delivery, 29 urgent caesarean section (with foetal distress) and 26 elective caesarean section). All cases were followed-up by hospitalization. Umbilical cord sampling was carried out for IL-1β, umbilical artery gas parameters and other asphyxia enzymes at the time of delivery. Cord blood IL-1β was measured by enzyme-linked immunosorbent assay. The perinatal outcomes of the cases were recorded after birth. Demographic characteristics, neonatal outcomes and laboratory findings were compared in all the three groups.

RESULTS

IL-1β levels showed statistically significant difference between groups (p < 0.01). The relationship was found between IL-1β cord blood levels and the mode of delivery. IL-1β levels of urgent caesarean section group were significantly higher than elective caesarean section and normal delivery group (p:0.001 and p:0.001, respectively). Normal delivery levels were significantly higher than the elective caesarean group (p:0.001).

CONCLUSION

Urgent section (foetal distress) and vaginal delivery (labour) were each associated with elevated IL-1β cord blood levels in noninfected full-term neonates, while only elective caesarean section was associated with decreased IL-1β levels. For the evaluation of newborns at high risk for perinatal hypoxic stress, cord blood IL-1β levels may lead the way. On the other hand, the mode of delivery may be associated with the effects on the immune system. Further investigations with larger patient groups are required to confirm our results.

The complication and mode of delivery in Chinese women with severe preeclampsia: a retrospective study

OBJECTIVE

Severe preeclampsia is a serious threat for pregnant women and fetuses. The complications of severe preeclampsia greatly affect perinatal outcome. This study aimed to investigate the complication and delivery mode of Chinese pregnant women with severe preeclampsia, and analyze the change in these aspects in the past decades.

METHODS

Clinical data of 1713 pregnant women with severe preeclampsia were collected and analyzed. The patients were divided into two groups: early period (1985-1997) and later period (1998-2010).

RESULTS

The complications for severe preeclampsia included preterm birth, fetal distress, postpartum hemorrhage, fetal growth restriction (FGR). Compared to early period, the rates of preterm birth, FGR, oligohydramnios, abnormal pregnancy outcome increased while the rates of fetal distress, postpartum hemorrhage and eclampsia decreased in later period. The rate of cesarean section was 73.073% in the early period and increased to 88.258% in the later period. Accordingly, the rate of natural childbirth, forceps extraction, vacuum extraction and breech extraction decreased in the later period.

CONCLUSIONS

Our data provide important information on the complication and mode of delivery in Chinese women with severe preeclampsia in the past decades, which may be helpful for clinical management of severe preeclampsia in Chinese women.

Effect of delivery approach on outcomes in fetuses with gastroschisis

BACKGROUND/PURPOSE

There is considerable controversy regarding optimal mode and timing of delivery for fetuses with gastroschisis. Our objectives were to describe the variation in institutional approach regarding these factors, and to evaluate the effect of timing of delivery on outcomes in fetuses with gastroschesis.

METHODS

Members of the maternal-fetal medicine community across Canada were surveyed regarding their personal and institutional approach of delivery. Data from the Canadian Pediatric Surgery Network (CAPSnet) were analyzed.

RESULTS

The survey showed significant variability in delivery approach between institutions, although no center routinely performs cesarean section. Infants delivered vaginally (VD) were categorized into three groups: Group 1, VD <36 weeks (n=114); Group 2, VD 36-37 weeks (n=218); and Group 3, VD ≥38 weeks (n=75). Score of Neonatal Acute Physiology, complication rates, length of time on total parenteral nutrition (TPN), and length of hospital stay (LOS) were higher in Group 1; bowel matting was greater in Group 3. There were no differences between the groups regarding other complications.

CONCLUSIONS

Our data suggest that preterm delivery was associated with more complications, longer time on TPN, and longer LOS; delivery ≥38 weeks was associated with increased bowel matting. These outcomes should be considered when determining institutional protocol.

[Severe neonatal acidosis: comparison and analysis of obstetrical practices in two French perinatal centers]

OBJECTIVES

To identify and compare risk factors for severe neonatal acidosis, defined by an umbilical artery pH inferior to 7.00, and clinical practices in two different perinatal centers.

PATIENTS AND METHODS

In a retrospective study, from 2003 to 2008, in two university perinatal centers (Poitiers and Saint-Antoine in Paris) on all term pregnancies complicated by severe neonatal acidosis (umbilical artery pH<7.00), we elected to compare the following risk factors: maternal characteristics, medical and obstetrical histories, progress of pregnancy, labour and delivery as well as the neonatal status.

RESULTS

Among 23,508 births, 177 term newborns had severe neonatal acidosis. The rate was similar for both perinatal centers of Poitiers and Saint-Antoine (0.92% and 0.77% respectively). Factors associated with severe neonatal acidosis were similar in both centers: maternal age, thick meconium, prior cesarean section. There were differences in obstetrical practices between the two centers: there were more caesarean sections and assisted vaginal deliveries in Paris and more inductions of labour in Poitiers.

CONCLUSION

Severe neonatal acidosis is associated with the geographical origin, the progress of labour and the mode of delivery. It seems that severe neonatal acidosis is unrelated to cesarean delivery.

Mode of delivery and adiposity: Hong Kong's "Children of 1997" birth cohort

PURPOSE

To examine whether mode of delivery was associated with childhood adiposity in a developed non-Western context.

METHODS

We used generalized estimating equations to estimate the association of mode of delivery (vaginal or cesarean) with body mass index (BMI) z-score and overweight (including obesity) from 3 months to 13 years, in 7809 term birth (94% follow-up) from a population-representative Chinese birth cohort, "Children of 1997." We used multiple imputation for missing data.

RESULTS

The cesarean section rate (26%) was higher for children born in private hospitals, with lower gestational age, lower birth order, higher maternal age, higher maternal BMI, and higher family socioeconomic position. Cesarean section was not associated with BMI z-score from 3 months to 13 years (mean difference, 0.03; 95% confidence interval, -0.02 to 0.09) or overweight from 3 years to 13 years (odds ratio, 0.98; 95% confidence interval, 0.77 to 1.25) after adjusting for infant and maternal characteristics and family socioeconomic position.

CONCLUSIONS

In a non-Western developed setting, mode of delivery was not clearly associated with BMI or overweight (including obesity) into late childhood. From a public health perspective, the role of mode of delivery and its mechanistic pathway in the current burgeoning epidemic of obesity needs to be clarified.

Prostate specific antigen in cord blood

Recent studies have demonstrated the presence of prostate specific antigen (PSA) in cord blood of male as well as female babies. The placental progesterone and estradiol up-regulate the synthesis and secretion of PSA in Placenta. This PSA is presumed to play a role in intrauterine growth of fetus by virtue of its proteolytic action on several substrates including insulin-like-growth-factor-binding-protein-3, insulin chains and Interleukin-2. This study was planned with the objective of correlating the levels of PSA in cord blood to gestation at delivery, the type of delivery and gender of the fetus. Fifty-seven cord blood samples were collected from the umbilical cord during delivery or mid-trimester abortion and analyzed for PSA using 'Active PSA DSL-9700 ultra sensitive' kit employing two-site immuno-radiometric assay principle and having a detection limit of 0.001 ng/ml. Mean PSA levels in cord blood were found to be 0.112 ± 0.027 ng/ml. The concentration of PSA in cord blood was found to be higher in case of higher gestational age, male baby and operative delivery. 50 % of cord bloods for female babies had PSA below detection limit (range <0.001-0.460 ng/ml), while all the male samples had detectable PSA (range 0.11-0.973 ng/ml). Higher Progesterone levels found in prenatal maternal blood in case of male babies may be responsible for the higher cord blood PSA. Mean cord blood PSA was 0.150 ± 0.150 ng/ml in forceps delivery and 0.078 ± 0.012 ng/ml in normal vaginal delivery. Forceps delivery causes much more stress and strain as compared to a normal vaginal delivery, resulting in increased levels of adrenal glucocorticoids, and therefore, higher cord blood PSA.