The effect of the mode of delivery on neonatal thyroid function

Background. We aimed to investigate the effect of the mode of delivery and the type of anesthesia on postnatal thyroxine (T4), free T4 (f-T4) and thyroid-stimulating hormone (TSH) in a large number of healthy full-term neonates.

Methods. Serum samples for T4, TSH and f-T4 were drawn from neonates at the time of discharge (postnatal days 1–7) in a pilot thyroid-screening program. Six hundred and thirty-eight neonates were grouped as: vaginal delivery (VD; 332), elective cesarean section (elective C/S; 252) and emergency cesarean section (emergency C/S; 54). The elective C/S group was subdivided into local and general anesthesia groups to investigate the influence of the type of anesthesia used on thyroid function.

Results. Mean±SD serum T4, TSH and f-T4 levels tended to be higher in the VD group compared to the elective C/S group at almost all time points. However the differences did not reach statistical significance, except for the T4 levels at postnatal day 3 in the VD group, which was higher (195.6±37.3 nmol/L) compared to the elective C/S group (160.9±34.8 nmol/L) (p < 0.001). The only difference in the anesthesia groups was the slightly higher f-T4 levels from postnatal day 4 in the local anesthesia group compared to the general anesthesia group.

Conclusions. The mode of delivery or type of anesthesia does not have considerable influence on postnatal thyroid functions in the neonates, although minor differences exist. Therefore similar cut-off values can be used for thyroid screening of term newborns regardless of the mode of delivery or type of anesthesia used.     

The effect of the modes of delivery on the maternal and neonatal dynamic thiol–disulfide homeostasis

Abstract

Background: Thiols are organic compounds containing sulfhydryl groups which exert antioxidant effects via dynamic thiol–disulfide homeostasis. The shift towards disulfide indicates the presence of oxidative environment. The thiol–disulfide homeostasis has not been studied in different mode of delivery before.

Aims: To investigate the effects of mode of parturition on the thiol–disulfide homeostasis in mothers and term infants.

Study design: The participants were grouped according to the mode of their delivery: group vaginal delivery (VD, n?=?40) and group cesarean section (C/S, n?=?40). Three serum samples were collected: from mothers at the beginning of labor, from the cord blood (CB), and from the infants at the 24th hour after birth. The dynamic thiol–disulfide homeostasis in both groups were compared.

Results: The levels of native-thiol and total-thiol in CB were significantly higher in VD group than those with C/S group. The levels of disulfide were higher in infants born by C/S compared with those born by VD. The disulfide-to-native thiol ratio, disulfide-to-total thiol ratio, and native thiol-to-total thiol ratio were similar between two groups.

Conclusion: Our results showed that the dynamic thiol–disulfide homeostasis of the neonate was greatly influenced by the way of delivery and supported that vaginally delivered infants have less oxidative stress.     

Differences in levels of oxidative stress in mothers and neonate: the impact of mode of delivery

Abstract

Objective: To determine there are differences in the production levels of oxygen free radical between mothers and neonates by the mode of delivery, we measured oxygen free radical concentrations in maternal vein and umbilical artery.

Methods: Forty-four women with singleton term pregnancies were prospectively recruited and classified into two groups: those who had a spontaneous uncomplicated vaginal delivery (VD group; n?=?21), and those who had an elective cesarean delivery (CD group; n?=?23). We determined maternal and fetal oxidative stress levels by measuring concentrations of derivatives of reactive oxygen metabolites (d-ROMs) in maternal vein before delivery and on postnatal day 5, and in umbilical artery at delivery. We also measured the pH, partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂) and base excess (BE) in umbilical artery blood collected at delivery.

Results: The concentrations of d-ROMs in maternal vein on postnatal day 5 were significantly decreased in the VD group, but were significantly increased in the CD group, compared to before delivery. The concentrations of d-ROMs in umbilical artery were significantly higher in the VD group than the CD group. Compared to the CD group, umbilical artery pH tended to be lower (p?=?0.07), and BE significantly lower (p?<?0.005), in the VD group. There were no significant differences in umbilical artery PaO₂ and PaCO₂ between the two groups.

Conclusion: Our findings indicate that those production levels of oxygen free radical in mothers are greater by CD than by VD, while those in neonates are greater by VD than by CD.     

C-reactive protein: a marker of neonatal stress?

Abstract

Aim: To assess whether blood values of C-reactive protein (CRP) in healthy term newborns, are influenced by stress.

Material and methods: Since different types of delivery (vaginal delivery [VD], emergency C-section [EMCS] and elective C-section [ELCS]) are notoriously characterized by different levels of stress for the baby, these three groups were used as models of different levels of stress. The mean CRP values of the three groups obtained in the first hours of life were compared.

Results: We retrieved 1012 babies. Median values (3rd–97th ct) were: 0.05 (0.01–0.46), 0.17 (0.02–1.54), 0.30 (0.04–1.77), 0.43 (0.05–1.31), 0.40 (0.04–1.13) at 12, 24, 48, 72 and 96?h, respectively. Mean values in babies born after VD were statistically higher than those born after C-section, and higher CRP values were present in EMCS with respect to ELCS.

Conclusion: This study described normal blood CRP values in a wide population of term babies. An influence of the type of delivery on blood CRP is evident, and this may be explained by the different amount of perinatal stress induced by anyone of the three types of delivery we considered.     

Mothers' views of their childbirth experience two years after term breech delivery

Introduction. This study was performed to evaluate mothers' views of their childbirth experience two years after term breech delivery.

Methods. Two years after delivery mothers were asked to fill out a questionnaire concerning their breech birth experience and their view about the care provided to them while giving birth. Outcomes of the planned cesarean section (CS) group were compared with outcomes of the planned vaginal delivery (VD) group, whether or not a vaginal birth was realized or an emergency cesarean section was performed. Any differences were further analyzed by use of logistic regression, controlling for potential confounders.

Results. Significantly more women in the planned CS group were reassured about their baby's health (67.4% vs. 37.9%, p = 0.0006) at the time of delivery, whereas more women in the planned VD group recalled having been worried about their baby's health at the time of delivery (45.0% vs. 25.6%, p = 0.02). Also, more women in the planned VD group experienced more pain during labor and delivery than expected (46.9% vs. 18.5%, p = 0.008). In the planned VD group fewer women indicated they had an active say in decision-making (59.1% vs. 85.3%, p = 0.001).

Conclusions. Evaluation of the mothers' views of their childbirth experience two years after term breech delivery showed that more women in the planned VD group recalled having been worried about their child's health at the time of delivery, experienced more pain than expected, and reported less involvement in decision-making.     

The effect of the mode of delivery on neonatal thyroid function.

BACKGROUND: We aimed to investigate the effect of the mode of delivery and the type of anesthesia on postnatal thyroxine (T4), free T4 (f-T4) and thyroid-stimulating hormone (TSH) in a large number of healthy full-term neonates. METHODS: Serum samples for T4, TSH and f-T4 were drawn from neonates at the time of discharge (postnatal days 1-7) in a pilot thyroid-screening program. Six hundred and thirty-eight neonates were grouped as: vaginal delivery (VD; 332), elective cesarean section (elective C/S; 252) and emergency cesarean section (emergency C/S; 54). The elective C/S group was subdivided into local and general anesthesia groups to investigate the influence of the type of anesthesia used on thyroid function. RESULTS: Mean+/-SD serum T4, TSH and f-T4 levels tended to be higher in the VD group compared to the elective C/S group at almost all time points. However the differences did not reach statistical significance, except for the T4 levels at postnatal day 3 in the VD group, which was higher (195.6+/-37.3 nmol/L) compared to the elective C/S group (160.9+/-34.8 nmol/L) (p < 0.001). The only difference in the anesthesia groups was the slightly higher f-T4 levels from postnatal day 4 in the local anesthesia group compared to the general anesthesia group. CONCLUSIONS: The mode of delivery or type of anesthesia does not have considerable influence on postnatal thyroid functions in the neonates, although minor differences exist. Therefore similar cut-off values can be used for thyroid screening of term newborns regardless of the mode of delivery or type of anesthesia used.     

Assessment of maternal cerebral blood flow velocity by transcranial Doppler ultrasound before delivery and in the early postpartum period

Objective: This prospective observational study aimed to identify the effects of labor on cerebral hemodynamics by measuring the middle cerebral artery (MCA) blood flow velocity by transcranial Doppler ultrasound (TCD), and the related factors just before delivery and within the 24?h after delivery.

Methods: The study included 35 healthy pregnant women with a gestational age of >37 weeks who were in labor and a control group including healthy, age-matched, nonpregnant women (n?=?24). Demographic characteristics and significant clinical information of pregnant women were recorded. The MCA blood flow velocity was assessed by TCD just before and within 24?h after delivery. The parameters assessed by TCD were mean cerebral blood flow velocity (MCBFV), peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio.

Results: There was no significant difference between the pregnant and nonpregnant women regarding age (27?±?5 years versus 28?±?7 years; p?=?.751). The MCBFV, PSV, PI, and RI showed a significant increase within the 24?h after delivery as compared with those before delivery. Comparison of the pregnant women with the control group in terms of the values of all parameters related to the MCA blood flow velocity revealed that the values that were significantly low before delivery reached to the level of the control group after delivery

Conclusion: The findings of this study demonstrated that the blood flow velocity of the MCA decreased during the late pregnancy period and increased in the early postpartum period to the level similar to that of the nonpregnant group.     

The effects of the mode of delivery on oxidative-antioxidative balance

Objective.?The purpose of this study was to investigate the effects of the mode of delivery on the oxidant and antioxidant systems in mothers and infants and to demonstrate which mode leads more oxidative stress.

Methods.?The participants were divided into two groups according to the mode of their labour and delivery: group 1 (n?=?33) women with normal labour and delivery and group 2 (n?=?33) with scheduled caesarean section (C/S) and delivery. The maternal, cord, and infant blood samples in both groups were collected. The serum total antioxidant capacity (TAC) and the total oxidant status (TOS) were evaluated by using an automated colorimetric measurement method.

Results.?The parameters indicating oxidative stress (TOS, oxidative stress index, and lipid hydroperoxide) in maternal, cord, and newborn blood samples were higher in patients delivering with C/S than those normal spontaneous vaginal deliveries (NSVD) patient group, while it was vice versa for TAC.

Conclusions.?It may be concluded that both the mothers and neonates in C/S group are exposed to higher oxidative stress as compared with those in NSVD group and the antioxidant mechanisms are insufficient to cope with this stress during C/S. This result indicates that the normal delivery through the physiological route is healthier for the bodies of mothers and infants.     

Effect of delivery mode on postpartum neonatal body temperatures

Objective: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section.

Methods: We performed a prospective study of 106 term newborn – 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers’ temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth.

Results: Environmental temperature was maintained at 22–24?°C. Pre-operative mother temperatures were 36.31?±?0.30?°C in group 1, 36.36?±?0.26?°C in group 2 and 36.39?±?0.19?°C in group 3 (p?=?0.414). Post-operative mother temperatures were 36.39?±?0.27?°C in group 1, 36.29?±?0.31?°C in group 2 and 36.25?±?0.28?°C in group 3 (p?=?0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5?±?0.6?°C, 37.2?±?0.2?°C and 36.8?±?0.4?°C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p?<?0.001).

Conclusions: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.     

Preference toward future mode of delivery: how do antepartum preferences and prior delivery experience contribute?

Objective: Examine postpartum preferences toward future mode of delivery (MOD), considering recent MOD, antepartum preferences, and demographics.

Study design: Prospective cohort study where a survey was distributed in outpatient obstetrics clinics to pregnant women over 18 years at 28 weeks gestation or later. Surveys gathered demographics, obstetric history, and preference toward vaginal delivery (VD) versus cesarean delivery (CD). Women were again surveyed at 6–8 weeks postpartum. Chi-square test compared proportions, and logistic regression controlled for potential confounders.

Results: A total of 299 women returned postpartum surveys and expressed preferences. Comparing women who experienced VD versus CD, the majority who had a VD (92.1%) would choose this again, while only 1.9% preferred CD. Among the CD group, preferences were mixed: 29.4% desired repeat CD, 34.1% preferred VD, and 36.5% were undecided (p?<?0.001). Adjusted odds were 34.4 (95% CI 9.4–126.1) for preferring VD over CD among women who experienced a recent VD, adjusting for parity, age, ethnicity, education, possible depression, and type of provider.

Conclusions: The majority of women preferred VD postpartum. Of the minority who desired CD, antenatal preference for cesarean and prior experience with CD were important factors. This highlights the impact of individual desires and experience, and underscores importance of antenatal counseling.     

Antibiotic prophylaxis for premature rupture of membranes and perinatal outcome

Aim: To evaluate the perinatal outcomes of newborns after premature rupture of membranes (PROM) at the term according to the timing of initial antibiotic administration.

Material and methods: This is a retrospective, cohort study investigating perinatal outcomes of newborns in pregnant women with PROM at the term who were treated with ampicillin within or after 6?h from the PROM. Statistical analysis was performed using Student’s t-test for continuous variables test and chi-square or for categorical data.

Results: The study involved 144 pregnant women with PROM and their newborns, a lower number received antibiotics after birth were in the group who received antibiotics within 6?h of PROM (26.4% versus 73.6%), the mediane values of C-reactive protein were lower (3.0?±?2.9?mg/l versus 6.1?±?7.3?mg/l; p?p =0.023) and time between PROM and delivery was shorter (p?Conclusion: Timely usage of antibiotic prophylaxis and shorter time between PROM and delivery improve perinatal outcomes.     

Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors

Abstract

Objective: To correlate vitamin D level in Egyptian mothers with that of their newborns, and examine risk factors related to maternal vitamin D deficiency.

Methods: A cross-sectional study was carried out at the university teaching hospital in Cairo, Egypt. Serum 25(OH) D levels were measured by enzyme-linked immunosorbent assay in 135 pregnant women at ≥37 weeks’ gestation immediately before delivery and in cord blood of their newborns.

Results: The levels of serum 25(OH) D were 32.6?±?21.4?ng/ml in mothers and 16.7?±?10?ng/ml in their newborns. Maternal vitamin D level was strongly correlated with that of the newborns (r?=?0.7, p?<?0.0001). Maternal vitamin D deficiency/insufficiency and neonatal vitamin D deficiency/insufficiency were encountered in (40%, 28.9% and 60%, 32.6% respectively). Maternal vitamin D levels showed significant correlations with maternal body mass index (BMI; r?=??0.201, p?=?0.021), gestational age at delivery (r?=?0.315, p?≤?0.0001), fish consumption (r?=?0.185, p?=?0.032), educational level (r?=?0.29, p?=?0.001), and skin exposure (r?=?0.247, p?=?0.004).

Conclusion: Maternal vitamin D levels strongly correlate with neonatal levels. Maternal vitamin D deficiency is a real problem in Egypt; this is generally related to high BMI, low fish consumption, low educational level, and limited skin exposure.     

Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

Objective: To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy.

Methods: We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11–14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR)?=?PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ²) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA.

Results: 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p?=?0.043 and p?=?0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p?=?0.003).

Conclusion: The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.     

Effects of mode of delivery on pro-oxidant/antioxidant balance in fetal circulation

Objective: This study was undertaken to assess the influence of mode of delivery on the balance between pro-oxidant/antioxidant systems in fetal circulation.

Materials and methods: Both umbilical arterial and venous blood samples were obtained from 37 pregnant women who delivered by spontaneous vaginal delivery (VD group) and from 29 pregnant women who delivered by elective cesarean section (CS group). Oxidative stress and antioxidant activity were evaluated by reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP), respectively.

Results: The d-ROMs values of the VD group were higher than that of the CS group in both umbilical arterial and venous blood and these differences were found to be statistically significant (p?p?p?p?Conclusions: Our statistical analyses suggest that vaginal delivery has an effect on increasing oxidative stress as a result of the stress of labor and that an elective cesarean section does not impair the mother’s oxidative stress status. Furthermore, the high BAP values in all the measurements suggest that neonates just after birth have the ability to cope with oxidative stress.

• Rationale

• In many studies, the diversity of views on the influence of mode of delivery on the redox status of neonates is likely to be caused by the use of different biomarkers to measure either the oxidative stress, the antioxidant activity, or both. Furthermore, incomplete explanation for sampling cord blood in these studies, either arterial, venous blood or both, complicates matters. To solve the above, this study was designed to assess the effects of mode of delivery on both pro-oxidants, via d-ROMs, and antioxidants, via BAP, in both umbilical arterial and venous blood samples obtained just after birth. There are no existing studies of BAP in both umbilical arterial and venous blood to which we can refer. In conclusion, our study suggests that the pro-oxidant/antioxidant balance in neonates just after birth is better than may be expected when compared to the potentials of adults (including pregnant mothers) according to interpretations of BAP/d-ROMs. This can be understood that neonates may have already been endowed with the ability to cope with oxidative stress, as informed by high BAP values in both umbilical arterial and venous blood. Vaginal delivery may have an effect on increasing oxidative stress as a result of the stress of labors (as measured by d-ROMs), and an elective cesarean section, which has better BAP/d-ROMs in umbilical venous blood than that of vaginal delivery, may not impair the mother’s oxidative stress status.

     

Impact of intrapartum factors on oxidative stress in newborns

Objective.?To determine the impact of the method of delivery and type of obstetric anesthesia on oxidative stress in neonates.

Methods.?The trial included 164 women in two groups of elective cesarean delivery (CD) and uncomplicated vaginal delivery (VD) at term. The CD group was randomized to either a spinal or general anesthesia and the VD group was randomized to either a local or a spinal saddle block. The main outcome measures were the umbilical venous blood glutathione and malondialdhyde (MDA).

Results.?Neonates of CD had significantly higher levels of MDA and pO₂ and lower glutathione levels than VD. However, in regression analysis, the mode of delivery and type of anesthesia were independent factors that determine the level of MDA but not the level of glutathione. Gestational age was a significant predictor of the glutathione level while birth weight was a significant predictor of the MDA level.

Conclusion.?The oxidative status of the newborn is not simply a reflection of the mode of delivery and type of anesthesia. The impact of gestational age and birth weight appears to be crucial. This must be considered when planning elective delivery.     

Status of vitamin D,antioxidant enzymes,and antioxidant substances in neonates with neonatal hypoxic-ischemic encephalopathy

Objective: To investigate the concentration of vitamin D (VD), glutathione peroxidase (GP), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) in neonates with hypoxic-ischemic encephalopathy (HIE).

Material and methods: This study was performed prospectively in term neonates treated for HIE. Samples were collected from the neonates in study and control groups at 6–14 h and on day 5 of their lives for 25-OH vitaminD3, antioxidant enzymes including GP and SOD and oxidants substances including MDA and AOPP.

Results: This study was performed with 31 term neonates with HIE and 30 healthy term neonates. Maternal VD level was statistically lower in the study group (9.8±6.8 ng/mL) than the control (16.4±8.7?ng/mL) (p?=?0.002). SOD and MDA levels were significantly high, and VD level was significantly low in the study group on the first day of life (p?=?0.001 and p?=?0.028, respectively). SOD and GP levels were significantly high in the study group on day 5 (p?<?0.05). VD was significantly low in the study group on day 5 and the proportion of subjects with VD below 5 ng/ml was significantly lower in the control group (p?=?<0.05).

Conclusion: VD has neuroprotective and antioxidant properties. We detected VD levels were low in infants with HIE and their mothers. This finding may be useful for decreasing of brain damage.     

Are there any relationships between umbilical artery Pulsatility Index and macrosomia in fetuses of type I diabetic mothers?

Abstract

Objective: To establish whether there are relationships between umbilical artery Pulsatility Index (PI) and fetal macrosomia in pregnancies complicated by type I diabetes.

Methods: In a retrospective observational study, 102 singleton pregnant women with type I diabetes were considered. Umbilical artery PI was measured by Doppler ultrasonography within one week from delivery and related to neonatal weight. Pregnancies were grouped according to birtweight in macrosomic group (≥4000?g) and normal growth group (<4000?g). Relationships between umbilical artery PI and birth weight and birth weight centile were tested by Pearson’s correlation analysis. Further umbilical artery PI values were compared between macrosomic and normally grown fetuses.

Results: Birth weight was ≥4000?g in 24 pregnancies (23.5%). A significant relationship was found between umbilical artery PI and neonatal weight (r?=?0.512; p?<?0.01) and neonatal weight centile (r?=?0.400; p?<?0.01). Umbilical artery PI were significantly lower (t?=??6.013; p?<?0.001) in the macrosomic group (0.78; 95% confidence interval (CI) 0.73–0.84) than in the normal growth group (1.00; 95% CI 0.97–1.04).

Conclusions: In pregnancies complicated by type I diabetes there is a significant relationship between umbilical artery PI value before delivery and absolute birth weight and birth weight centile. Macrosomic fetuses show a significant reduction in umbilical artery PI when compared with diabetic pregnancies without fetal overgrowth.     

Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomized controlled trial

Background/Aims: To compare the prevalence of positive bacterial cultures at the cesarean delivery (CD) incision site in patients with pre-operative application of chlorhexidine gluconate (CG) versus povidone iodine (PI).

Methods: Women undergoing a scheduled CD at ≥36 gestational weeks were randomly assigned to receive CG or PI. A swab of the incision site was performed at 3?min after disinfectant application and at 18 post-operative hours, and the prevalence of cultures with any detected bacterial growth was compared for the two groups.

Results: Of the 60 participants, 33 (55.0%) were in the PI group. There were no differences detected at 3?min, with 9.1% positive in the PI group versus 0% positive in the CG group (p?=?0.2499). However, at 18?h, women in the PI group were seven times more likely than women in the CG group to have a positive culture (16/33 [48.5%] versus 3/27 [11.1%], OR?=?7.53 [95% CI 1.67–38.83], p?=?0.0023). Multivariate logistic regression demonstrated similar results: OR?=?7.33 (95% CI 1.77–30.35), p?=?0.0060.

Conclusion: The prevalence of positive bacterial cultures obtained at the site of the skin incision 18?h after CD was higher in the PI versus the CG group.     

Vascular assessment of the right internal jugular vein in low birth weight newborns

Abstract

Objective: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery.

Method: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500?g; very low birth weight (VLBW) newborns, <1500?g; and extremely low birth weight (ELBW) newborns <1000?g.

Results: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300?g, anteroposterior diameter of the RIJV 2.2?mm, and the distance from the skin–RIJV 3.6?mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7?mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p?<?0.001); the median distance from skin to RIJV for LBW newborns was 4.1?mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p?<?0.01); differences that were statistically significant.

Conclusions: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.     

Does fetal macrosomia affect umbilical artery Doppler velocity waveforms in pregnancies complicated by gestational diabetes?

Objectives: We aimed to establish whether macrosomic fetuses in pregnancies complicated by gestational diabetes (GDM) show different Pulsatility Index (PI) values in umbilical artery (UA) than in non-macrosomic fetuses.

Methods: We considered 106 pregnant women with GDM. Doppler recordings of UA-PI were performed at 34–41 weeks and related to neonatal birthweight. Pregnancies were divided in two groups according to birthweight, macrosomic group (>4000?g) and controls (<4000?g), and according to birthweight centile,?>90th centile and?<90th centile. Differences in UA-PI and maternal and fetal characteristics between groups were tested.

Results: Mean UA-PI was significantly lower in newborns with birthweight?>4000?g than in controls (PI?=?0.69; 95% CI 0.64–0.74 versus PI?=?0.87; 95% CI 0.84–0.90, p?<?000.1). Mean UA-PI was significantly lower in newborns with birthweight centile?>90th centile than in controls (PI?=?0.79; 95% CI 0.74–0.84 versus PI?=?0.87; 95% CI 0.83–0.90; t?=?2.653; p?=?0.01). Linear regression analysis revealed a significant correlation between UA-PI and neonatal birthweight and between UA-PI and neonatal birthweight centile.

Conclusions: Macrosomic fetuses of pregnancies complicated by GDM show lower values of UA-PI compared with controls. Despite UA-PI results, a variable related to macrosomia its role in the management of these pregnancies remains to be established.