Stress of delivery results in marked elevations of catecholamine levels and activates fetal gluconeogenesis. We examined by ABL90 FLEX Radiometer analyzer (Copenhagen, Denmark) glucose and acidemia levels in umbilical artery blood at birth in 341 spontaneous and 25 vacuum extractor at term vaginal deliveries (VD) and in 85 elective and 49 emergency of term caesarean sections (CS), respectively performed at the Policlinico Abano Terme (Abano Terme, Italy) from January to June 2013. The mean (±SD) average neonatal blood glucose at birth was 95.0 (±20.6) mg% in the spontaneous VD group, 101.4 (±30.6) mg% in the vacuum extractor VD group, 69.9 (±13.8) mg% in the elective CS group and 85.4 (±16.1) mg% in the emergency CS group. The VD by vacuum extractor group had significantly increased neonatal cord blood glucose values (p < 0.001) and a significantly lower cord blood pH than the other groups (p < 0.001). Conversely, the elective CS group showed significantly reduced neonatal cord blood glucose values (p = 0.004) and significantly higher cord blood pH than the other groups (p < 0.001). In addition, glucose levels in the total population and in the VD by vacuum extractor group were significantly negatively correlated with pH (r = -0.094, p = 0.036 and r = -0.594, p = 0.007, respectively). In conclusion, the stress of labour increases both umbilical cord blood glucose and acidemia levels in term neonates.

Background The timing of umbilical cord clamping has a profound effect on the amount of blood that remains in the infant’s circulation at birth. However, there is no evidence to support a relationship between cord clamping time and other active management techniques of labor. Objective To examine the association between head-to-body delivery by ‘two-step’ approach, that include waiting for the next contraction to deliver the shoulders, and early cord clamping (< 1 min) and its effect on the amount of blood that remains in the infant’s circulation at birth and cord artery blood gas parameters. Study Design Prospective observational study on 50 consecutive at term, uncomplicated vaginal deliveries with singleton cephalic fetuses during January 2012 in Policlinico Abano Terme, Abano Terme, Italy. Cord arterial blood gas parameters and hematocrit (Htc) were compared to the reference values obtained in 50 healthy, control neonates, matched for gestational age, vaginally delivered by ‘one-step’ approach. Data analysis was performed with SPSS for Windows statistical package (version 13). Results In our study population, head-to-body interval was timed and was always inferior to 3 minutes. The groups had similar demographic and biomedical characteristics at baseline. The mean cord artery hematocrit (Hct 50.2 vs. 44.9; p<0.001) levels were significantly higher in the head-to-body interval ‘two-step’ approach group, but there was no significant difference in the umbilical artery pH (7.30 vs. 7.29; p=0.45). Conclusion Head-to-body delivery by ‘two-step’ approach increases the red cell mass in term infants and does not increase the risk of neonatal academia.

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S491-S492 Free communication (oral) presentations O657 HEAD-TO-BODY DELIVERY BY 'TWO-STEP' APPROACH: EFFECT ON UMBILICAL ARTERY HEMATOCRIT AND PH G. Straface, G. StrafaceSearch for more papers by this authorA. Simbi, A. SimbiSearch for more papers by this authorB. Benevento, B. BeneventoSearch for more papers by this authorD. Trevisanuto, D. TrevisanutoSearch for more papers by this authorV. Dal Cengio, V. Dal CengioSearch for more papers by this authorA. Ercoli, A. ErcoliSearch for more papers by this authorG. Fortunato, G. FortunatoSearch for more papers by this authorI. Gattolin, I. GattolinSearch for more papers by this authorG. Scambia, G. ScambiaSearch for more papers by this authorV. Zanardo, V. ZanardoSearch for more papers by this author G. Straface, G. StrafaceSearch for more papers by this authorA. Simbi, A. SimbiSearch for more papers by this authorB. Benevento, B. BeneventoSearch for more papers by this authorD. Trevisanuto, D. TrevisanutoSearch for more papers by this authorV. Dal Cengio, V. Dal CengioSearch for more papers by this authorA. Ercoli, A. ErcoliSearch for more papers by this authorG. Fortunato, G. FortunatoSearch for more papers by this authorI. Gattolin, I. GattolinSearch for more papers by this authorG. Scambia, G. ScambiaSearch for more papers by this authorV. Zanardo, V. ZanardoSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61087-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S491-S492 RelatedInformation

The aim of this case-control study was to determine whether unplanned resuscitation using a laryngeal mask airway (LMA) is suitable for neonates delivered by elective cesarean section, a procedure known to carry a risk of inadequate physiological response to birth with a consequent adverse respiratory outcome. During a 3-year period, from January 1998 to December 2000, all newborns delivered by elective cesarean section at term were compared with the next infant born vaginally in the same maternity unit (level III center). The two groups were matched for gestational age >37 weeks. The requirement for resuscitation with positive-pressure ventilation (PPV) using either the LMA or an endotracheal tube (ETT), together with the occurrence of an adverse neonatal outcome, was recorded and analyzed in the cesarean section and vaginal delivery groups. During this time 1,284 at-term elective cesarean sections were performed. 3% (n = 43) of the cesarean section deliveries and 1.4% (n = 18) of the vaginal controls required PPV resuscitation by LMA or ETT, a significant difference (OR 1.26; 95% CI 2.38–5.1; p < 0.01). Of the cesarean section group requiring resuscitation, 30 neonates were managed with the LMA and 13 with the ETT, while in the control vaginal delivery group the numbers were 13 and 5, respectively. LMA use accounted of about 70% of the overall PPV resuscitations and was associated with a successful outcome in 42 of 43 cases. One case was unsuccessfully managed with the LMA, and the ETT subsequently used was effective. Moreover, the probability for the LMA-resuscitated newborns of both cesarean and vaginal groups to have a <5 Apgar score at 1 and 5 min, neonatal intensive care unit admission, and respiratory insufficiency requiring oxygen and intermittent mandatory ventilation was statistically lower than for the ETT group (p < 0.01). In conclusion, infants born by elective cesarean section at term are at increased risk of requiring PPV resuscitation as compared with those born by vaginal delivery. We have shown that about 70% of the neonates who required PPV resuscitation after elective cesarean section and vaginal delivery were arbitrarily treated with LMA by the attending anesthesiologist, without adverse negative respiratory outcome.

Aim: To establish whether the timing of delivery between 37 + 0 and 41 + 6 wk gestation influences neonatal respiratory outcome in elective caesarean delivery, following uncomplicated pregnancy, thus providing information that can be used to aid planning of elective delivery at term. Methods: All pregnant women who were delivered by elective caesarean delivery at term during a 3-y period were identified from a perinatal database and compared retrospectively with pregnant women matched for week of gestation, who were vaginally delivered. Maternal characteristics, neonatal outcome, incidence of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) were analysed. During this time, 1284 elective caesarean section deliveries occurred at or after 37 + 0 wk of gestation. Results: Neonatal respiratory morbidity risk (odds ratio, OR), including RDS and TTN, was significantly higher in the infant group delivered by elective caesarean delivery compared with vaginal delivery (OR 2.6; 95% CI: 1.35-5.9; p < 0.01). While TTN risk in caesarean delivery was not increased (OR 1.19; 95% CI: 0.58-2.4; p > 0.05), the RDS risk was significantly increased (OR 5.85; 95% CI: 2.27-32.4; p < 0.01). This RDS risk is greatly increased in weeks 37 + 0 to 38 + 6 (OR 12.9; 95% CI: 3.57-35.53; p < 0.01). After 39 + 0 wk, there was no significant difference in RDS risk.Conclusions: Infants born by elective caesarean delivery at term are at increased risk for developing respiratory disorders compared with those born by vaginal delivery. A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy.

(2002). In utero ductal closure following near-term maternal self-medication with nimesulide and acetaminophen. Journal of Obstetrics and Gynaecology: Vol. 22, No. 4, pp. 440-441.

We report a case of a neonate with tetralogy of Fallot with aneurysmal dilatation of the pulmonary artery, complicated by bilateral relapsing pneumothorax. The relapsing air leak made it necessary to place up to five chest drains and to switch from conventional ventilation to high frequency ventilation. In the course of 30 days, all drains were removed. Once other anatomical and functional malformations of the respiratory system had been appropriately excluded and reasonable haemodynamic stability had been achieved, the patient underwent successful radical corrective heart surgery in hypothermia and cardioplegia. We emphasize the advantage of resolving respiratory failure preoperatively to guarantee the success of corrective heart surgery and treatment of other surgically severe cases.

Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltranspeptidase (γ-GT) and lactate dehydrogenase (LDH) activities were measured in 26 premature infants with bronchopulmonary dysplasia (BPD) (group 1), and in 24 premature controls, matched for gestational age and birth weight (group 2). Blood samples were taken serially on 3, 10, 20, 30 and 60 postpartum days. Group 1 and group 2 premature infants showed statistically higher LDH activities on the 3rd postpartum day. These differences disappeared later and LDH activities progressively decreased with time in both premature groups. Mean AST values of group 1 and group 2 premature infants were also significantly higher on the 3rd postpartum day. Subsequently, in all groups, AST showed a postpartal decrease, and a stabilization from the 10th day of life until the 2nd postnatal month. Mean ALT values were instead, comparable on the 3rd postnatal day and subsequently increased, although not significantly. Like the AST, γ-GT of group 1 and group 2 premature infants were slightly more elevated on the 3rd postpartum day. The subsequent decrease was however transitory, and at 1 and 2 postnatal months a noticeable, significant progressive increase in mean values was found. It is concluded that serum ALT, AST, LDH and γ-GT measurement of sick premature infants within the first 2 months of life are not significantly altered by the occurrence of BPD.