‘Two-step’ head-to-body delivery activates foetal gluconeogenesis
Version of Record online: 3 MAY 2013
©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd
Volume 102, Issue 7, pages e334–e338, July 2013
How to Cite
Zanardo, V., de Luca, F., Trevisanuto, D., Simbi, A., Scambia, G. and Straface, G. (2013), ‘Two-step’ head-to-body delivery activates foetal gluconeogenesis. Acta Paediatrica, 102: e334–e338. doi: 10.1111/apa.12261
- Issue online: 30 MAY 2013
- Version of Record online: 3 MAY 2013
- Accepted manuscript online: 11 APR 2013 10:43AM EST
- Manuscript Accepted: 8 APR 2013
- Manuscript Revised: 5 APR 2013
- Manuscript Received: 28 FEB 2013
- ‘Two-step’ vaginal delivery;
- Umbilical cord glucose;
- Umbilical cord pH
The ‘two-step’ head-to-body delivery method, which involves waiting for the next contraction to deliver the shoulders, causes a decrease in umbilical artery pH. The aim of this study was to assess whether foetal acidemia activates gluconeogenesis.
We tested umbilical artery cord blood glucose concentration and pH after 341 spontaneous and 25 vacuum extractor ‘two-step’ vaginal deliveries (VD) and after 85 elective and 49 emergency caesarean sections (CS).
Cord blood glucose concentration was significantly higher (95.5 ± 21.4 mg/dL vs 75.6 ± 16.4, p < 0.001), and pH values significantly lower (7.31 ± 0.09 vs 7.33 ± 0.06, p = 0.003) in ‘two-step’ VD neonates than in CS delivered neonates. In addition, cord blood glucose concentration was significantly higher (101.4 ± 30.6 mg/dL, p = 0.004), and pH values were significantly lower (7.26 ± 0.10, p < 0.001) in VD by vacuum extractor than in all other groups. The cord blood glucose concentration is significantly and negatively correlated with pH in the study population (r = −0.094, p = 0.036) and strongly significantly and negatively correlated in VD by vacuum extractor (r = −0.594, p = 0.007).
Cord blood glucose concentrations are significantly higher and pH values significantly lower in ‘two-step’ VD neonates, indicating activated foetal gluconeogenesis.