Department of Obstetrics and Gynecology and Division of Neonatology, Policlinico Abano Terme, Abano Terme, Italy.
Acta Paediatr. 2013 Jul;102(7):e334-8. doi: 10.1111/apa.12261. Epub 2013 May 3.
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.
“两步法”头-身分娩方式，即等待下一次宫缩来娩出肩部，会导致脐动脉 pH 值下降。本研究旨在评估胎儿酸中毒是否会激活糖异生。
我们测试了 341 例自发性和 25 例真空吸引器“两步法”阴道分娩（VD）以及 85 例选择性和 49 例紧急剖宫产（CS）后脐动脉脐带血的葡萄糖浓度和 pH 值。
“两步法”VD 新生儿的脐动脉血葡萄糖浓度明显较高（95.5 ± 21.4 mg/dL 比 75.6 ± 16.4，p < 0.001），pH 值明显较低（7.31 ± 0.09 比 7.33 ± 0.06，p = 0.003）。此外，与所有其他组相比，真空吸引器 VD 新生儿的脐动脉血葡萄糖浓度明显较高（101.4 ± 30.6 mg/dL，p = 0.004），pH 值明显较低（7.26 ± 0.10，p < 0.001）。研究人群中脐动脉血葡萄糖浓度与 pH 值呈显著负相关（r = -0.094，p = 0.036），在真空吸引器 VD 中呈强显著负相关（r = -0.594，p = 0.007）。
“两步法”VD 新生儿的脐动脉血葡萄糖浓度明显较高，pH 值明显较低，表明胎儿糖异生被激活。
