Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
UCHealth Maternal Fetal Medicine Clinic, Memorial Hospital Central, Colorado Springs, Colorado.
Am J Perinatol. 2020 Oct;37(12):1195-1200. doi: 10.1055/s-0040-1708801. Epub 2020 Mar 25.
This study aimed to evaluate if maternal serum hormones along the maternal-fetal hypothalamic-pituitary-adrenal (HPA) axis, when drawn prior to labor induction, differed between women who delivered vaginally and those who underwent cesarean.
This was a prospective observational study at a single perinatal center performed from August 2017 to May 2018. Nulliparous women with uncomplicated singleton pregnancies ≥39 weeks had maternal serum collected prior to induction. Corticotrophin-releasing hormone (CRH) was measured by ELISA; dehydroepiandrosterone sulfate (DHEA-S), cortisol, estriol (E) estradiol (E), and progesterone (P) were measured by chemiluminescent reaction. Mean analyte concentrations as well as three ratios (E/P, E/P and E/E) were compared between women who had a vaginal versus cesarean delivery. Logistic regression was used to model the relationship between CRH and the odds of vaginal birth. We estimated that a sample size of 66 would have 90% power to detect a 25% difference in mean CRH levels assuming a vaginal:cesarean ratio of 2:1 with a baseline CRH concentration of 140 (standard deviation = 36) pg/mL.
Of the 88 women who had their serum analyzed, 27 (31%) underwent cesarean. Mean maternal serum CRH levels were similar between the vaginal delivery and cesarean groups (122.6 ± 95.2 vs. 112.3 ± 142.4, = 0.73). Similarly, there were no significant differences in any other maternal serum analytes or ratios. Logistic regression showed a nonsignificant odds ratio for successful vaginal birth ( = 0.69) even when evaluating only the 16 women who had a cesarean for an arrest disorder ( = 0.08).
In low-risk nulliparous women undergoing full-term labor induction, there were no differences noted in a broad array of other maternal-fetal HPA-axis hormones between women who had a vaginal or cesarean delivery.
本研究旨在评估在分娩诱导前采集的母体-胎儿下丘脑-垂体-肾上腺（HPA）轴激素是否存在差异，这些激素存在于阴道分娩的女性和剖宫产的女性之间。
这是一项于 2017 年 8 月至 2018 年 5 月在一家围产期中心进行的前瞻性观察性研究。无并发症的单胎妊娠≥39 周的初产妇在诱导前采集母体血清。采用 ELISA 法检测促肾上腺皮质释放激素（CRH）；采用化学发光反应法检测脱氢表雄酮硫酸酯（DHEA-S）、皮质醇、雌三醇（E）、雌二醇（E）和孕酮（P）。比较阴道分娩与剖宫产分娩的女性之间的平均分析物浓度以及三个比值（E/P、E/P 和 E/E）。采用逻辑回归模型来研究 CRH 与阴道分娩概率之间的关系。我们估计，在假设阴道分娩与剖宫产的比例为 2:1，且基线 CRH 浓度为 140（标准差=36）pg/ml 的情况下，样本量为 66 时，将有 90%的把握检测到平均 CRH 水平 25%的差异。
在 88 位接受血清分析的女性中，27 位（31%）接受了剖宫产。阴道分娩组和剖宫产组的母体血清 CRH 水平相似（122.6±95.2 与 112.3±142.4， = 0.73）。同样，其他母体血清分析物或比值也没有显著差异。逻辑回归显示，阴道分娩成功的比值比（ = 0.69）没有统计学意义，即使仅评估了 16 位因阻滞障碍而行剖宫产的女性，其比值比（ = 0.08）也没有统计学意义。
在接受足月分娩诱导的低危初产妇中，阴道分娩和剖宫产分娩的女性之间，在广泛的其他母体-胎儿 HPA 轴激素方面没有差异。
