Hata T, Manabe A, Makihara K, Hata K, Miyazaki K
Department of Obstetrics and Gynecology, Shimane Medical University, Izumo, Japan.
Gynecol Obstet Invest. 1997;44(3):173-6. doi: 10.1159/000291513.
Our purpose was to compare Doppler-derived cardiac time intervals and cord plasma levels of catecholamines in vaginally and cesarean delivered neonates.
Doppler echocardiographic assessments of fetal and neonatal cardiac time intervals were made to determine differences in circulatory changes in 8 neonates delivered vaginally and 12 delivered by elective cesarean section. Aortic and pulmonary acceleration time (AT), ejection time (ET), and the AT/ET ratio in systole were assessed at various time points from antenatal to 72 h after delivery. Umbilical artery blood gas and acid-base values, and cord blood concentrations of epinephrine and norepinephrine were also measured.
Umbilical artery blood pH in the cesarean section group was significantly lower than that in the vaginal delivery group (p < 0.05). Base deficit in umbilical artery blood and cord blood norepinephrine in cesarean delivered neonates were significantly higher than those in vaginally delivered neonates, respectively (p < 0.05). There were no significant changes in aortic cardiac time intervals between the 2 groups at any of the various time points. However, pulmonary AT and the AT/ET ratio were significantly lower in the normal vaginal delivery group than those in the cesarean section group 6 h after delivery (p < 0.05).
The lower AT and AT/ET ratio of the pulmonary artery in vaginally delivered neonates may reflect an increase in pulmonary vascular resistance, indicating transient pulmonary hypertension. The findings were the reverse of what might be expected from an elevated pulmonary vascular resistance and transient pulmonary hypertension in cesarean delivered neonates.
我们的目的是比较经阴道分娩和剖宫产分娩新生儿中，多普勒衍生的心脏时间间隔以及脐带血浆中儿茶酚胺水平。
对胎儿和新生儿的心脏时间间隔进行多普勒超声心动图评估，以确定8例经阴道分娩新生儿和12例择期剖宫产分娩新生儿循环变化的差异。在从产前到产后72小时的不同时间点，评估主动脉和肺动脉加速时间（AT）、射血时间（ET）以及收缩期的AT/ET比值。还测量了脐动脉血气和酸碱值，以及脐带血中肾上腺素和去甲肾上腺素的浓度。
剖宫产组脐动脉血pH值显著低于阴道分娩组（p < 0.05）。剖宫产分娩新生儿的脐动脉血碱缺失和脐带血去甲肾上腺素分别显著高于阴道分娩新生儿（p < 0.05）。在各个时间点，两组之间主动脉心脏时间间隔均无显著变化。然而，正常阴道分娩组产后6小时的肺动脉AT和AT/ET比值显著低于剖宫产组（p < 0.05）。
经阴道分娩新生儿肺动脉的AT和AT/ET比值较低，可能反映了肺血管阻力增加，提示短暂性肺动脉高压。这些发现与剖宫产分娩新生儿肺血管阻力升高和短暂性肺动脉高压的预期情况相反。
