title: Head-to-body delivery by "two-step" approach: effect on cord blood hematocrit.
abstract: BACKGROUND
  There is no study to support a relationship between placental transfusion and active management techniques of the second stage of labor.
  
  
  OBJECTIVE
  To examine the association between head-to-body delivery by a "two-step" approach (which includes waiting for the next contraction to deliver the shoulders) and its effect on the amount of blood that remains in the infant's circulation at birth.
  
  
  METHODS
  Observational study on 500 consecutive, singleton, and at term deliveries from January to June 2012 in Policlinico Abano Terme, Abano Terme, Italy. Umbilical artery hematocrit (Htc) was evaluated in reference to contemporary tested pH values, involving neonates vaginally delivered by the "two-step" approach and by cesarean section, respectively.
  
  
  RESULTS
  Head-to-body delivery by the "two-step" approach significantly increased Htc values with respect to cesarean delivery (50.16% versus 47.24%, p < 0.001) and at the same time reduced pH (7.31 ± 0.09 versus 7.33 ± 0.06, p = 0.007) in umbilical artery. In addition, Htc levels for this group were significantly negatively correlated with umbilical artery pH (r = -0.137, p < 0.018).
  
  
  CONCLUSIONS
  Head-to-body delivery by the "two-step" approach increases the red cell mass in term infants without any clinical risk of neonatal acidemia.
authors: Department of Obstetrics and Gynecology and Division of Neonatology, Policlinico Abano Terme, Abano Terme, Padua, Italy. vincenzo.zanardo@libero.it
authors: Vincenzo
authors: V
authors: Zanardo
authors: Catia
authors: C
authors: Gabrieli
authors: Federico
authors: F
authors: de Luca
authors: Daniele
authors: D
authors: Trevisanuto
authors: Marco
authors: M
authors: De Santis
authors: Giovanni
authors: G
authors: Scambia
authors: Gianluca
authors: G
authors: Straface
mesh_terms: D000138:Acidosis / Q000097:blood; D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005312:Fetal Blood; D006400:Hematocrit; D006801:Humans; D036801:Parturition / Q000502:physiology*; D011247:Pregnancy; D014469:Umbilical Arteries