title: 'Two-step' head-to-body delivery activates foetal gluconeogenesis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Cord blood glucose concentrations are significantly higher and pH values significantly lower in 'two-step' VD neonates, indicating activated foetal gluconeogenesis.
authors.affiliation: Department of Obstetrics and Gynecology and Division of Neonatology, Policlinico Abano Terme, Abano Terme, Italy. vincenzo.zanardo@libero.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Zanardo
authors.forename: Federico
authors.initials: F
authors.lastname: de Luca
authors.forename: Daniele
authors.initials: D
authors.lastname: Trevisanuto
authors.forename: Alphonse
authors.initials: A
authors.lastname: Simbi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.forename: Gianluca
authors.initials: G
authors.lastname: Straface
mesh_terms: D000138:Acidosis / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005333:Fetus / Q000378:metabolism*; D005943:Gluconeogenesis; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose