Abstract
OBJECTIVE: The aim of this study is to find out the effect of delivery mode on newborn’s cord blood parameters particularly hemoglobin and hematocrite values. SETTING: Obstetrics and Gynecology Department, Qena Faculty of Medicine, South Valley University, Egypt. DURATION: From April 2015 to December 2017. STUDY DESIGN: A cross sectional study. METHODS: 900 live born neonates for healthy mothers were included in this study; all cases were delivered at full-term, with birth weight ranged from 2.5 to 3.5 Kg and had APGAR scores above 7 at 1 and 5 minutes. Newborns were divided into three groups (Group I included 300 newborns delivered by vaginal delivery without augmentation of labor, Group II included 300 newborns delivered vaginally with augmentation of labor and Group III included 300 newborns delivered by elective cesarean section). Blood sample was collected from the umbilical vein of each neonate for estimation of hemoglobin, hematocrit, RBCs count, platelets, WBCs count and reticulocytes. RESULTS: Cesarean section delivery had a statistically significant decrease in the level of iron-related hematologic indices including hemoglobin, hematocrit and RBCs count (p value 0.05). CONCLUSIONS: Cesarean section delivery had a significant decrease in the level of iron-related hematologic indices including hemoglobin, hematocrit and RBCs count and has a non-significant decrease in WBCs and platelets counts in neonatal cord blood, which suggest high prevalence of newborn iron-deficiency anemia among cesarean births particularly in developing communities.
Highlights
Iron deficiency anemia usually affects both physical and mental development of children which is more prevalent in the developing countries
This study showed, newborn’s cord blood hemoglobin & hematocrit values and red blood cells count in group III (Cesarean section group) were significantly lower than those in groups I and II these results agreed with what had been reported by Fady et al [9], this may be attributed to, that cesarean section is usually associated with reduced placental perfusion and decreased in the level of iron-related hematologic parameters include hemoglobin and hematocrit values in both cord and newborn’s peripheral blood [3]
This study showed no statistically significant decrease in white blood cells (WBCs) and platelets counts in newborns’ cord blood sample but showed a mildly statistically significant difference in the reticulocyte count between the group I and group II, where the augmented vaginal group showed reticulocyte count higher than spontaneous vaginal group, in the other hand no statistically significant difference was found between vaginal and cesarean section group in reticulocyte count (Table 3) which may explained as that augmented group exposed to more hypoxia and stress due to more contractions
Summary
Iron deficiency anemia usually affects both physical and mental development of children which is more prevalent in the developing countries (in 2005, prevalence of anemia in children < 4 years old was 30%). Placental perfusion reduction at time of birth was suggested to increase the risk of early life iron deficiency anemia [1]. Post-delivery, the newborn’s hemoglobin and hematocrit values increase about 10% during the first 6 - 8 hours of early neonatal life; these enhancements are due to increase in the placental perfusion which occurs at birth time [2]. The umbilical cord circulation is relatively not reactive and does not respond to the changes that occur in the maternal placental blood flow during uterine contractions [4]. Cesarean section in comparison with vaginal delivery is usually associated with a reduction in placental perfusion and so poor iron-related hematologic indices in the cord and peripheral blood, which indicates that, neonates who delivered by cesarean section may be more likely to develop iron-deficiency anemia in infanthood [3]. In the last decade there was an increase in the cesarean delivery rate which synchronously was associated with an increase in the prevalence of infant anemia in developing countries in our communities so we assigned this study to give alarm to obstetricians to stop unnecessary cesarean delivery and to encourage for vaginal delivery
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