The relationship between appearance of oxidative stress indicators and method of childbirth complicated with intrauterine growth restriction in correlation with a condition of a neonate


Radoń-Pokracka, Małgorzata


oxidative stress ; intrauterine growth retardation ; small for gestational age ; birth weight ; Apgar score


Low birth weight is responsible for 69.6% of neonatal deaths and for 66.4% of stillbirths. It has been shown that approximately 10% of maternal mortality is the result of intrauterine growth restriction, which is associated with the occurrence of complications in later stages of life or diseases manifest themselves in adulthood.Most scholars defines the term IUGR in relation to the fetus did not use its growth potential because of pathological causes. It is believed that hypotrophy of the fetus is a consequence of homeostasis disturbance and placental insufficiency. The mechanism of this process may be multifactorial, but in many cases remain idiopathic. Numerous studies and scientific reports confirmed the participation of oxidative stress in the pathogenesis of IUGR, but the exact pathogenesis of this phenomenon is not fully understood. The relationship between the occurrence of oxidative stress, and the way to improve the general condition of pregnancy and the newborn remains controversial.The aim of the study was to determine the relation between occurrence of oxidative stress and the mode of delivery in the pregnancy complicated by intrauterine fetal growth restriction. Erected following research problems:• What relationship does exist between the level of oxidative stress markers in peripheral blood and the incidence of IUGR?• What is the relationship between the presence ; of oxidative stress markers in peripheral blood in pregnancies complicated by IUGR and a mode of delivery (uncomplicated vaginal birth or caesarean section)?• What relationships exist between Apgar score as an independent marker of the health of the newborn at 1, 3, and 5 minutes after birth, and the level of oxidative stress markers in blood and a mode of delivery in pregnancies complicated by IUGR?The study was prospective, cohort and involved 80 pregnant women hospitalized in the Department of Obstetrics and Perinatology Jagiellonian University in Krakow in the period from 01.04.2014-01.02.2015. The study included full-term pregnant women between 37 and 42 weeks of pregnancy. The study used a random selection of patients. Participation in the survey was voluntary, and patients were informed of the nature and appropriateness of performance and consented in writing to take part in it. The ability to opt out of further participation entitled at any stage of the study. Permission to carry out tests no KBET / 324 / B / 2014 issued Bioethics Committee of the Jagiellonian University in Krakow. The study was conducted with the financial resources of the labor office No. K / ZDS / 004712, granted by the Jagiellonian University. ; The study was isolated:• The first group (I) (n = 40) - women in pregnancy complicated by IUGR.• The second group (II controls) (n = 40) - pregnant women i ; n physiological pregnancy.In group I, diagnosis was based on ultrasound determining fetal weight below the 10th percentile for gestational age dating on the basis of ultrasound in the first trimester of pregnancy. The measurement was made twice by two independent obstetricians in order to minimize the risk of misdiagnosis, and the values thus estimated fetal weight percentile calculation referred to the grid. The condition for later inclusion of patients for the study was to confirm low (located below 10th percentile for gestational age), birth weight of baby.Group II consisted of 40 women whose pregnancies proceeded without perceptible complications and comorbidities.Exclusive elements in the study were diagnosed chronic disease before pregnancy or during its term, structural defects and chromosomal fetal intrauterine infections, smoking, and multiple pregnancy.Aim of the study was achieved based on the following analysis.• Analysis of medical records of patients and evaluation of clinical parameters relating to these mothers in the perinatal period:• age and education• the number of pregnancies and births• drugs taking during pregnancy• addictions• the result of the last prenatal ultrasound (including the assessment of the estimated fetal weight (EFW), cerebro-umbilical ratio (CPR) and the maximum fluid pocket (MVP))• the result of laboratory tests (including morphology and i ; on levels routinely assayed at a branch in the perinatal period)• mode of delivery.• Analysis of newborn medical records and clinical assessment of the following parameters relating to the child in the perinatal period:• sex• birth weight and length of body• the Apgar score in the 1st, 3rd and 5th minute after birth.• Evaluation of selected parameters of oxidative stress in the blood serum of pregnant women:• activity of catalase (CAT)• activity of superoxide dismutase (SOD)• total antioxidant capacity of plasma (FRAP).In order to analyze the mode of delivery patients were separated into 3 subgroups:1. Women who have given birth vaginally (PSN),2. women whose birth took it way primary cesarean delivery (performed with elective indications, without accompanying fetal distress, PCC)3. Women whose pregnancies ended in the secondary cesarean section (performed during childbirth, due to the deteriorating state of the fetus or lack of progress of labor, WCC).In addition, examined the impact of induction of labor on the results obtained in different groups. The analysis erected following conclusions:1. In the group of pregnancies with intrauterine growth retardation, maternal peripheral blood occurred significantly lower values of all investigated markers of oxidative stress (total antioxidant capacity of plasma superoxide dismutase and catalase). In addition, some differences were o ; bserved in the activity of catalase and total antioxidant capacity of plasma, depending on the prevalence of intrauterine growth disorders and the method of termination of pregnancy.2. The study showed that infants with intrauterine growth retardation are characterized by a lower health status as measured by Apgar score at 1, 3 and 5 minutes after birth. There is no evidence, however, that the impact of IUGR on the health of the newborn has been modified by mode of delivery, and the level of oxidative stress markers.3. Do not observed to influence fetal growth disorders on the health of the newborn measured by the Apgar scale depend on the use of induction of labor.4. In the course of the analyzes was confirmed the dependence of the occurrence of intrauterine growth of the newborn assessment parameters on ultrasound (estimated fetal weight and dimension of the largest pockets of amniotic fluid). There was, however, the relationship of fetal growth disturbance associated with outcomes of interest was the way of termination of pregnancy or induction of labor.5. The results of the study suggest that the diagnosis of intrauterine growth, low value estimated fetal weight and abnormal umbilical cerebrospinal values (<1.08) can be independent predictors of poorer health risk neonatal Apgar scale measured, and found to ultrasound the largest pocket dimension amniotic fluid <2cm may ind ; icate an increased risk of cesarean delivery performance of the secondary.

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2 - studia doktoranckie

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Wydział Nauk o Zdrowiu


Huras, Hubert



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