This retrospective cohort study assessed the association between nuchal cord and adverse outcomes during vacuum-assisted delivery (VAD). Women with singleton pregnancies, 34–41-weeks gestation, who underwent VAD, from 2014 to 2020 were included. The primary outcome was umbilical cord pH ≤ 7.1. Secondary outcomes were neonatal intensive care unit admission, Apgar scores, pH < 7.15, subgaleal hematoma, shoulder dystocia and third/fourth-degree perineal tear. Outcomes were compared between neonates with (1059/3754, 28.2%) or without (71.8%) nuchal cord after VAD. No difference in cord pH ≤ 7.1 was found between groups. The nuchal cord group had a lower rate of nulliparity (729 (68.8%) vs. 2004 (74.4%), p = 0.001) and higher maternal BMI (23.6 ± 4.3 vs. 23.1 ± 5, p = 0.017). Nuchal cord was associated with higher rates of induction (207 (19.5%) vs. 431 (16%), p = 0.009) and lower birthweights (3185 ± 413 vs. 3223 ± 436 g, p = 0.013). The main indication for VAD in 830 (80.7%) of the nuchal cord group was non-reassuring fetal heart rate (NRFHR) vs. 1989 (75.6%) controls (p = 0.004). The second stage was shorter in the nuchal cord group (128 ± 81 vs. 141 ± 80 min, p < 0.001). Multivariate regression found nulliparity, induction and birthweight as independent risk factors for nuchal cord VAD. Although induction and NRFHR rates were higher in VAD with nuchal cord, the rate of umbilical cord acidemia was not.
OBJECTIVE: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that was diagnosed during pregnancy. It is one of the most common complications of pregnancy, and has short-and longterm effects on both the mother and child, specifically, an increased risk of diabetes mellitus and cardiovascular diseases. It is categorized as diet-controlled gestational diabetes (GDMA1) or gestational diabetes that requires medication (GDMA2). Galectin-3 (Gal-3) is a galactoside-binding lectin that mediates interactions with numerous ligands of significance in the process of cell growth, differentiation, inflammation, and fibrosis. We evaluated Gal-3 mRNA and protein expression in maternal serum, placenta, and umbilical blood cord of women with GDMA2 and normal pregnancies (NP). STUDY DESIGN: Sixty pregnant women (30 with GDMA2 and 30 NP) were recruited during admission for delivery. Blood samples were obtained from the parturients and umbilical cords, as well as placental tissue for mRNA, protein extraction and immunohistochemistry. RESULTS: Gal-3 mRNA expression was significantly increased in maternal serum and placentas of women with GDMA2 compared to NP (fold expression ratio 3.18AE1.22; P¼0.03 and 13.78AE2.70, P¼0.008, respectively). Gal-3 mRNA was decreased in GDMA2 cord blood (fold expression ratio 0.37AE0.08, P<0.01) compared to NP, as well as to GDMA2 maternal serum mRNA and GDMA2 placental mRNA. Gal-3 GDMA2 placental protein expression was increased compared to NP (fold expression ratio 2.41AE0.26, P¼0.03). Immunostaining revealed that Gal-3 is significantly upregulated in GDMA2 placental villous trophoblast.
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