"Two-step' head-to-body delivery activates foetal gluconeogenesis

Giovanni Scambia, Vincenzo Zanardo, Federico De Luca, Daniele Trevisanuto, Alphonse Simbi, Gianluca Straface

Research output: Contribution to journalArticle

4 Citations (Scopus)


AIM: 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). CONCLUSION: Cord blood glucose concentrations are significantly higher and pH values significantly lower in 'two-step' VD neonates, indicating activated foetal gluconeogenesis.
Original languageEnglish
Pages (from-to)e334-e338
Publication statusPublished - 2013


  • foetal
  • gluconeogenesis


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