Cerebral oxygenation during the period of transition to extrauterine life after natural versus cesarean birth
Authors:   ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Neonatology, Bucharest, Romania, Nastase Leonard ,   Department of Obstetrics, Gynecology and Neonatology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Condrat Carmen Elena ,   Fetal Medicine Excellence Research Center, ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania, Stefan Mihaela Gabriela ,   Fetal Medicine Excellence Research Center, ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania, Gusa Lavinia ,   Fetal Medicine Excellence Research Center, ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania, Cretoiu Dragos ,   Fetal Medicine Excellence Research Center, ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania,   Department of Cell and Molecular Biology and Histology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Dima Vlad ,   Filantropia Clinical Hospital, Bucharest, Romania, Suciu Nicolae ,   Department of Obstetrics, Gynecology and Neonatology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   Fetal Medicine Excellence Research Center, ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania,   Department of Obstetrics and Gynecology, Polizu Clinical Hospital, ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania, Stoicescu Silvia-Maria ,   ”Alessandrescu-Rusescu” National Institute for Mother and Child Health, Neonatology, Bucharest, Romania,   Department of Obstetrics, Gynecology and Neonatology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Published: January 2023

Objective. We aim to evaluate the implications of cesarean delivery compared to natural birth by analyzing newborns’ systemic and cerebral oxygenation levels during the first 10 minutes of life. Design. This paper presents a 4-year prospective cohort study. Setting. Polizu Maternity, "Alessandrescu-Rusescu" National Institute for Mother and Child's Protection, Bucharest, Romania. Patients. Randomly selected pregnant women and their fetuses. Interventions. During the 10 min following umbilical cord clamping, regional cerebral oxygen saturation (rcSO2) was measured using the INVOS 5100 device and peripheral oxygen saturation (SpO2) was determined using the Masimo SET pulse oximeter in neonates from cesarean and natural deliveries. Main outcome measures. The cerebral fractional tissue oxygen extraction (cFTOE) in the first 10 minutes of life was calculated based on these values. Results. Newborns delivered vaginally showed higher rcSO2 levels at 1 minute of life than those born via C-section (40.5 ± 16.5% vs 33.7 ± 14.8%, AUC = 0.625; IC 95%: 0.506 - 0.743; p = 0.043). Neonatal cFTOE at 1 minute of life was significantly higher in caesarean-delivered newborns versus naturally born neonates (0.40 ± 0.25 vs 0.50 ± 0.19, p = 0.03; AUC = 0.638; IC 95%: 0.517-0.758; p = 0.023). Conclusions. Prelabor cesarean delivery seemingly plays a significant role in the process of fetal and neonatal cerebral oxygenation immediately postnatally, which is highlighted by lower rcSO2 and higher cFTOE values. Cerebral oxygen saturation monitoring in the delivery room allows the optimization of oxygen therapy in order to prevent the consequences of hypoxia or hyperoxia.