Circulating maternal cortisol levels during vaginal delivery and elective cesarean section

Area of Science:

• Endocrinology
• Obstetrics
• Perinatology

Background:

• Maternal serum cortisol (S-cortisol) naturally rises during pregnancy, peaking in the third trimester.
• Labor involves significant physical stress, historically associated with elevated S-cortisol.
• Advancements in labor analgesia may have altered the maternal stress response during childbirth.

Purpose of the Study:

• To compare maternal S-cortisol levels between women undergoing spontaneous vaginal delivery and elective cesarean section.
• To evaluate the impact of delivery mode on maternal stress as indicated by S-cortisol.

Main Methods:

• Studied 20 healthy women with spontaneous vaginal delivery and 20 undergoing elective cesarean section.
• Measured S-cortisol at three stages during vaginal delivery (tvd1, tvd2, tvd3).
• Measured S-cortisol before and after elective cesarean section (tcs1, tcs2).

Main Results:

• Mean S-cortisol levels were significantly higher in the vaginal delivery group compared to the cesarean section group at the onset of labor (p=0.006).
• Postpartum S-cortisol levels in the vaginal delivery group were significantly higher than postoperative levels in the cesarean section group (p<0.001).
• Vaginal delivery was associated with higher mean S-cortisol levels (tvd1: 1325 ± 521 nmol/L, tvd2: 1559 ± 591 nmol/L, tvd3: 1368 ± 479 nmol/L) compared to cesarean section (tcs1: 906 ± 243 nmol/L, tcs2: 831 ± 257 nmol/L).

Conclusions:

• Maternal S-cortisol levels are elevated during vaginal delivery compared to elective cesarean section, indicating greater physiological stress.
• Consideration should be given to adjusting hydrocortisone dosage in pregnant women with adrenal insufficiency, especially those undergoing elective cesarean section.