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Cesarean section predominantly affects right ventricular diastolic function during the early transitional period.

Katsuo Tao1, Yoshikazu Hara2, Yasunori Ishihara3

  • 1Department of Pediatrics, Fukui Aiiku Hospital, Fukui, Japan; Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.

Pediatrics and Neonatology
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Summary

Cesarean delivery (CS) temporarily impacts neonatal right ventricular diastolic function compared to vaginal delivery (VD). These cardiac changes, particularly elevated E/e

Keywords:
cesarean sectionechocardiographyventricular function

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Area of Science:

  • Neonatal Cardiology
  • Pediatric Cardiac Mechanics
  • Fetal to Neonatal Transition

Background:

  • Mode of delivery is known to influence pulmonary function.
  • The specific effects of cesarean delivery (CS) on postnatal cardiac mechanics remain unclear.
  • Understanding these effects is crucial for neonatal adaptation.

Purpose of the Study:

  • To investigate whether the mode of delivery influences cardiac function during the early neonatal transitional period.
  • To compare serial echocardiographic parameters between infants born via CS and vaginal delivery (VD).

Main Methods:

  • Serial echocardiography performed on 42 infants delivered by CS and 110 by VD at 0, 1, 2, and 5 days of age.
  • Longitudinal assessment of cardiac function parameters including ejection fraction (EF), fractional area change (FAC), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), Tei index, E/e' ratio, and deceleration time (DcT).
  • Multivariate analysis adjusted for birth weight, gestational age, and oxygen administration.

Main Results:

  • Fractional area change (FAC) and deceleration time (DcT) increased, while Tei index decreased in both ventricles, irrespective of delivery mode.
  • Infants born via CS exhibited significantly higher E/e' ratios and lower MAPSE compared to VD infants throughout the observation period.
  • Right ventricular E/e', indicative of diastolic function, was significantly affected by delivery mode after adjusting for confounding factors.

Conclusions:

  • Cesarean delivery transiently affected right ventricular diastolic function on the second day postpartum, with effects not persisting long-term.
  • Potential explanations for observed hemodynamic changes in neonates born via CS include delayed myocardial adaptation and/or persistent pulmonary hypertension.
  • Delivery mode is a significant factor influencing early neonatal cardiac adaptation, particularly right ventricular diastolic function.