Contents    Cover    Publication Date: 25.06.2019
Year 2019 - Volume 29 - Issue 2

Comparison of Thiol/Disulfide Balance in Elective and Emergency Cesarean Sections: A Prospective, Observational Study

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JCOG 2019;29(2):68-76
DOI: 10.5336/jcog.2019-66749
Article Language: EN
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Objective: The initial development of the fetus occurs in a low-oxygen environment. From the beginning of the second trimester, a high amount of oxygen is required to meet the growth requirements such that placenta becomes metabolically active. Under these conditions, oxidative stress (OS) can develop during pregnancy and may result in disorders such as miscarriage and preeclampsia. Although several methods have been used to examine the OS levels of mother and fetus, the current method is based on assessing the thiol/disulfide balance. In the present study, we investigated the thiol/disulfide balance in pregnant women undergoing emergent and elective cesarean sections (CS). Materials and Methods: A total of 166 pregnant women, 83 in the emergency CS group and 83 in the elective CS group, were included in this observational study. We measured the disulfide, native thiol, and total thiol levels in blood samples collected from the umbilical artery of cords during CS. Results: The native thiol/total thiol ratio was significantly higher (p = 0.007) and native thiol, total thiol, disulfide, disulfide/native thiol ratio, and disulfide/total thiol ratio were lower (p = 0.001, p < 0.001, p = 0.001, p = 0.006, and p = 0.009, respectively) in the elective CS group compared with the emergency CS group. Forty pregnant women received general anesthesia (GA), whereas 43 women were administered spinal anesthesia (SA) in the elective CS group. Women who received GA had significantly lower native thiol/total thiol ratio (p = 0.002). Moreover, they reported a significantly higher total thiol, disulfide, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios (p = 0.015, p = 0.002, p = 0.003, and p = 0.003, respectively) compared with women who had SA. Conclusion: Oxidative stress increases in emergency CS, accompanied by a significant change in the thiol/disulfide balance in favor of disulfides in emergency CS. Although OS levels increased in emergency CS, there was no difference between the groups in terms of neonatal Apgar scores.
  1. Yüksel S, Yigit AA. Malondialdehyde and nitric oxide levels and catalase, superoxide dismutase, and glutathione peroxidase levels in maternal blood during different trimesters of pregnancy and in the cord blood of newborns. Turk J Med Sci. 2015;45(2):454-9. [Crossref] [PubMed]
  2. Burton GJ, Jauniaux E. Oxidative stress. Best Pract Res Clin Obstet Gynaecol. 2011;25(3): 287-99. [Crossref] [PubMed] [PMC]
  3. D?Autreaux B, Toledano MB. ROS as signalling molecules: mechanisms that generate specificity in ROS homeostasis. Nat Rev Mol Cell Biol. 2007;8(10):813-24. [Crossref] [PubMed]
  4. Korkmaz V, Kurdoglu Z, Alisik M, Cetin O, Korkmaz H, Surer H, et al. Impairment of thiol-disulfide homeostasis in preeclampsia. J Matern Fetal Neonatal Med. 2016;29(23): 3848-53. [Crossref] [PubMed]
  5. Marseglia L, D?Angelo G, Manti S, Arrigo T, Barberi I, Reiter RJ, et al. Oxidative stress-mediated aging during the fetal and perinatal periods. Oxid Med Cell Longev. 2014;2014: 358375. [Crossref] [PubMed] [PMC]
  6. Paamoni-Keren O, Silberstein T, Burg A, Raz I, Mazor M, Saphier O, et al. Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery. Arch Gynecol Obstet. 2007;276(1):43-6. [Crossref] [PubMed]
  7. Nabhan AF, El-Din LB, Rabie AH, Fahmy GM. Impact of intrapartum factors on oxidative stress in newborns. J Matern Fetal Neonatal Med. 2009;22(10):867-72. [Crossref] [PubMed]
  8. Yalcin S, Aydoğan H, Kucuk A, Yuce HH, Altay N, Karahan MA, et al. Supplemental oxygen in elective cesarean section under spinal anesthesia: handle the sword with care. Braz J Anesthesiol. 2013;63(5):393-7. [Crossref] [PubMed]
  9. Karabayırlı S, Keskin EA, Kaya A, Koca C, Erel O, Demircioglu RI, et al. Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections. J Res Med Sci. 2015;20(8): 739-44. [Crossref] [PubMed] [PMC]
  10. Lurie S, Matas Z, Boaz M, Fux A, Golan A, Sadan O. Different degrees of fetal oxidative stress in elective and emergent cesarean section. Neonatology. 2007;92(2):111-5. [Crossref] [PubMed]
  11. Gülbayzar S, Arica V, Hatipoğlu S, Kaya A, Arica S, Karatekin G. Malondialdehyde level in the cord blood of newborn infants. Iran J Pediatr. 2011;21(3):313-9.
  12. Jain S, Nair A, Shrivastava C. Evaluation of oxidative stress marker malondialdehyde level in the cord blood of newborn infants. Int J Sci Study. 2015;3(6):73-6.
  13. Raicević S, Cubrilo D, Arsenijević S, Vukcević G, Zivković V, Vuletić M, et al. Oxidative stress in fetal distress: potential prospects for diagnosis. Oxid Med Cell Longev. 2010;3(3): 214-8. [Crossref] [PubMed] [PMC]
  14. Inanc F, Kilinc M, Kiran G, Guven A, Kurutas E, Cikim IG, et al. Relationship between oxidative stress in cord blood and route of delivery. Fetal Diagn Ther. 2005;20(5):450-3. [Crossref] [PubMed]
  15. Vakilian K, Ranjbar A, Zarganjfard A, Mortazavi M, Vosough-Ghanbari S, Mashaiee S, et al. On the relation of oxidative stress in delivery mode in pregnant women; a toxicological concern. Toxicol Mech Methods. 2009;19(2):94-9. [Crossref] [PubMed]
  16. Noh EJ, Kim YH, Cho MK, Kim JW, Kim JW, Byun YJ, et al. Comparison of oxidative stress markers in umbilical cord blood after vaginal and cesarean delivery. Obstet Gynecol Sci. 2014;57(2):109-14. [Crossref] [PubMed] [PMC]
  17. Hung TH, Chen SF, Hsieh TT, Lo LM, Li MJ, Yeh YL. The associations between labor and delivery mode and maternal and placental oxidative stress. Reprod Toxicol. 2011;31(2): 144-50. [Crossref] [PubMed]
  18. Ayres-de-Campos D, Spong CY, Chandraharan E; FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstet. 2015;131(1):13-24. [Crossref][PubMed]
  19. Visser GH, Ayres-de-Campos D; FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: adjunctive technologies. Int J Gynaecol Obstet. 2015;131(1):25-9. [Crossref] [PubMed]
  20. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem. 2014;47(18):326-32. [Crossref] [PubMed]
  21. Oghagbon SE, Agu KC, Omorowa FE, Okolie NP, Okwumabua M, Omo-Erhabor JA. Oxidative stress parameters as markers of the different trimesters in normal pregnancy. JASEM. 2016;20(3). [Crossref]
  22. Martin A, Faes C, Debevec T, Rytz C, Millet G, Pialoux V. Preterm birth and oxidative stress: Effects of acute physical exercise and hypoxia physiological responses. Redox Biol. 2018;17: 315-22. [Crossref] [PubMed] [PMC]
  23. Harma M, Harma M, Erel O. Measurement of the total antioxidant response in preeclampsia with a novel automated method. Eur J Obstet Gynecol Reprod Biol. 2005;118(1):47-51. [Crossref] [PubMed]
  24. Cetin O, Karaman E, Boza B, Cim N, Alisik M, Erel O, et al. The maternal serum thiol/disulfide home ostasis is impaired in pregnancies complicated by idiopathic intrauterine growth restriction. J Matern Fetal Neonatal Med. 2018;31(5):607-13. [Crossref] [PubMed]
  25. Ulubas Isik D, Akdaş Reis Y, Bas AY, Unal S, Ozcan B, Mollamahmutoglu L, et al. The effect of the modes of delivery on the maternal and neonatal dynamic thiol-disulfide homeostasis. J Matern Fetal Neonatal Med. 2018;1-5. [Crossref] [PubMed]
  26. Vlachos GD, Bartzeliotou A, Schulpis KH, Partsinevelos GA, Lazaropoulou C, Papadima C, et al. Maternal-neonatal serum paraoxonase 1 activity in relation to the mode of delivery. Clin Biochem. 2006;39(9):923-8. [Crossref] [PubMed]
  27. Chiba T, Omori A, Takahashi K, Tanaka K, Kudo K, Manabe M, et al. Correlations between the detection of stress-associated hormone/oxida tive stress markers in umbilical cord blood and the physical condition of the mother and neonate. J Obstet Gynaecol Res. 2010;36(5):958-64.[Crossref] [PubMed]
  28. Schneid-Kofman N, Silberstein T, Saphier O, Shai I, Tavor D, Burg A. Labor augmentation with oxytocin decreases glutathione level. Obstet Gynecol Int. 2009;2009:807659. [Crossref] [PubMed][PMC]
  29. Eryilmaz OG, Kansu-Celik H, Erel O, Erdogan S. Thiol/disulfide parameters as a novel oxidative marker in medical labor induction with oxytocin. Horm Mol Biol Clin Investig. 2017;29(2):61-5.