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Effects of caesarean section on serum levels of NT ‐pro BNP
Author(s) -
Yamada Takashi,
Koyama Takahiro,
Furuta Itsuko,
Takeda Masamitsu,
Nishida Ryutaro,
Yamada Takahiro,
Morikawa Mamoru,
Minakami Hisanori
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2012.04511.x
Subject(s) - medicine , caesarean section , vaginal delivery , natriuretic peptide , gestation , pregnancy , childbirth , obstetrics , endocrinology , gynecology , heart failure , genetics , biology
Summary Objective To determine the effects of delivery by caesarean on serum levels of N ‐terminal fragment of precursor protein brain‐type natriuretic peptide ( NT ‐pro BNP ). Methods Serum NT ‐pro BNP levels were determined longitudinally at 24 and 36 weeks of gestation ( GW ) and on post‐partum day 3 and month 1 ( PPD 3 and PPM 1, respectively) in 78 women with normotensive singleton pregnancies. Thirty‐nine women underwent caesarean delivery. Plasma renin activity ( PRA ) and plasma aldosterone concentration ( PAC ) were determined on PPD 3. Effects of maternal demographic characteristics on NT ‐pro BNP levels were also analysed. Results NT ‐pro BNP levels (pg/ml) either in pregnancy or on PPM 1 did not differ between women with vaginal and caesarean deliveries (44 ± 24 vs 41 ± 30, 24 GW ; 37 ± 22 vs 29 ± 22, 36 GW ; 43 ± 28 vs 39 ± 24, PPM 1, respectively). Levels on PPD 3 were significantly higher (94 ± 105 vs 247 ± 186, P < 0·0001) in women with caesarean delivery. Among women with caesarean delivery, a larger rise of NT ‐pro BNP on PPD 3 occurred in nulliparous than in multiparous women (319 ± 232 vs 185 ± 107, P = 0·023), while no rise occurred among multiparous women with vaginal delivery (108 ± 115 vs 47 ± 27). NT ‐pro BNP levels on PPD 3 were significantly and negatively correlated with PRA, PAC and maternal weight loss after childbirth on PPD 3. These 3 variables on PPD3 were significantly lower in women undergoing caesarean than vaginal delivery (0·8 ± 0·4 vs 1·9 ± 1·4 ng/ml/h for PRA ; 70 ± 38 vs 136 ± 88 pg/ml for PAC ; 2·7 ± 1·2 vs 4·3 ± 1·1 kg for weight loss, each P < 0·0001). Conclusions The transient post‐partum rise in serum NT ‐pro BNP may reflect transient volume overload after parturition and is remarkable in nulliparous women, especially after caesarean section.