The relationship between fetal distress and umbilical venous troponin T during labor

Document Type : Original Article

Authors

1 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

2 Gynecologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

3 Assistant professor, Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Associate Professor, Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

5 Instructor, Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran.

Abstract

Introduction: For many years, electrocardiogram have been used to diagnose fetal distress around childbirth. If the heart cells are damaged, troponin T is released. Few studies have been performed about the relationship between abnormality of fetal heart rate and troponin T. So, this study was performed with aim to determine the relationship between fetal distress and umbilical venous troponin T level (utTl).
Methods: This case-control study was conducted on 80 neonates in Zanjan Ayatolah Mousavi hospital in 2016. The neonates were compared in two groups of 40 cases with Fetal heart rate abnormalities and control group. utTl was measured using a kit (Bioassay Technology biology) and Elisa technique with sensitivity of 2.54 ng / L. The demographic and obstetric information were recorded. Data were analyzed by SPSS software (version 22), and independent and paired t-test. P<0.05 was considered statistically significant.
Results: utTl of fetal distress group was 531.04 ± 499.55 ng/l and was significantly higher than control group (187.47 ± 59.66 ng/l) (p<0.001). utTl in the early deceleration was the lowest and in the variable deceleration was the highest, but it was not significantly different (p= 0.195).
Conclusion: In neonates with abnormal fetal ECG, the troponin level of the umbilical cord blood was significantly higher, indicating that abnormalities of fetal heart rate during labor may cause neonatal heart damage.

Keywords

References

  1. Stoll BJ, Chapman IA. The fetus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BM, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Saunders; 2011. P. 569.
  2. Fattuoni C, Palmas F, Noto A, Fanos V, Barberini L. Perinatal asphyxia: a review from a metabolomics perspective. Molecules 2015; 20(4):7000-16.
  3. Chiabi A, Takou V, Mah E, Nguefack S, Siyou H, Takou V, et al. Risk factors for neonatal mortality at the Yaounde gynaeco-obstetric and pediatric hospital, Cameroon. Iran J Pediatr 2014; 24(4):393-400.
  4. Aslam HM, Saleem S, Afzal R, Iqbal U, Saleem SM, Shaikh MW, et al. Risk factors of birth asphyxia. Ital J Pediatr 2014; 40:94.
  5. Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017; 2:CD006066.
  6. Ayres-de-Campos D. Intrapartum fetal surveillance. Best Pract Res Clin Obstet Gynaecol 2016; 30:1-2.
  7. Nageotte MP. Fetal heart rate monitoring. Semin Fetal Neonatal Med 2015; 20(3):144-8.
  8. Makino S, Hirai C, Takeda J, Itakura A, Takeda S. Relationship between fetal heart rate patterns and a time course for evaluation of fetal well-being: "the 30 minutes rule" for decision of mechanical delivery. Taiwan J Obstet Gynecol 2017; 56(6):788-92.
  9. Turrini I, Sorbi F, Ghizzoni V, Mannini L, Fambrini M, Terreni A, et al. Severe fetal distress and placental damage might be associated with high troponin I (cTnI) levels in mothers. Am J Case Rep 2018; 19:194-8.
  10. Shiva R, Maryam R, Hajie B. Cardiac troponin T levels of umbilical cord in neonates with abnormal fetal heart rate. Iran J Pediatr 2013; 23(1):85-8.
  11. Shelton SD, Fouse BL, Holleman CM, Sedor FA, Herbert WN. Cardiac troponin T levels in umbilical cord blood. Am J Obstet Gynecol 1999; 181(5 Pt 1):1259-62.
  12. Jehlicka P, Huml M, Rajdl D, Mockova A, Matas M, Dort J, et al. How to interpret elevated plasmatic level of high-sensitive troponin T in newborns and infants? Physiol Res 2018; 67(2):191-5.
  13. Ohman EM. Redefining the gold standard of myocardial infarction using troponin T. Clin Chem 2017; 63(1):429-30.
  14. Trevisanuto D, Pitton M, Altinier S, Zaninotto M, Plebani M, Zanardo V. Cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in umbilical cord blood of healthy term neonates. Acta Paediatr 2003; 92(12):1463-7.
  15. Yildirim A, Ozgen F, Ucar B, Alatas O, Tekin N, Kilic Z. The diagnostic value of troponin T level in the determination of cardiac damage in perinatal asphyxia newborns. Fetal Pediatr Pathol 2016; 35(1):29-36.
  16. Costa MD, Schnettler WT, Amorim-Costa C, Bernardes J, Costa A, Goldberger AL, et al. Complexity-loss in fetal heart rate dynamics during labor as a potential biomarker of acidemia. Early Hum Dev 2014; 90(1):67-71.
  17. Siddiq A, Krisnadi SR, Effendi JS. The differences of cord blood troponin I (TnI) level between normal and asphyxiated infants and its correlation with apgar score. Open J Obstet Gynecol 2014; 4(15):954.
  18. Szymankiewicz M, Matuszczak-Wleklak M, Hodgman JE, Gadzinowski J. Usefulness of cardiac troponin T and echocardiography in the diagnosis of hypoxic myocardial injury of full-term neonates. Biol Neonate 2005; 88(1):19-23.
  19. Sadoh WE, Eregie CO, Nwaneri DU, Sadoh AE. The diagnostic value of both troponin T and creatinine kinase isoenzyme (CK-MB) in detecting combined renal and myocardial injuries in asphyxiated infants. PloS One 2014; 9(3):e91338.
  20. Cunningham FG, Kenneth J, Bloom SL, Spong CY, Dash JS, Hoffman BL, et al. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2018.
  21. 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.
  22. Lakhno I. Fetal non-invasive electrocardiography contributes to better diagnostics of fetal distress: a cross-sectional study among patients with pre-eclampsia. Ann Acad Med Singapore 2015; 44(11):519-23.
  23. Maeda Mde F, Nomura RM, Niigaki JI, Francisco RP, Zugaib M. Computerized fetal heart rate analysis in the prediction of myocardial damage in pregnancies with placental insufficiency. Eur J Obstet Gynecol Reprod Biol 2015; 190:7-10.
  24. Zietek M, Celewicz Z, Swiderski S, Bilar M, Ronin-Walknowska E. The relationship between intrapartum fetal heart rate disturbances, electrocardiographic changes and umbilical venous troponin-I (T-I). Ginekol Pol 2003; 74(8):650-5.
  25. Joseph S, Kumar S, Ahamed MZ, Lakshmi S. Cardiac troponin-T as a marker of myocardial dysfunction in term neonates with perinatal asphyxia. Indian J Pediatr 2018; 85(10):877-84.
  26. Fleming SM, O'Gorman T, O'Byrne L, Grimes H, Daly KM, Morrison JJ. Cardiac troponin I and N-terminal pro-brain natriuretic peptide in umbilical artery blood in relation to fetal heart rate abnormalities during labor. Pediatr Cardiol 2001; 22(5):393-6.
  27. Alexandre SM, D'Almeida V, Guinsburg R, Nakamura MU, Tufik S, Moron A. Cord blood cardiac troponin I, fetal Doppler velocimetry, and acid base status at birth. Int J Gynaecol Obstet 2008; 100(2):136-40.
  28. McAuliffe F, Mears K, Fleming S, Grimes H, Morrison JJ. Fetal cardiac troponin I in relation to intrapartum events and umbilical artery pH. Am J Perinatol 2004; 21(3):147-52.
  29. Costa S, Zecca E, De Rosa G, De Luca D, Barbato G, Pardeo M, et al. Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia? Acta Paediatr 2007; 96(2):181-4.
  30. Zaramella P, Saraceni E, Freato F, Falcon E, Suppiej A, Milan A, et al. Can tissue oxygenation index (TOI) and cotside neurophysiological variables predict outcome in depressed/asphyxiated newborn infants? Early Hum Dev 2007; 83(8):483-9.
  31. Nomura RM, Cabar FR, Costa VN, Miyadahira S, Zugaib M. Cardiac troponin T as a biochemical marker of cardiac dysfunction and ductus venosus Doppler velocimetry. Eur J Obstet Gynecol Reprod Biol 2009; 147(1):33-6.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 1
March 2019
Pages 9-14

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