بررسي اثر نوع و استفاده از مواد ضدعفوني كننده يددار در هنگام زايمان بر مقادير تيروتروپين بند ناف و ميزان هيپرتيرونزوپينمي در منطقه اي بايد كافي

An Assessment of the Mode of Delivery and Povidone-Iodine Disinfection at Delivery on Cord Blood Spot Thyrotropin Levels and the Rate of Hyperthyrotropinemia in an iodine-sufficient area

Introduction:Controversies still exist regarding the effect of mode of delivery and use of maternal Povidone-lodine (PVP-l) disinfection at delivery on TSH levels. In this report, these issues were assessed. Materials and Methods: Cord blood spot samples of all live born neonates were collected since February 1998, in Tehran and Damavand, and TSH values Z20 mUlL were considered as hyperthyrotropinemia (recalls). Data regarding vaginal (VGL) and caesarean section (CS) deliveries and PVP-l 10% and Chlorhexidine (CHL) 0. 5% (non-iodinated disinfectant) was recorded. PVP-l was used between 50-150mL in some VGL and 200-300 mL in all CS deliveries. Neonates <37 weeksʹ gestation and <2500 g of birth-weight were excluded from the study. !Results: Up to August 2002, 30492 cord spot samples were collected and 326 (1. 07%) were recalled. Median (95%Cl) TSH values in VGL-PVP-l (n=16284) was 5. 2 (5. 9-6. 1) and in VGL-CHL (n=4166) was 5. 2 (5. 8-6. 1) mU/L (p=O. 81). Median (95%CI) TSH in CS-PVP-l (n=10042) was 4. 8 (5. 2-5. 5) mU/L that was significantly lower than those of VGL groups (p<0. 001). Frequency distribution of recalls in VGL-PVP-I (202 of 16284) and VGL-CHL (49 of 4166) was similar (p=0. 74) and was significantly lower in CS-PVP-I (75 of 10042) as compared to VGL-PVP-I (p<0. 001) and VGL-CHL (p=0. 012). The odds ratio (95%CIOR) of recall occurrence in VGL-PVP-I was 1. 7 (1. 28-2. 18) and in VGL-CHL was 1. 6 (1. 10-2. 27) as compared to CS-PVP-I. Conclusion: PVP-l had no effect on the elevation of cord spot TSH levels and recall rate in our program. Instead, the mode of delivery played a more effective role on the elevation of TSH values and recall rate.