手术分娩对产妇和新生儿B细胞的影响

目的:探讨手术分娩对产妇和新生儿血中B细胞数值的影响。方法:选择足月分娩产妇60例:其中自然分娩(NL)组、择期剖宫产(CS)组、经试产而急诊剖宫产(CS-E)组各20例。分娩时分别采集产妇外周血和新生儿脐血,采用流式细胞仪检测血中B细胞CD19+的百分数。结果:CS-E组产妇血中B细胞数(10.53±3.26%)明显高于NL组(7.81±2.90%)和CS组(6.89±4.72%)(P<0.01);新生儿脐血中B细胞数CS组(8.63±5.78%)低于NL组(12.95±5.37%)和CS-E组(12.48±5.42%)(P<0.05)。结论:CS-E产妇血中B细胞值的明显增高,可能与产妇分娩发动及胎儿状况有关;CS组新生儿脐血中B细胞数减少,可能会增加新生儿对某些病原体的易感性。     

促肾上腺皮质激素释放激素、皮质醇和硫酸脱氢表雄酮在早产发动中的作用

目的探讨促肾上腺皮质激素释放激素（CRH）、皮质醇、硫酸脱氢表雄酮（DHEA—S）在早产发动中的作用。方法用原位杂交法检测早产阴道分娩产妇26例（早产组）、足月临产阴道分娩产妇29例（足月临产组）、足月未临产剖宫产产妇25例（足月未临产组）胎盘、胎膜组织中CRH mRNA的分布与表达,用放射免疫法测定3组产妇分娩的新生儿脐静脉血CRH,脐动脉血DHEA-S及皮质醇的含量。结果（1）各组产妇胎盘、胎膜组织中均可见CRH mRNA表达。（2）CRH mRNA在胎盘组织中表达的阳性指数：早产组为5．5±1．4,足月临产组为5．4±1．5,均高于足月未临产组的2．7±1．5。差异均有统计学意义（P〈0．01）;CRHmRNA在胎膜组织中表达的阳性指数：早产组为5．4±1．7,足月临产组为5．4±1．4,足月未临产组为2．0±1．4,早产组、足月临产组与足月未临产组比较,差异也有统计学意义（P〈0．01）;CRH mRNA在胎盘及胎膜中表达的阳性指数早产组与足月临产组比较,差异无统计学意义（P〉0．05）;各组产妇CRH mRNA在胎盘与胎膜组织中的表达比较,差异均无统计学意义（P〉0．05）。（3）早产组和足月临产组新生儿脐静脉血CRH含量分别为（7．8±3．3）、（7．7±4．1）ng／L,脐动脉血DHEA-S含量分别为（514±295）、（483±207）μg／L,均高于足月未临产组的（4．8±2．4）ng／L、（360±80）μg／L,差异有统计学意义（P〈0．05）;而早产组与足月临产组比较,差异则无统计学意义（P〉0．05）。早产组脐静脉血CRH含量与胎盘、胎膜组织中CRH mRNA的表达均呈正相关关系（r=0．935、0．853,P〈0．01）,足月临产组脐静脉血CRH含量与胎盘、胎膜组织中CRH mRNA的表达也呈正相关关系（r=0．902、0．825,P〈0．01）。（4）早产组新生儿脐动脉血皮质醇含量为（246±117）μg／L,明显高于足月临产组的（172±72）μg／L和足月未临产组的（127±60）μg／L,差异均有统计学意义（P〈0．05,P〈0．01）。早产组新生儿脐静脉血CRH与脐动脉血皮质醇、DHEA-S含量均呈正相关关系（r=0．523、0．424,P〈0．05）,足月临产组新生儿脐静脉血CRH与脐动脉血皮质醇、DHEA—S含量也呈正相关关系（r=0．438、0．354,P〈0．05）。结论（1）CRH与分娩发动密切相关,胎盘、胎膜组织中CRH mRNA表达升高可能是早产发动的重要原因。（2）DHEA—S、皮质醇与分娩的发动密切相关。     

促肾上腺皮质激素释放激素、皮质醇及硫酸脱氢表雄酮与分娩发动关系的研究

目的 :测定足月妊娠妇女在分娩发动前后外周血及脐静脉血中促肾上腺皮质激素释放激素 (CRH)、皮质醇 (CORT)、硫酸脱氢表雄酮 (DHEAs)水平 ,以探讨CRH、CORT及DHEAs在足月分娩发动中的作用。方法 :测定 4 0例自然分娩发动孕妇及 4 0例同孕周的选择性剖宫产孕妇外周血、脐静脉血CRH、CORT及DHEAs水平。CRH的测定用放射免疫法 ,CORT用 2 0 0 0型全自动化学发光检测系统 ,DHEAs用酶联免疫法。结果 :(1)自然分娩发动组潜伏期及活跃期血CRH水平均显著高于选择性剖宫产组 (P <0 .0 5 ) ,而潜伏期及活跃期CRH水平无统计学差异 (P >0 .0 5 ) ;自然分娩发动组潜伏期、活跃期及选择性剖宫产组之间的血DHEAs水平无统计学差异 (P >0 .0 5 ) ;自然分娩发动组潜伏期、活跃期的血CORT水平与剖宫产组相比有升高的趋势 ,但 3者间差异无显著性 (P >0 .0 5 ) ;(2 )自然分娩发动组脐血CRH、CORT、DHEAs水平均显著高于选择性剖宫产组 (P <0 .0 5 ,P <0 .0 1,P <0 .0 5 ) ,且CORT、DHEAs与CRH水平均呈正相关 (r1=0 .74 ,P <0 .0 5 ;r2 =0 .91,P <0 .0 1) ;两组新生儿的平均体重差异无显著性 (P >0 .0 5 )。结论 :胎盘CRH与胎儿来源的CORT、DHEAs ,可能在足月分娩发动中起重要作用     

阴道分娩与剖宫产对母儿血清胃泌素水平的影响

目的　探讨经阴道分娩与剖宫产对母血和新生儿脐血胃泌素水平的影响。　方法　采用放射免疫法测定择期剖宫产、阴道分娩的孕妇及产后 3～ 5 d的产妇各 2 0例的血清胃泌素水平。同时测定 2 0例经阴道产儿和 2 2例剖宫产儿的脐血胃泌素水平。　结果　分娩发动后母血清胃泌素水平为 (10 8.2 3± 2 4.39) ng/ L ,较未发动宫缩的足月孕妇血清胃泌素水平 (78.2 8± 31.13) ng/ L升高(P<0 .0 5 ) ;产后 3～ 5 d母血清胃泌素水平为 (143.33± 35 .6 1) ng/ L ,较产前明显升高 (与阴道分娩和剖宫产相比分别为 P<0 .0 5 ;P<0 .0 1)。经阴道产儿脐血胃泌素水平为 (138.37± 2 0 .2 8) ng/ L ,明显高于剖宫产儿脐血胃泌素水平 (10 1.2 3± 18.16 ) ng/ L (P<0 .0 5 )。　结论　阴道分娩有利于新生儿胃肠功能的成熟与完善     

脂联素和胰岛素与胎儿生长的关系

目的:探讨脂联素,胰岛素与胎儿生长发育的关系。方法:选取21例分娩生长受限胎儿(FGR组)、21例分娩巨大儿(巨大儿组)及21例分娩正常儿(对照组)的产妇,抽取3组产妇分娩后肘静脉血及其新生儿脐静脉血.分离血清。采用双抗体夹心酶联免疫吸附法和放射免疫法测定3组产妇血清及新生儿脐静脉血清中脂联素和胰岛素的水平。结果:FGR组产妇血清脂联素水平明显低于对照组及巨大儿组(P<0.01);FGR组新生儿脐血清脂联素水平明显低于对照组及巨大儿组(P<0.05);3组产妇血清中脂联素水平均明显低于新生儿脐血清中脂联素水平(P<0.01)。FGR组胎盘重量明显低于对照组及巨大儿组(P<0.01);3组产妇血清及新生儿脐血血清中胰岛素水平差异无显著性(P>0.05)。3组产妇血清脂联素水平与胰岛素水平无相关(P>0.05);3组新生儿脐血清脂联素水平与胰岛素水平呈明显负相关性(P<0.05);3组产妇血清脂联素水平与新生儿脂联素水平无相关(P>0.05);3组产妇血清胰岛素水平和新生儿脐血胰岛素水平无相关性(P>0.05)。3组新生儿脐血清脂联素水平与新生儿出生体重、胎盘重量、新生儿头围、身长、体重/身长比呈明显正相关关系(P<0.05);3组新生儿脐血清胰岛素水平、产妇血清脂联素水平、产妇血清胰岛素水平与新生儿出生体重、胎盘重量、头围、身长、体重/身长比均无相关性。结论:脐血中的脂联素、胰岛素在胎儿宫内生长和发育过程中可能起重要的调节作用,可作为评价胎儿生长发育及体内脂肪储备状态的临床指标之一。胎儿自身分泌的脂联素与胎儿生长关系密切。     

胰岛素样生长因子及胰岛素样生长因子结合蛋白-3与胎儿生长受限的关系

目的　探讨胰岛素样生长因子 (IGF) Ⅰ、IGF Ⅱ和IGF结合蛋白 3(IGFBP 3)与胎儿生长的关系 ,以及IGF在胎儿生长受限 (FGR)发病中的作用。方法　选取 2 0例分娩FGR胎儿 (FGR组 )、10例分娩巨大儿 (巨大儿组 )及 2 0例分娩正常儿 (对照组 )的产妇 ,抽取 3组产妇分娩后肘静脉血及其新生儿脐静脉血 ,分离血清。采用放射免疫法和免疫放射法测定 3组产妇及其新生儿血清中IGF Ⅰ、IGF Ⅱ及IGFBP 3的水平。结果　 (1)FGR组产妇血清IGF Ⅰ、IGF Ⅱ及IGFBP 3水平分别为(130 5± 2 6 0 ) μg/L、(2 40± 0 42 ) μg/L及(5 5 79± 848) μg/L ;新生儿脐血清IGF Ⅰ、IGF Ⅱ及IGFBP 3水平分别为 (6 6± 1 7) μg/L、(1 5 4± 0 31) μg/L及 (86 9± 183) μg/L。 (2 )巨大儿组产妇血清IGF Ⅰ、IGF Ⅱ及IGFBP 3水平分别为 (30 9 7± 44 6 ) μg/L、(2 43± 0 2 5 ) μg/L及(5 5 6 2± 742 ) μg/L ;新生儿脐血清IGF Ⅰ、IGF Ⅱ及IGFBP 3水平分别为 (6 9 6± 2 3 9) μg/L、(2 19± 0 2 9) μg/L及(16 82± 130 )μg/L。(3)对照组产妇血清IGF Ⅰ、IGF Ⅱ及IGFBP 3水平分别为 (30 7 9± 70 7) μg/L、(2 41± 0 36 )μg/L及 (5 5 86± 6 78) μg/L ;新生儿脐血清IGF Ⅰ、IGF Ⅱ及IGFBP 3水平分别为 (6 8 9     

双胎妊娠的分娩方式与妊娠结局探讨

目的　探讨双胎妊娠的分娩方式与妊娠结局的关系。方法　将 1995年 1月至 2 0 0 3年 5月 98例双胎妊娠产妇按分娩方式分为阴道分娩组及剖宫产组 ,对其临床资料进行回顾性分析。结果　两组的孕周、产后出血率比较差异无显著性意义 (P >0 0 5 ) ,剖宫产组新生儿体重显著高于阴道分娩组 (P <0 0 1) ,两组第 1胎分娩新生儿窒息率差异无显著性意义 (P >0 0 5 ) ,而第 2胎分娩新生儿窒息率剖宫产组显著低于阴道分娩组(P <0 0 5 )。结论　正确选择双胎妊娠的分娩方式 ,将有助于降低剖宫产率及新生儿窒息率     

孕妇尿碘及甲状腺功能监测

目的　探讨不同孕周、不同碘营养状况下孕妇尿碘水平及孕妇、新生儿甲状腺功能 ,分析孕妇碘营养状况及药物治疗的必要性。方法　于 1997年 7月～ 2 0 0 3年 3月期间 ,收集在我院就诊及分娩的孕产妇尿标本 185 2 8例次 ,按照是否补充“金典”分为A组 (未补碘 )及B组 (补碘 ) ,按照孕周分为 :孕早期 1组 ,孕中期 2组 ,孕晚期 3组 ;另随机抽取 2 4 6例孕产妇 ,并分组 :早孕未补充“金典”者 81例为JA1组 ,孕足月未补充“金典”者 86例为JA3组 ,孕足月补充“金典”者 79例为JB3组 ,对该组孕妇其及分娩的新生儿脐带血进行甲状腺功能的检测。结果　①本组孕产妇尿碘中位数为 2 31μg L ,尿碘值 <5 0 μg L、 <10 0 μg L、 <2 0 0 μg L的发生率分别为 2 4 %、 13 9%及 4 3 4 % ;②孕早、中、晚期未补充“金典” (及补充“金典”)组尿碘值中位数分别为 :16 2 μg L (377μg L)、 193μg L (2 86 μg L)、 2 6 0 μg L (382 μg L) ,前者尿碘值均低于后者 ,其差异有显著性 (P =0 0 0 0 ) ;随着孕周的增加 ,未补充“金典”组尿碘值依次升高 ,差异有显著性 (P =0 0 0 0 ) ;③三组孕妇甲状腺功能检测值的中位数均在正常范围内 ,除TG一项外 ,FT3、FT4 、TSH、TM等几项差异均有统计学意义(P =0 0 0 0 ) ;④足月     

椎管内阻滞麻醉与笑气吸入用于分娩镇痛的效果比较

目的　比较椎管内阻滞麻醉和笑气吸入两种方法的分娩镇痛效果和对产妇及新生儿的影响。方法　随机选取 30 0例产妇分为笑气组、椎管内阻滞组和对照组 ,每组各 10 0例。在分娩过程中 ,笑气组给予吸入含 5 0 %笑气与 5 0 %氧气的混合气体 ;椎管内阻滞组给予蛛网膜下腔 +硬膜外腔联合注入芬太尼和布比卡因 ;对照组未给予镇痛药物。并分别观察 3组产妇的镇痛效果、产程时间、分娩方式、产后出血量、产妇桡动脉血及新生儿脐血的血气分析以及新生儿窒息情况。结果　 (1)镇痛效果比较 :椎管内阻滞组镇痛分级 0级为 88例 ,笑气组为 12例 ,对照组为 0例。 3组之间比较 ,差异有极显著性 (P <0 0 1)。 (2 )产程时间比较 :第一产程和总产程时间 ,椎管内阻滞组短于对照组和笑气组 (P <0 0 5 ) ,笑气组与对照组比较 ,差异无显著性 (P >0 0 5 ) ;第二产程时间椎管内阻滞组长于对照组和笑气组 ,但差异无显著性 (P >0 0 5 )。 (3)剖宫产术后出血量比较 :笑气组为 (373± 77)ml,椎管内阻滞组为 (2 5 9± 78)ml,对照组为 (2 39± 89)ml,笑气组与其他两组比较 ,差异有极显著性 (P<0 0 1)。(4)血气分析结果比较 :3组产妇桡动脉血及新生儿脐血血气分析结果各组之间比较 ,差异均无显著性 (P >0 0 5 )。 (5 )分娩方式比较     

分娩方式对产妇及其新生儿促甲状腺激素水平影响的研究

目的探讨不同分娩方式对产妇及其新生儿促甲状腺激素(TSH)水平的影响.方法应用放射免疫分析法,检测213例产妇及其新生儿的TSH水平,按分娩方式不同分为正常分娩组140例,剖宫产组38例,产钳组35例.结果(1)产钳组产妇TSH为(4.13±0.69)mU/L,正常分娩组产妇为(2.58±0.87)mU/L,两组比较,差异有极显著性(P＜0.01).剖宫产组产妇TSH为(2.81±0.45)mU/L,同产钳组产妇比较,差异有极显著性(P＜0.01);同正常分娩组产妇比较,差异无显著性(P＞0.05).(2)产钳组新生儿TSH为(8.85±2.48)mU/L,正常分娩组新生儿为(5.36±2.23)mU/L,两组比较,差异有极显著性(P＜0.01).剖宫产组新生儿TSH为(3.84±2.16)mU/L,同正常分娩组比较,差异有显著性(P＜0.05).(3)3组产妇及其新生儿TSH水平之间呈显著正相关.结论产妇和新生儿TSH水平的高低与不同分娩方式有关.产妇TSH水平变化用于评估新生儿TSH水平具有可行性.     

Cortisol levels in umbilical cord plasma in relation to labor and delivery.

Cortisol was determined by a competitive protein-binding method in umbilical cord plasma from pregnancies of 37 or more weeks' gestation. In 162 cases of vaginal delivery following spontaneous labor the mean +/- S.E. of cortisol values was 7.43 +/- 0.29 mug per 100 ml. of plasma. This cortisol level was not significantly different from that observed in 51 cases of vaginal delivery after oxytocin-induced labor (6.53 +/- 0.49 mug per 100 ml.) or in 47 cases of delivery by emergency cesarean section following labor (6.21 +/- 0.66 mug per 100 ml.). The mean cortisol level in cases of elective cesarean section with no prior labor (4.67 +/- 0.60 mug per 100 ml.) was significantly less than the value for vaginal delivery after spontaneous or induced labor. The cord plasma and amniotic fluid concentrations of cortisol in a pregnancy complicated by fetal anencephaly and terminated at 44 weeks by induction were normal. It is concluded that labor and vaginal delivery resulted in a significant increase in cord plasma cortisol levels but there was no significant difference between spontaneous and induced labors. These findings do not support the hypothesis that a surge in fetal cortisol production immediately precedes and initiates spontaneous labor in human pregnancy.     

Fetal plasma cortisol and dehydroepiandrosterone sulfate concentrations in pregnancy and term parturition.

OBJECTIVE: To examine if changes in fetal plasma concentrations of cortisol or dehydroepiandrosterone sulfate (DHEAS) levels are associated with human term parturition. METHODS: Umbilical cord plasma cortisol and DHEAS concentrations were measured in 374 singleton pregnancies that delivered at term in the following six groups: group 1, cordocentesis for clinical indications before 36 weeks of gestation (n = 93); group 2, cordocentesis for clinical indications after 36 weeks of gestation (n = 9); group 3, cord blood sampling after elective cesarean section (CS) at term without labor (n = 140); group 4, cord blood sampling after CS at term with early labor (cervical dilatation < or =3 cm, n = 18); group 5, cord blood sampling after CS at term with active labor (cervical dilatation 4 cm or greater, n = 26); group 6, cord blood sampling after vaginal delivery at term (n = 88). Corticosteroids were not administered before blood collection. RESULTS: (1) Fetal plasma cortisol remained unchanged until 36 weeks of gestation and increased thereafter to term; (2) active labor was associated with a significant increase in fetal plasma cortisol; (3) fetal plasma DHEAS increased at term gestation (>36 weeks) but did not increase during active labor; (4) the cortisol/DHEAS ratio (stress index) increased with advancing gestation and with active labor at term. CONCLUSIONS. Human parturition at term is associated with an increase in fetal plasma cortisol and in the cortisol/DHEAS ratio, but not in DHEAS.     

Fetal plasma cortisol and dehydroepiandrosterone sulfate concentrations in pregnancy and term parturition

Objective.?To examine if changes in fetal plasma concentrations of cortisol or dehydroepiandrosterone sulfate (DHEAS) levels are associated with human term parturition.

Methods.?Umbilical cord plasma cortisol and DHEAS concentrations were measured in 374 singleton pregnancies that delivered at term in the following six groups: group 1, cordocentesis for clinical indications before 36 weeks of gestation (n = 93); group 2, cordocentesis for clinical indications after 36 weeks of gestation (n = 9); group 3, cord blood sampling after elective cesarean section (CS) at term without labor (n = 140); group 4, cord blood sampling after CS at term with early labor (cervical dilatation ≤3 cm, n = 18); group 5, cord blood sampling after CS at term with active labor (cervical dilatation 4 cm or greater, n = 26); group 6, cord blood sampling after vaginal delivery at term (n = 88). Corticosteroids were not administered before blood collection.

Results.?(1) Fetal plasma cortisol remained unchanged until 36 weeks of gestation and increased thereafter to term; (2) active labor was associated with a significant increase in fetal plasma cortisol; (3) fetal plasma DHEAS increased at term gestation (>36 weeks) but did not increase during active labor; (4) the cortisol/DHEAS ratio (stress index) increased with advancing gestation and with active labor at term.

Conclusions.?Human parturition at term is associated with an increase in fetal plasma cortisol and in the cortisol/DHEAS ratio, but not in DHEAS.     

The effect of delivery on umbilical arterial cord blood gases and lipid peroxides: comparison of vaginal delivery and cesarean section

Umbilical arterial blood gas analysis is the most objective method to assess fetal well being at birth, is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth, and it excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. This study was designed to determine the effect of the type of delivery on umbilical cord blood gases and on free radical activity together with antioxidation in the fetus. Ninety-six pregnant women between 37 and 42 weeks of gestation were included to the study and randomly assigned to the one of three groups: Group 1 (n = 40) were vaginally delivered, Group 2 (n = 26) had cesarean section with epidural anaesthesia, and Group 3 (n = 30) had cesarean section under general anaesthesia. Umbilical artery blood gas analysis was performed just after the delivery of the fetus together with melondealdehyde and glutathione. The umbilical arterial PO2 was found to be higher in Group 3, and malondealdehyde and glutathione levels were lower in newborns of Group 2. It can be concluded that cesarean section with epidural anaesthesia is safer when lipid peroxides are concerned.     

Fetomaternal opioid levels and parturition

The present study evaluates the plasma level changes in beta-lipotropin and beta-endorphin in nine women at term throughout spontaneous labor, in ten pregnant women undergoing elective cesarean section in the absence of uterine contractions, and in ten women submitted to emergency cesarean section because of fetal distress occurring during labor. A basal plasma sample was taken before labor in the 39th week of pregnancy. Two subsequent samples were then obtained before and after parturition, together with umbilical cord samples at birth. beta-lipotropin and beta-endorphin were measured by radioimmunoassay after silicic acid plasma extraction and gel filtration. In cases of spontaneous labor, there was a progressive increase in opioid concentrations as labor progressed, the maximal values being observed after delivery. Cord values were similar to those observed in the mother, without showing any relationship to them. Pregnant women undergoing cesarean section in the absence of labor show constant beta-lipotropin and beta-endorphin concentrations both before and after fetal extraction, both values being significantly lower than those found at delivery after spontaneous labor. beta-Endorphin neonatal levels were significantly higher than in the respective mothers and were in the same range as those of infants born through vaginal delivery. In the third group (cesarean section performed at the first stage of labor), presurgical opioid levels were higher than in women at the same stage of spontaneous labor, whereas postextraction values showed a wide range, with mean values similar to those observed after spontaneous delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Umbilical cord cortisol in breech delivery

Mixed umbilical cord blood samples were obtained in 31 cases immediately after vaginal breech delivery at term and in 31 cases immediately after vaginal vertex delivery at term. The total cortisol concentrations were determined using a direct radioimmunologic method (Amerlex cortisol kit). The mean umbilical cord total cortisol concentration was 790 +/- 363 nmol/liter in breech delivery as compared with 493 +/- 125 nmol/liter in vertex delivery. The difference was highly significant (p less than 0.0005). There was a highly positive correlation (r = 0.59, p less than 0.0005) between duration of labor and total cortisol concentrations in umbilical plasma after breech delivery. In contrast to that we found only a slightly positive correlation between duration of labor and total cortisol concentrations after vaginal vertex delivery (r = 0.23, p less than 0.10). Significant differences in pH values between breech and vertex deliveries (p less than 0.01) and a slight but significant correlation (r = 0.35, p less than 0.002) between umbilical vein pH values and umbilical total cortisol concentrations indicate that the increase in cortisol during vaginal breech delivery could be attributed partially to some hypoxic events. These results support the concept that the increase in cortisol in the umbilical cord plasma during labor reflects the fetal adrenal response secondary to stress in utero and contribute to our understanding of why an increased risk exists for the fetus during vaginal breech delivery of long duration.     

Isolated oligohydramnios in term pregnancy as an indication for induction of labor.

OBJECTIVE: To evaluate the outcome of active induction of labor for isolated oligohydramnios in low-risk term gestation. METHODS: This retrospective study analyzed the obstetric and perinatal outcome of 412 singleton term pregnancies with cephalic presentation and no maternal risk factors or fetal abnormalities. Two groups were compared: 206 deliveries after induced labor for isolated oligohydramnios, and 206 deliveries matched for gestational age following spontaneous labor with normal amniotic fluid index. RESULTS: The overall rate of cesarean deliveries and cesarean deliveries for nonreassuring fetal status, and operative vaginal delivery rates and those for nonreassuring fetal status were higher in the oligohydramnios group than in the control group. There were no differences between groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION: Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome.     

Possible adrenocortical insufficiency in postmature neonates.

Total plasma cortisol in cord and neonatal blood was measured by a radioassay method in neonates resulting from (1) term vaginal delivery following uncomplicated labor (control group), (2) term vaginal delivery following fetal distress during labor, (3) postterm, postmature vaginal delivery following fetal distress during labor, and (4) postterm, postmature emergency cesarean section performed because of signs of severe fetal distress during labor. Comparison of the mean peripheral plasma cortisol values showed that whereas the mean level (plus or minus S.E.) of the distressed term neonates (22.2 plus or minus 5.3 mug per 100 ml.) use 180 per cent of that of the control group (12.3 plus or minus 1.1 mug per 100 ml.; P smaller than 0.01) the mean level for the vaginally delivered postmature group (7.5 plus or minus 1.8 mug per 100 ml.) was only 61 per cent of that of the control group (P smaller than 0.05). Furthermore, in the postmature group with sufficient intrapartum distress to warrant emergency cesarean section the mean level (4.6 plus or minus 1.5 mug per 100 ml.) was found to be only 37 per cent of that of the control group. No differences were observed among the cord plasma cortisol values. These results are strongly suggestive of a relative adrenocortical insufficiency in postmature neonates. Such insufficiency could result from a defect in any portion of the adrenal-pituitary-hypothalamic axis. Effort is under way to further define such a defect.     

Plasma oxytocin in human pregnancy and parturition

Oxytocin concentrations were determined in serial peripheral plasma samples collected from clinically normal women during pregnancy and labor. Measurable concentrations of this hormone were detected in all maternal plasma samples during pregnancy, but there were wide differences in values between patients. Serial samples from individual patients revealed a pattern of gradual rise of oxytocin levels with advancing gestation and the increase in concentration was statistically significant. There were no significant differences in oxytocin levels at any stage of labor, with or without epidural analgesia. Oxytocin levels at the onset of the second stage did not differ statistically from those at crowning. Comparison of cross-sectional data showed no significant difference between the mean oxytocin concentration in early labor and in late pregnancy. Oxytocin surges occurred, but not in a regular pattern. Plasma oxytocin concentration did not increase after pelvic examination, sweeping of the membranes, low amniotomy or after cervical vibration. After spontaneous vaginal delivery, umbilical arterial plasma levels of oxytocin were consistently higher than plasma concentrations from the umbilical vein. The fetal arterio-venous difference was less pronounced at elective cesarean section. At spontaneous vaginal delivery, with and without epidural anesthesia, plasma levels from the umbilical artery were significantly higher than the maternal levels. After vaginal delivery, oxytocin levels in cord plasma were significantly higher than at elective abdominal delivery. Some methodological aspects with regard to blood sampling and to plasma oxytocin radioimmunoassay procedures are discussed. From the results presented it is concluded that the human fetus can be an important source of oxytocin and that neurohumoral birth reflexes described in animals do not occur systematically in man.     

Relation between leptin and cortisol values in umbilical vessels at normal vaginal delivery.

To study the role of various hormones in the control of fetal leptin secretion during labour, 33 pregnant women with normal singleton term pregnancy were recruited. At the time of spontaneous vaginal delivery, a venous blood sample was taken from the women together with a venous and an arterial cord blood sample. In all blood samples, leptin, cortisol, prolactin and progesterone were measured. Serum leptin and cortisol values were significantly higher, while those of prolactin and progesterone were significantly lower in the mother than in the two umbilical vessels (p < 0.01). Cortisol levels were significantly higher in the umbilical artery than in the umbilical vein (p < 0.01). Serum leptin values in the umbilical artery and vein correlated significantly with the corresponding values of cortisol (r = 0.523 and r = 0.580 respectively, p < 0.01), but not with those of prolactin and progesterone. A weak but significant correlation was found between leptin values in the two umbilical vessels and birth weight (r = 0.385 and r = 0.401 respectively, p < 0.05). In multiple regression analysis, cortisol values but not birth weight was the most important determinant of leptin values. Birth weight, however, correlated significantly with placental weight (r = 0.776, p < 0.001). These results demonstrate for the first time that leptin concentrations in the umbilical vessels at normal vaginal delivery correlate significantly with cortisol values, thus providing evidence that cortisol mediates a labour stimulating effect on fetal leptin secretion. It is suggested that cord blood leptin values at delivery are not a good predictor of neonatal weight.