羊水乳酸值对胎儿窘迫的预测价值

目的:探讨足月胎儿临产时的羊水乳酸水平对胎儿窘迫的预测价值。方法:收集2006年4月~2010年1月在我院阴道分娩的孕37~41+6足月单胎头位产妇,临产前B超胎儿发育正常,将产程中出现不良胎监图形130例和羊水粪染87例作为观察组,将产前正常胎监图形、羊水清且有良好结局的新生儿240例作为对照组,测定羊水乳酸水平,同时采脐血做血气分析。结果:羊水Ⅰ度及Ⅱ度粪染而胎儿监护正常的病例,其羊水乳酸值与对照组比较,差异无显著性意义(P>0.05),羊水Ⅲ度粪染的羊水乳酸值水平明显升高(P<0.05)。观察组发生胎儿窘迫及新生儿窒息的病例,其羊水乳酸水平明显高于对照组(P<0.05)。结论:胎儿缺氧时羊水乳酸水平升高,对诊断胎儿窘迫有一定的价值。     

正常和胎儿窘迫新生儿脐血中8-异前列腺素F2α水平及临床意义

目的:探讨8-iso-PGF2α在正常和胎儿窘迫的新生几脐血中浓度;探讨羊水粪染与新生儿脐血中8-iso-PGF2α的关系.方法:选取2008年9月至2011年6月在我院分娩过程中出现胎儿窘迫者103例为实验组、同期随机选取正常对照新生儿73例为对照组;于分娩或剖宫产过程中断脐后采取脐带动脉中血液4mL.其中胎儿窘迫组根据分娩过程中或剖宫产术中羊水粪染新生儿共56例,羊水清亮47例、羊水Ⅰ度粪染5例、羊水Ⅱ度粪染19例、羊水Ⅲ度粪染32例.采用ELISA法测定新生儿脐血血清中8-iso-PGF2α含量.结果:胎儿窘迫新生儿脐血中8-iso-PGF2α较正常组明显升高,差异有显著性(P=0.001);通过对胎儿窘迫组新生儿8-异前列腺素F2α的比较发现Ⅱ、Ⅲ度羊水粪染新生儿脐血8-异前列腺素F2a浓度显著高于羊水Ⅰ度和羊水清组,比较差异有显著性(P=0.004).结论:胎儿窘迫的发生与脂质过氧化有关;羊水粪染(Ⅱ、Ⅲ度)存在8-异前列腺素F2α浓度升高,提示脐血8-异前列腺素F2α测定可作为羊水粪染新生儿预后早期预报的一个指标.     

脐血流S/D值及胎心监护诊断胎儿宫内窘迫的临床意义

目的探讨彩色多普勒检测脐血流S/D值与胎心监护对胎儿宫内窘迫及新生儿窒息的诊断价值。方法选取2016年01月~2017年01月在我院住院晚期妊娠孕妇700名,选择脐血流异常者350例作为Ⅰ组,随机抽取同期分娩的脐血流正常者350例作为Ⅱ组。再对Ⅰ组和Ⅱ组分别分为Ⅰa(胎监正常组)、Ⅰb(胎监异常组)和Ⅱa(胎监正常组)、Ⅱb(胎监异常组),通过观察胎心率、脐带、羊水、胎儿脐血流S/D值及胎心监护图谱显示的胎心变异情况记录脐血流检测、胎心监护与围产儿预后的关系,脐血流、胎心监护相互异常与胎儿宫内窘迫、新生儿窒息的关系。结果脐血流异常对羊水过少、脐带异常、羊水污染、小于胎龄儿及新生儿窒息均有较明显影响,两组相比有高度显著性差异,P0.001;Ⅰa组与其他3组相比,羊水污染、新生儿窒息均有显著性差异,P0.001,Ⅰa与Ⅱa、Ⅱb相比,羊水污染、羊水过少、脐带异常、小于胎龄儿、新生儿窒息均有显著性差异,P0.001。结论彩色多普勒运用到监测脐血流S/D值及胎心监护是诊断胎儿宫内窘迫的主要方法,具有安全、快捷、准确、方便、可重复性、易观察等优点,二者结合明显提高了胎儿宫内窘迫的诊断准确率,对预防和降低新生儿窒息发生率有着重要的临床意义。     

不同胆汁酸水平对妊娠期肝内胆汁淤积症孕妇和胎儿的影响

探讨不同胆汁酸水平对妊娠期肝内胆汁淤积症孕妇和胎儿的影响。选取我院2012年4月~2015年9月产科就诊治疗的68例ICP孕妇作为研究对象。并根据血清胆汁酸水平(TBA)不同分为A组、B组各34例(即A组TBA水平≥40umo L,B组TBA水平40umo L),比较并分析两组孕妇出现皮肤瘙痒的孕周、黄疸发生率、ALT水平、AST水平及胎儿窘迫、羊水粪染(Ⅱ~Ⅲ度)、早产、胎儿窒息发生率等。A组的皮肤瘙痒出现时孕周明显早于B组(P0.05),且A组黄疸发生率、ALT及AST水平明显高于B组(P0.05),A组胎儿窘迫、胎儿羊水粪染(Ⅱ~Ⅲ度)、早产、胎儿窒息发生率均明显高于B组(P0.05)。TBA在对ICP诊断具有重要意义,妊娠期胆汁淤积症中、重度孕妇,孕妇妊娠情况及新生儿结局情况较差,我们应当增强关注度,及时的干预治疗降低TBA水平,可避免孕妇及新生儿的危险情况发生。     

未足月胎膜早破期待时间的影响因素及妊娠结局

目的:探讨34周前未足月胎膜早破(PPROM)期待时间的影响因素及妊娠结局.方法:回顾性分析213例28 ～ 34周PPROM单胎孕妇和新生儿的临床资料,根据期待时间分为3组:期待时间＜48h组67例,期待时间48h～7d组100例及期待时间＞7d组46例,观察各组临床特征和母儿并发症.结果:(1)孕妇年龄、产次、入院体温,3组比较差异无统计学意义(P＞0.05),期待时间＞7d组入院孕周小于其他两组(P＜0.05).期待时间＜48 h组入院时白细胞计数及中性粒细胞分类、C反应蛋白(CRP)水平和羊水过少发生率高于其他两组(P＜0.05).(2)通过多因素Logistic回归分析,入院孕周、羊水过少、入院白细胞计数和血清CRP水平与期待时间有关,而孕妇年龄和产次与期待时间长短无关.(3)期待时间＜48h组剖宫产率及严重新生儿发病率高于其他两组(P＜0.05).3组孕妇胎儿宫内窘迫、临床绒毛膜羊膜炎发生率、新生儿死亡率比较差异无统计学意义(P＞0.05).结论:PPROM期待时间与入院孕周、羊水过少、入院时孕妇外周血白细胞计数和血清CRP水平有关.延长期待时间,可以改善围产儿结局,未增加临床绒毛膜羊膜炎.     

新生儿神经行为发育与脐血及胎粪铅含量的关系

背景以往大量研究都是以生产时一次性脐血铅的浓度来进行研究的,但生产时一次性脐血铅的浓度并不能很好的代表在整个妊娠期间铅对胎儿神经系统的累积损伤.胎粪中的铅主要来源于胎儿消化道分泌的消化液、新生儿肠道脱落的上皮细胞、胎儿吞咽下的羊水、皮脂,是从妊娠一开始直至新生儿出生后24h内排出,它反映的是整个妊娠过程中铅在新生儿胃肠道中的蓄积量.目的探讨在宫内低水平铅暴露状态下,比较新生儿脐血铅含量及胎粪铅含量与新生儿神经行为发育的相关性.设计以脐血铅和胎粪铅含量作为新生儿宫内铅暴露的指标,新生儿神经行为发育评分作为效应指标,采用描述性分析方法评价其相关关系.单位武汉科技大学,华中科技大学同济医学院职业病流行病学实验室,武汉第一冶金建筑总公司职工医院.对象选择武汉市新型工业区的青山区第一冶金建筑总公司职工医院妇产科1999-01/10出生的足月、健康新生儿103例作为观察对象.家属同意参加课题研究并填写问卷调查,提供新生儿胎粪,按时进行新生儿测试.方法①样本的采集及测定采取脐血5 mL,于-4℃冰箱中冷藏保存.收集出生24 h内的胎便,干重5～10 g,用石墨炉原子吸收光谱法测定脐血铅与胎粪铅的含量.②分组以脐血铅0.483 μmol/L为分界值,将新生儿分成高铅组与低铅组.以127.78 mg/kg作为胎粪铅的分界点,并将观察对象分为高铅组与低铅组.③新生儿神经行为发育检查采用新生儿神经行为发育检查法,于分娩第3天进行检查.同时采用自行设计的问卷对产妇进行调查.主要观察指标①新生儿脐血与胎粪中铅含量.②不同浓度脐血铅和胎粪铅的新生儿神经行为发育评分.结果103例新生儿均进入结果分析.①脐血高铅组与低铅组仅在新生儿神经行为发育总评分、生物视听定向反应得分上差异有显著性意义(P＜0.05),但脐血铅含量与新生儿神经行为发育总评分、非生物听定向反应、非生物视定向反应、生物视听定向反应之间不存在等级相关关系.②胎粪高铅组与低铅组在新生儿神经行为发育总评分、非生物听定向反应、非生物视定向反应、生物视听定向反应4项评分上,两组差异有显著性和非常或极显著性意义(P＜0.05～0.01).胎粪铅含量与新生儿神经行为发育总评分、非生物视定向反应、生物视听定向反应3项神经评分有明确的等级负相关关系.结论胎粪铅含量与新生儿神经行为发育评分更为密切,胎粪铅含量可作为妊娠期胎儿体内铅蓄积的指标.     

妊娠期糖尿病经产妇口服葡萄糖耐量试验时间-血糖曲线的曲线下面积与妊娠结局的相关性

目的 探讨妊娠期糖尿病(GDM)经产妇口服葡萄糖耐量试验(OGTT)时间-血糖曲线的曲线下面积(AUC)与妊娠结局的相关性.方法 选取551例单胎GDM经产妇,分为AUC≤15.59 mmol/(L·h)组、AUC＞ 15.59～ 16.79 mmol/(L·h)组、AUC＞16.79～17.67 mmol/(L·h)组和AUC ＞17.67 mmol/(L·h)组.分析AUC与GDM经产妇不良妊娠结局的相关性.结果 4组孕妇年龄、分娩孕周比较,差异有统计学意义(P＜0.05).4组孕妇早产、胎膜早破、羊水异常、剖宫产及产后出血的发生率比较,差异无统计学意义(P＞0.05).AUC≤15.59 mmol/(L·h)组新生儿平均出生体质量高于AUC ＞15.59 ～16.79 mmol/(L·h)组,差异有统计学意义(P＜0.05).AUC≤15.59 mmol/(L·h)组、AUC＞ 16.79 ～ 17.67 mmol/(L·h)组与AUC ＞17.67 mmol/(L·h)组的新生儿转儿科发生率差异有统计学意义(P＜0.05).Logistic二元回归分析显示,AUC与GDM孕妇新生儿转儿科发生率有显著相关性(P＜0.05).结论 GDM经产妇的OGTT时间-血糖曲线的AUC可以作为评价血糖水平的指标,在预测新生儿转儿科发生率方面有一定的价值.     

小剂量硝酸甘油对胎儿宫内发育迟缓孕妇及脐血一氧化氮水平的影响

目的　探讨小剂量硝酸甘油对胎儿宫内发育迟缓(IUGR)孕妇及脐血一氧化氮水平的影响。方法　 将我院2004年1月～2004年6月妊娠合并IUGR孕妇30例随机分为A、B两组。A组予10%葡萄糖500ml 复 方丹参液10ml静脉滴注,B组在A组用药的基础上加用5%葡萄糖250ml 硝酸甘油1mg静脉滴注,30例正常孕 妇为C组,未使用任何药物。采用硝酸盐还原酶还原,格瑞显色法,测定三组孕妇的肘静脉血和新生儿脐静脉血中 的一氧化氮代谢产物亚硝酸基/硝酸基水平。结果　三组孕妇静脉血和新生儿脐静脉血中NO-2/NO-3水平分别 为:A组(52.65±18.3)μmol/L、(23.41±4.43)μmol/L;B组(76.58±26.36)μmol/L、(39.58±2.65)μmol/L;C组 (55.39±21.01)μmol/L、(20.17±5.25)μmol/L。B组与A、C组比较差异有统计学意义(P<0.05〉,A、C两组差 异无统计学意义(P>0.05)。结论　小剂量硝酸甘油静脉滴注能提高孕妇和新生儿脐静脉血中的一氧化氮水平, 可用于治疗IUGR。     

硬膜外分娩镇痛对胎盘内分泌功能的影响

目的 研究硬膜外分娩镇痛对胎盘内分泌功能的影响。方法40例单胎初产妇随机分为未镇痛组和硬膜外分娩镇痛组。两组孕妇分别在宫口开3cm、宫口开全及胎儿娩出时抽取外周静脉血，胎儿娩出后抽取脐血和羊水，测量血和羊水中促皮质激素释放激素（CRH）、皮质醇、前列腺素E2的浓度，同时记录第一、二产程时间和分娩方式。结果 分娩镇痛组孕妇外周血宫口开全及胎儿娩出时皮质醇的水平显著低于未镇痛组（P〈0．05或0．01），但两组脐血和羊水中皮质醇的水平差异均无显著性（P〉0．05）；两组孕妇外周血各个时点以及脐血和羊水中CRH、前列腺索E2的水平差异均无显著性（P〉0．05）；两组第一、二产程时间及分娩方式等指标差异均无显著性（P〉0．05）。结论 分娩镇痛明显减轻孕妇的应激反应。但对胎盘的内分泌功能没有影响。     

新生儿总胆红素水平与血糖和血脂的相关性研究

目的 探讨新生儿总胆红素(TBIL)水平对糖、脂代谢的影响.方法 检测115例新生儿血糖、血脂及TBIL;按TBIL水平分为3组:＜34.3μmol/L组,34.3～205.0 μmol/L组,＞205.0μmol/L组.对各组间及组内男、女婴总胆固醇(TC)、甘油三酯(TG)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)、血糖进行比较.结果 TBIL＞205.0μmol/L组血糖为(1.83±0.89)mmol/L,TG为(0.49±0.15)mmol/L;TBIL＜34.3μmol/L组分别为(3.74±1.12)、(1.08±0.37)mmol/L;TBIL 34.3～205.0μmol/L组分别为(2.89±0.54)、(0.78±0.43)mmol/L,3组间两两比较差异均有统计学意义(F值分别为16.65、8.51,P均＜0.05);3组间apoA1、apoB差异均无统计学意义(F值分别为0.12、0.08,P均＞0.05);不同TBIL水平组内男、女婴血糖、TG、TC、apoA1、apoB差异均无统计学意义(P均＞0.05).结论 新生儿TBIL水平升高,血糖、血脂水平常降低.     

The effect of acute volume expansion and vasodilatation with verapamil on uterine and umbilical artery Doppler indices in severe preeclampsia

Preeclampsia is associated with increased peripheral, uterine, and umbilical artery resistance. Acute blood pressure reduction may result in shunting of blood and sudden fetal distress. We therefore investigated the effects of volume expansion and verapamil therapy on uteroplacental and umbilical resistance during treatment of preeclampsia. Materials and Methods: Five severe preeclamptics underwent volume expansion and subsequent vasodilatation with an infusion of verapamil. Invasive hemodynamic monitoring and Doppler ultrasonography were used to study changes in maternal, uterine, and umbilical hemodynamics. Results: Volume expansion and subsequent verapamil therapy was associated with significant changes in maternal hemodynamics without significant change in uteroplacental or umbilical resistance. Uterine artery waveform changes were noted, with disappearance of notching in some cases. Conclusions: Volume expansion and verapamil therapy effectively reduces maternal blood pressure in preeclampsia, without adversely affecting uteroplacental or umbilical artery resistance. Uterine artery waveform changes may be associated with improved fetal outcome. © 1994 John Wiley & Sons, Inc.     

脐血S-100B蛋白在新生儿缺氧缺血性脑病早期诊断中的价值

目的 通过观察S-100B蛋白在新生儿缺氧缺血性脑病(HIE)患儿脐血中的变化,探讨其在HIE早期诊断中的作用.方法 选择足月窒息新生儿307例为观察对象,其中符合HIE诊断标准的46例纳入HIE组.HIE组中轻度HIE 31例,中、重度15例.同期分娩的正常足月新生儿43例为正常对照组.分别留取脐血.采用双抗体夹心ELISA方法检测脐血血清S-100B蛋白浓度.结果 ①在正常组内男性与女性脐血血清S-100B无差异.②正常组脐血血清S-100B蛋白浓度为(1.03±0.32)μg/L,HIE组为(2.53±1.10)μg/L,2组比较差异有统计学意义(t=8.848,P＜0.05).③轻度HIE组与中、重度HIE组脐血S-100B蛋白浓度分别为(2.06±0.65)μg/L与(3.49±1.23)μg/L,与正常组比较差异有统计学意义(F=79.6909,P＜0.01).结论 性别对新生儿脐血S-100B无影响.脐血S-100B可作为HIE的早期生化指标,且可以判断脑损伤程度.     

胰岛素样生长因子-Ⅰ、Ⅱ水平与子癎前期相关性研究

目的：探讨胰岛素样生长因子Ⅰ、Ⅱ水平在子癎前期发病机制及诊断中的作用。方法：选择38例子癎前期孕妇为子癎前期组（其中轻度18例,重度20例）,30例正常妊娠晚期孕妇为对照组,应用ELISA检测对照组和轻、重度子癎前期组孕妇静脉血、新生儿脐血及羊水中胰岛素样生长因子-Ⅰ、Ⅱ的含量,分析与子癎前期发病相关性。结果：（1）孕妇血、新生儿脐血及羊水中胰岛素样生长因子 含量在重度子癎前期组明显低于轻度子癎前期组（P〈0．01）,轻度子癎前期组明显低于对照组（P〈0．01）。（2）孕妇血及羊水中胰岛素样生长因子Ⅱ含量在重度子癎前期组明显低于轻度子癎前期组（P〈0．01）,轻度子癎前期组明显低于对照组（P〈0．01）;新生儿脐血中胰岛素样生长因子-Ⅱ含量在重度子痢前期组明显高于轻度子癎前期组（P〈0．01）,轻度子癎前期组明显高于对照组（P〈0．01）。（3）子痢前期孕妇血及羊水中胰岛素样生长因子-Ⅰ、Ⅱ的水平与病情轻重呈正相关,新生儿脐血,胰岛素样生长因子-Ⅰ水平与病情轻重呈正相关,胰岛素样生长因子-Ⅱ水平与病情轻重呈负相关。结论：孕妇血、新生儿脐血及羊水中胰岛素样生长因子-Ⅰ、Ⅱ水平变化可作为预测和诊断子癎前期发病和疾病程度的一个指标。     

混合移植治疗儿童血液病疗效观察

本研究探讨HLA不全相合骨髓造血干细胞及外周造血干细胞、加入第三方脐血造血干细胞混合移植治疗小儿血液病的疗效。对2012年8月至12月我院5例难治性血液病患儿进行异基因造血干细胞移植,移植方式为HLA不全相合骨髓造血干细胞、外周血造血干细胞及脐血造血干细胞混合移植,观察混合移植中的第三方脐血干细胞对于移植后造血重建时间、STR嵌合度、GVHD发生情况及移植相关近期并发症的作用。结果表明,5例患儿移植后均获得造血重建,ANC〉0．5×10^9／L的中位时间是移植后11d,Pit〉20×10^9／L的中位时间移植后10d;外周血STR-PCR嵌合度检测显示,于移植后30d均达到稳定嵌合;5例患儿出现轻至中度GVHD症状,表现为Ⅰ-Ⅱ皮肤GVHD,其中2例患儿发生腹泻,出现Ⅰ-Ⅱ肠道GVHD,5例患儿均无肝功能损害。随访至2013年4月30日,中位随访时间137d（130d-250d）,1例移植后131d死于严重出血性膀胱炎及多部位感染,其余4例均无病生存至今,存活时间分别为130、137、193、250d,中位生存时间134d。结论：HLA不全相合骨髓造血干细胞、外周血造血干细胞、第三方脐血造血干细胞混合移植对提高小儿血液病的存活率、延长存活时间有一定疗效。     

Doppler sonography for predicting fetal anemia caused by massive fetomaternal hemorrhage

Fetomaternal hemorrhage (FMH) can cause severe anemia in the fetus. Untreated, this may cause hydrops or even fetal death. However, correct diagnosis of FMH followed by blood transfusion can prevent these life-threatening consequences. We describe two cases in which fetal anemia was suspected because of maternal reporting of decreased or absent fetal movements, the detection of a sinusoidal heart rate pattern and increased blood flow velocities of the middle cerebral artery and umbilical vein. Together with the Betke-Kleihauer test showing fetal cells in the maternal circulation, this led to the correct diagnosis of severe fetal anemia caused by FMH. A Cesarean section was performed within a few hours. Both neonates were severely anemic and received immediate blood transfusions. They are currently alive and well.     

单倍体相合造血干细胞联合脐带血间充质干细胞移植治疗急性重型再生障碍性贫血的疗效观察

本研究探讨单倍体相合造血干细胞移植联合脐带血间充质干细胞治疗重型再生障碍性贫血(SAA)的方法和疗效。对5例SAA的患者进行了单倍体相合造血干细胞移植。移植物选择单倍体相合供者骨髓或外周造血干细胞加脐带血间充质干细胞。观察移植后临床造血重建时间及近期并发症。结果显示,所有SAA患者移植后均获得造血重建,白细胞计数大于2×109/L的平均时间是13.8天,血小板计数大于20×109/L的平均时间是17.8天,第30天行患者外周血STR-PCR检测显示为完全供者的基因型。除1例发生癫痫失去联系外,其余4例均无病存活至今,仍在继续随访中。总之,单倍体相合造血干细胞联合脐带血间充质干细胞移植是治疗急性SAA有效可行的方法,但还须大样本的研究。     

Clinical correlation between adenosine deaminase activity and pre-eclampsia severity

This study evaluated the relationship between the activity of the inflammatory indicator adenosine deaminase (ADA) in placental tissue and maternal and fetal (umbilical cord) plasma and the severity of pre-eclampsia. Maternal and umbilical vein whole blood and placental tissue samples were collected from women with normal pregnancies (n = 33) and patients with mild (n = 12) or severe (n = 17) preeclampsia. ADA activity was measured spectrophotometrically. Significantly increased ADA activity was detected in maternal and fetal plasma, and placental tissue in patients with mild and severe pre-eclampsia compared with normal pregnancies; there were no significant differences between the mild and severe cases. The presence of increased ADA activity in pre-eclampsia is consistent with activation of the inflammatory system in this condition. The increased ADA activity was related to the presence of the disease but not the severity of clinical symptoms. Neonatal outcome did not significantly correlate with observed ADA activity.     

The pathophysiology of acute syphilitic funisitis.

There is an increase in the number of cases of syphilis in pregnancy in the United States. Fetal death may occur in syphilis from acute or chronic infections. A case is presented in which an acute fetal infection occurred. The patient presented at 31 weeks' gestation, with a decrease in fetal movements and non-reactive cardiotocography. Ultrasound and Doppler analysis of the fetal heart, cerebral and umbilical arteries, aorta and umbilical vein led to the suspicion of acute cardiac failure. An amniocentesis yielded a white cell count of 1122 white blood cells, with 91% polymorphs, but the Gram stain was negative. The fetus developed a persistent bradycardia and was delivered. The diagnosis of acute severe syphilitic funisitis was suspected from histological sections of the cord. Diagnosis was established from maternal and fetal blood. Modern ultrasound techniques, including imaging, Doppler and cardiotocography, can lead to the analysis of the pathophysiology of disease states. An acute syphilitic infection should be suspected when this constellation of findings is found.     

N-terminal pro-C-type natriuretic peptide, but not C-type natriuretic peptide, is greatly elevated in the fetal circulation

We have identified recently a new peptide, NT-proCNP(1-50) (N-terminal pro-C-type natriuretic peptide), in the circulation of humans and sheep. A previous report of an elevated fetal-maternal gradient in immunoreactive CNP raised the possibility that processing and metabolism of proCNP may differ in maternal and fetal tissues. We therefore collected matching peripheral maternal and umbilical cord plasma samples at delivery from women with normotensive and pre-eclamptic pregnancies to investigate the presence and concentrations of CNP and NT-proCNP using HPLC and RIA. Plasma concentrations of NT-proCNP in normotensive umbilical cord plasma were 10-fold higher than maternal venous levels (246+/-17 compared with 24.3+/-1.8 pmol/l; P <0.001) and much higher than corresponding levels of CNP (3.6+/-0.4 compared with 1.8+/-0.3 pmol/l in the fetal and maternal plasma respectively; P <0.001). Although there was no significant difference between normotensive and pre-eclamptic plasma CNP concentrations in either maternal or umbilical cord blood, NT-proCNP showed a significant statistical interaction ( F =5.8, P =0.025) between the source (maternal or fetal) and gestational group (normotensive or pre-eclamptic). Maternal NT-proCNP levels were raised in the pre-eclampsia group, whereas the converse was observed in umbilical cord blood. In conclusion, the greatly elevated ratio of NT-proCNP/CNP in fetal compared with maternal plasma suggests that synthesis, as well as clearance, of CNP (but not NT-proCNP clearance) are markedly increased in fetal tissues.     

Angiogenic growth factors in maternal and fetal serum in pregnancies complicated by intrauterine growth restriction

The present study was performed to compare serum concentrations of maternal and fetal angiogenic growth factors in IUGR (intrauterine growth restriction) and normal pregnancy at the time of delivery. VEGF (vascular endothelial growth factor), PlGF (placental growth factor), sFlt-1 (soluble fms-like tyrosine kinase 1), sKDR (soluble kinase domain receptor) and bFGF (basic fibroblast growth factor) were measured by ELISA in serum from a maternal peripheral vein, the umbilical vein and the umbilical arteries in 15 women with pregnancies complicated by IUGR and 16 controls (women with normal pregnancies). In IUGR, sFlt-1 was increased, and PlGF and sKDR were decreased, in both maternal serum and serum from the umbilical vein. Additionally, bFGF was increased in serum from the umbilical vein of women with pregnancies complicated by IUGR. No significant differences in growth factor concentrations between the groups were found in serum from the umbilical artery. In both groups, levels of VEGF were higher and levels of sFlt-1 were lower in serum from the umbilical vein and umbilical artery compared with maternal serum. PlGF levels were found to be lower in serum from the umbilical vein compared with maternal serum in both groups, whereas PlGF levels in serum from the umbilical artery were significantly lower only in the control group. These findings suggest an imbalance of angiogenic and anti-angiogenic factors in IUGR, with formation of an anti-angiogenic state in maternal and, to a lesser extent, umbilical vein blood. The placenta appears to play a central role in the release of sFlt-1 into maternal and umbilical blood. Umbilical artery blood was unaffected in IUGR, indicating that the fetus does not contribute to changes in angiogenic growth factor concentrations.