Prostaglandin F2 alpha metabolite levels in plasma, amniotic fluid, and urine during pregnancy and labor.

Levels of 13, 14-dihydro 15-keto-prostaglandin F2alpha (dhk PGF2alpha) in the plasma of 30 patients as well as in the amniotic fluid of 17 patients, and 5alpha,7alpha-dihydroxy 11-keto tetranor-prostane 1,16-dioic acid (the main urinary metabolite of PGF2alpha [PGF2alpha MUM]) levels in the urine of 30 patients were measured by radioimmunoassay during pregnancy, labor, and the puerperium. During pregnancy, no increase in dhk PGF2alpha (ng/ml) in plasma was detected as the time of delivery approached. The levels of dhk PGF2alpha during the second stage (0.64 +/- 0.15) and also at delivery (0.88 +/- 0.27) were significantly elevated over those in the first stage (0.38 +/- 0.29) (P less than 0.025 and P less than 0.005, respectively). Its level 2 hours after delivery was reduced to predelivery levels. Its levels in umbilical arterial and venous blood were 0.71 +/- 0.26 and 0.67 +/- 0.26, respectively. A significant elevation (P less than 0.01) of dhk PGF2alpha from 0.89 +/- 0.21 before labor to 6.16 +/- 2.40 at delivery was found in amniotic fluid. The hourly excretion of PGF2alpha MUM (microgram/hour) increased significantly from pregnancy levels to 1.06 +/- 0.45 in the first stage (P less than 0.01), to 7.67 +/- 4.31 (P less than 0.005) for the first 2 hours after delivery, and 2.37 +/- 1.08 from 2 to 12 hours after delivery (P less than 0.01). The excretion of PGF2alpha MUM decreased to pregnancy levels 12 hours post partum. These data indicate that during labor the production of PGF2alpha is remarkably increased.     

正常妊娠及妊高征患者静脉血及新生儿脐血一氧化氮含量的测…

探讨一氧化氮含量与妊娠及妊高征的关系。方法,采用硝酸根还原酶与Ｇｒｉｅｓｓ反应相结合的方法,对４０例妊高征患者、４０例正常晚期妊娠妇女、２０例非孕妇女静脉血及妊高征组和晚孕组各２８例新生儿脐血中的ＮＯ代谢产物亚硝酸基／硝酸基进行测定。     

Blood gases and acid-base status of the human second-trimester fetus

Maternal arterial, umbilical venous, and umbilical arterial blood were obtained at fetoscopy in the second trimester and analyzed for blood gases and acid-base indexes. In comparing umbilical venous (N = 31) with maternal arterial (N = 39) samples, the mean (+/- SD) PO2 was lower (55 +/- 7 versus 100 +/- 15 mmHg, P less than .001) and PCO2 (37 +/- 4 versus 34 +/- 4 mmHg), bicarbonate (20 +/- 2.0 versus 18.5 +/- 1.5 mmol/L), lactate (1.10 +/- 0.25 versus 0.80 +/- 0.30 mmol/L), and base excess (-4.2 +/- 2.3 versus -6.0 +/- 1.5 mmol/L) were higher (P less than .001). The mean umbilical venous pH did not differ significantly from the maternal arterial (7.358 +/- 0.040 versus 7.373 +/- 0.035). Comparing umbilical arterial (N = 21) with umbilical venous (N = 31) samples, the PO2 level was lower (34 +/- 4 versus 55 +/- 7 mmHg, P less than .001) and PCO2 higher (42 +/- 4 verus 37 +/- 4 mmHg, (P less than .001); the pH was marginally lower (7.339 +/- 0.03 versus 7.358 +/- 0.040; P less than .05) and bicarbonate higher (22 +/- 1.5 versus 20 +/- 2.0 mmol/L, P less than .001). Umbilical arterial and umbilical venous values were similar in the case of lactate and base excess.     

正常妊娠和妊高征孕妇血浆降钙素基因相关肽的研究

目的探讨降钙素基因相关肽（ＣＧＲＰ）在正常妊娠时的变化及与妊高征发病的关系。方法采用放射免疫法对正常妊娠妇女５９例（正常妊娠组）、妊高征孕妇５７例（妊高征组）和正常非孕妇女１０例（对照组）的血浆ＣＧＲＰ水平进行测定。结果正常妊娠组血浆ＣＧＲＰ水平随孕周的进展而增加,孕晚期达高峰（７６８４±２７７５ｎｇ／Ｌ）;妊高征组其血浆ＣＧＲＰ水平随病情的加重而降低;中度妊高征患者ＣＧＲＰ水平（４９７６±２３１１ｎｇ／Ｌ）和重度妊高征患者ＣＧＲＰ水平（４６３５±２２３２ｎｇ／Ｌ）明显低于轻度妊高征患者（７１２８±２１９８ｎｇ／Ｌ）和正常晚孕妇女（７６８４±２７７５）（Ｐ＜０．０５）。血浆ＣＧＲＰ水平与平均动脉压、新生儿体重均无明显相关关系（Ｐ＞０．０５）。结论ＣＧＲＰ的变化在妊高征的发病过程中可能起重要作用     

Rheological analysis of suppressed leukocytosis in patients with pregnancy induced hypertension (PIH)

It is documented that the number of leukocytes in peripheral blood increases considerably during pregnancy. We observed that the range of leukocytosis differs in normal pregnancy differs from that in cases with severe pregnancy induced hypertension (PIH). The data obtained in our university hospital, for example, give the number of leukocytes after twenty-four weeks of gestation as 9,000 +/- 1,600/mm3 (mean +/- SD) for normal cases (93 measurements in 37 cases) and 6,600 +/- 1,100/mm3 for PIH (72 measurements in 18 cases; p less than 0.001). To elucidate the cause and relation to PIH, we studied changes in the activity of leukocytes during pregnancy by means of a modified Nuclepore filtration method (Kikuchi et al., 1983). The time required for leukocytes to squeeze through filter pores under constant suction varies greatly depending on their active states; more active cells show greater resistance to pore passage, which can be clearly shown by exposing cells to various stimuli. The filtration time for 0.5ml blood containing 5,000/mm3 leukocytes minus that of leukocyte poor blood with the same hematocrit was taken as an index of the activity, which we called the rheological activity of leukocytes (RAL). RAL values for blood taken at delivery were 3.4 +/- 1.5 sec for normal cases and 5.0 +/- 2.1 sec for PIH (N.S.). RAL values obtained after the addition of a chemotactic stimulant FMLP (formyl-methionyl-leucyl-phenylalanine) (10nM) to the same samples were 21 +/- 10 sec for normal cases and 405 +/- 265 sec for PIH (p less than 0.001). Leukocyte activity, particularly, response to chemotactic stimulation, was the before thought to be considerably increased in PIH.(ABSTRACT TRUNCATED AT 250 WORDS)     

妊高征患者血浆肾上腺髓质素含量的初步探讨

目的探讨肾上腺髓质素（ＡＤＭ）与妊高征之间的关系。方法应用特异性放射免疫法测定１２例正常妊娠妇女（正常妊娠组）及２６例妊高征患者（妊高征组）的血浆ＡＤＭ水平。结果（１）妊高征组血浆ＡＤＭ水平为（２４．６７±１．２７）ｎｇ／Ｌ,高于正常妊娠组（１９．１６±１．１７）ｎｇ／Ｌ,两组间比较,差异有显著性（Ｐ＜０．０５）;（２）妊高征组血浆ＡＤＭ水平：重度妊高征为（３０．００±１．１７）ｎｇ／Ｌ＞中度妊高征为（２４．８０±０．７０）ｎｇ／Ｌ＞轻度妊高征（１９．３８±２．６５）ｎｇ／Ｌ,３者间比较,差异有显著性（Ｐ＜０．００１）;（３）妊高征ＡＤＭ水平升高与平均动脉压呈明显正相关（ｒ＝０．７７５,Ｐ＜０．００１）。结论ＡＤＭ与妊高征关系密切,可能在妊高征发病和防治中具有重要的生理及病理学意义。     

脐静脉体外舒缩反应及局部一氧化氮合酶变化在妊高征发病中 …

目的 探讨脐静血管舒缩反应及其病理生理学意义与局部一氧化氮合酶变化在妊高征发病中的作用。方法 测定、１４例妊高患者和１４妊娠分娩的 生儿脐静脉在离体血管功能实验中,对苯肾上腺素、异丙肾上腺素和乙酰胆碱的收缩和舒张反应曲线,计算反应的最大值和亲和力指数值;同时测定脐血管组织ＮＯＳ活性和历乐中一氧化氮代谢产物亚硝基／硝酸基（ＮＯ２／ＮＯ３）浓度。结果（１）对照组脐静脉乙酰胆碱舒张反应曲一的Ｅｍａｘ为（     

Concentrations of ritodrine hydrochloride in maternal and fetal serum and amniotic fluid following intravenous administration in late pregnancy

Seven healthy pregnant volunteers undergoing elective cesarean section at 39-40 weeks of gestation were studied for transplacental passage of ritodrine hydrochloride, which was administered by intravenous infusion at the rate of 72-149 micrograms/min for 161-335 min. The concentrations of ritodrine in the collected maternal and fetal blood and the amniotic fluid were radioimmunoassayed. The levels of ritodrine in maternal serum were between 22.5 and 51.0 ng/ml one hour after the initiation of infusion, 33.7-66.4 ng/ml after 2 h, 18.2-73.6 ng/ml after 4 h and 45.7-189.6 ng/ml at delivery, respectively. The umbilical blood and amniotic fluid concentrations of ritodrine at delivery were between 15.6 and 35.1 ng/ml in arterial blood, 12.5-29.6 ng/ml in venous blood and 10.0-49.1 ng/ml in amniotic fluid. The ratio of umbilical venous blood concentrations to maternal venous concentrations (CV/MV) ranged from 0.066 to 0.544 with the mean of 0.263 +/- 0.063 (M +/- S.E.). The results obtained substantiate the rapid and appreciable transfer of ritodrine to the fetus and amniotic fluid.     

Leptin as an acute stress-related hormone in the fetoplacental circulation

OBJECTIVE: To investigate the relationship between fetoplacental leptin secretion and blood gases. METHODS: We measured the levels of umbilical arterial and venous leptin, umbilical cord gas, umbilical venous blood glucose, and estradiol-17beta (E2) in 89 pregnant women. Correlation between the leptin levels and other variables (gestational age, birth weight, maternal body weight, height, body mass index, maternal body weight gain, placental weight, umbilical cord gas data, and levels of umbilical venous blood glucose and E2) were examined statistically. RESULTS: Umbilical arterial and venous leptin levels were 7.64 +/- 12.76 and 7.76 +/- 13.17 (ng/mL), respectively, correlating positively with carbon dioxide pressure levels (r = 0.446, P <.001; r = 0.406, P <.001, respectively) and correlating inversely with pH (r = -0.337, P =.001; r = -0.247, P =.019, respectively). Umbilical venous glucose, E2, and other factors did not correlate with leptin levels. CONCLUSION: Leptin secretion into the fetoplacental circulation may be associated with fetal hypercapnia, suggesting two important roles for leptin: one for basal control of fetal fat tissue and one as an acute stress-related hormone.     

Umbilical cord pH, PCO2, and bicarbonate following uncomplicated term vaginal deliveries

Normal values for umbilical arterial and venous pH, PCO2, PO2, and bicarbonate must be known before these parameters can be used for assistance in clinical decisions. We evaluated the cord blood from 146 infants born after uncomplicated labor and vaginal deliveries at 37 to 42 weeks' gestation. All infants had a normal baseline fetal heart rate and normal beat-to-beat variability for at least 10 minutes preceding expulsion. The cord blood of infants born to women with pregnancy complications such as diabetes mellitus, preeclampsia, twins, meconium-stained amniotic fluid, or fetal growth retardation was not included. Mean umbilical arterial values +/- 1 SD for the parameters studied were: pH, 7.28 +/- 0.05; PCO2, 49.2 +/- 8.4 mm Hg; PO2, 18.0 +/- 6.2 mm Hg; bicarbonate, 22.3 +/- 2.5 mEq/L. Umbilical venous values were: pH, 7.35 +/- 0.05; PCO2, 38.2 +/- 5.6 mm Hg; PO2, 29.2 +/- 5.9 mm Hg; bicarbonate, 20.4 +/- 4.1 mEq/L.     

妊娠高血压综合征患者胎盘和脐带血管内皮细胞损伤与肿瘤坏死因子的关系

目的　探讨妊娠高血压综合征 (妊高征 )患者胎盘和脐带血管内皮细胞损伤及功能变化与肿瘤坏死因子 (TNF)的关系。方法　采用放射免疫分析法 ,测定 41例妊高征患者 (妊高征组 )和 35例正常妊娠妇女 (对照组 )血浆TNF、内皮素和一氧化氮的水平 ;采用透射电镜观察两组胎盘和脐带血管内皮细胞的超微结构 ,并与在体外人重组TNF(rTNF)作用下培养的脐带血管内皮细胞形态相比较。结果　 (1)妊高征组血浆TNF和内皮素分别为 (2 .2 7± 0 .42 ) μg/L和 (73.31± 9.98)ng/L ,一氧化氮为(10 4.93± 2 0 .5 4) μmol/L ;对照组血浆TNF和内皮素分别为 (1.72± 0 .2 5 ) μg/L和 (5 2 .32± 10 .44 )ng/L ,一氧化氮水平为 (138.2 5± 2 2 .16 ) μmol/L。妊高征组TNF及内皮素增高 ,一氧化氮减少。两组比较 ,差异有显著性 (P <0 .0 5 )。(2 )电镜显示 ,妊高征组中除轻度患者的胎盘及脐带血管未见异常改变外 ,中、重度患者的胎盘和脐带血管内皮细胞均有损伤性表现。与rTNF作用下于体外培养的脐带血管内皮细胞形态学的改变相似。结论　TNF可引起胎盘和脐带血管内皮细胞损伤 ,可导致血管调节因子失衡 ,在妊高征的发病中有一定作用。     

妊高征患者血中内皮素与β-绒毛膜促性腺激素水平及其相互关系

目的 检测妊高征患者血清内皮素（ＥＴ）与β－绒毛膜促性腺激素（β－ｈＣＧ）水平及其相关关系,以探讨ＥＴ与β－ｈＣＧ在妊高征发病中的作用,方法 用放射免疫法对３２例妊高征患者（妊高征组）,１７例正常晚期单胎妊娠妇女（正常晚期妊娠组）以及１４例育龄期正常未妇女（正常未孕组）血中ＥＴ和β－ｈＣＧ水平进行检测。结果 妊高征组血ＥＴ和β－ｈＣＧ水平（３０．３５±１４．５２ｎｇ／Ｌ和７．３５±４．８６ｍｍｏｌ     

Uteroplacental unit as a source of elevated circulating prorenin levels in normal pregnancy

Circulating levels of inactive renin, that is, prorenin, are increased in normal pregnant women. To determine whether the uteroplacental unit secretes prorenin into the maternal circulation, we measured enzymatically active and inactive renin in plasma simultaneously obtained from the radial artery and uterine vein of 12 normotensive, nonlaboring patients undergoing elective cesarean section at term. We also measured these forms of renin in the umbilical arterial and venous blood of these patients. Our data reveal that the levels of inactive renin in both arterial and uterine venous blood of normal pregnant women are significantly higher than in peripheral venous blood of nonpregnant, normotensive control subjects; normotensive term patients have a ratio of plasma inactive to active renin of 9:1 in contrast to the 1:1 ratio in normotensive nonpregnant subjects; there is a significant uterine arteriovenous difference of prorenin (66.2 +/- 24.4 ng/ml/hr, p less than 0.05) but not of active renin (1.8 +/- 1.5 ng/ml/hr, not significant). These results suggest that the uteroplacental unit contributes to the elevated prorenin levels at term pregnancy.     

A study on dynamics of human atrial natriuretic polypeptide based on loading tests with angiotensin-II and NaCl in pregnancy induced hypertension

In order to investigate the regulating mechanism of Atrial Natriuretic Polypeptide (ANP) in women with Pregnancy Induced Hypertension (PIH), we measured plasma ANP levels with or without loading tests such as Angiotensin-II loading test or NaCl loading test. Plasma ANP in normal pregnancy gradually increased with advancing gestation, and decreased immediately after parturition. In PIH cases the ANP concentration was significantly higher (mild PIH 156.7 +/- 9.9 pg/ml, severe PIH 165.8 +/- 12.2 pg/ml) than in normal pregnancy cases (138.2 +/- 3.2 pg/ml). In Angiotensin-II loading, a significant positive correlation (r = 0.68, p less than 0.01) between the variance of mean arterial blood pressure (delta MAP) and that of ANP (delta ANP) was observed in normal pregnant women of third trimester, whereas in mild PIH cases a significant negative correlation (r = -0.59, p less than 0.01) was noted between them, and in severe PIH cases there existed no significant correlation. In normal pregnancy and in mild PIH, plasma ANP showed a 15.2% increase at fifteen minutes after 5% NaCl loading. In severe PIH there were no significant change in plasma ANP during and at fifteen minutes after NaCl loading test. From these results, it is suggested that the onset, the duration or the aggravation of hypertension in pregnancy may be partly due to the abnormality of ANP secretion.     

Term human fetal umbilical vein oxygen content, placental weight, and maternal blood pressure

The relationship of umbilical venous oxygen content to placental weight and mean maternal arterial blood pressure was investigated in 38 normal nonlaboring subjects undergoing elective cesarean section at 38.4 +/- 0.2 weeks (mean +/- SEM). In 14 subjects breathing room air, umbilical vein oxygen content was found to be a function of the lowest mean maternal arterial blood pressure (r = 0.48, P = 0.04), but not to placental weight. In 24 subjects breathing supplemental oxygen, umbilical vein oxygen content was not related to placental weight or lowest mean maternal arterial blood pressure. Fetuses attached to placentas less than 396 g had a higher hemoglobin concentration than fetuses attached to placentas greater than 396 g. This suggests the possibility of chronic in utero hypoxemia in human fetuses attached to small placentas.     

Increased maternal plasma levels of soluble vascular cell adhesion molecule-1 (VCAM-1) in pregnancy induced hypertension (PIH)

One of the reason of PIH problems may be due to the presence of increased circulating levels of cell adhesion molecules, markers of endothelial damage and leukocyte activation. The objective was to evaluate the plasma levels of soluble vascular cell adhesion molecule in maternal peripheral blood of patients with PIH (pregnancy induced hypertension) and compared to those of normal healthy women with uncomplicated pregnancy. Maternal plasma samples were prepared from peripheral venous blood collected from 10 patients with PIH and 10 matched normotensive patients with uncomplicated pregnancies. Samples were assayed for soluble VCAM-1 by specific enzyme-linked immunosorbent assay (ELISA). Women with PIH had significantly higher plasma level of soluble VCAM-1 as compared with healthy pregnant women without PIH (653.50 vs. 456.39 ng/mL, respectively, p < 0.005). Our results on the increased plasma levels of soluble VCAM-1 in patients with PIH provide evidence for endothelial activation of PIH. It suggest that increased plasma level of soluble VCAM-1 could be an early marker of the maternal syndrome of PIH.     

妊娠高血压综合征患者血浆C-型利钠肽水平变化的相关性研究

目的　探讨妊娠高血压综合征 (妊高征 )患者血浆C 型利钠肽水平的变化 ,及其与妊高征发病的关系。方法　采用放射免疫分析法测定了 89例妊高征患者 (妊高征组 )、193例正常妊娠妇女 (正常妊娠组 )和 46例正常孕龄妇女 (正常妇女组 )血浆C 型利钠肽水平。结果　妊高征组血浆C 型利钠肽水平明显升高 ,为 (30 .5 1± 33.6 1)ng/L ;正常妊娠组为 (19.43± 5 .13)ng/L ,正常妇女组为(17.15± 3.82 )ng/L。妊高征患者血浆C 型利钠肽水平明显高于正常妊娠妇女。妊高征组轻、中、重患者之间 ,血浆C 型利钠肽水平亦有极显著差别 ,分别为 (9.88± 2 .74)ng/L、(2 2 .15± 8.90 )ng/L和(6 4.2 6± 44 .0 3)ng/L ,3者比较 ,差异有极显著性 (P <0 .0 1)。结论　血浆C 型利钠肽水平由低到高的变化反映妊高征的疾病严重程度 ,可作为判断妊高征病情发展的一个生化指标。     

Prevention of vitamin K deficiency in the early neonatal period--prophylactic oral administration of VK to the mother

We studied the effect of vitamin K(MK-4) on the prevention of vitamin K deficiency in the early neonatal period. MK-4 (20 mg/day) was given orally for 1-7 days to 183 pregnant women at 37-39 weeks gestation. In the MK-4 treated group, there were no cases of melena neonatorum but there were 9 cases in the untreated group (9/757, 1.2%). To investigate the influence of MK-4 administration on liver function and the VK dependent coagulation system, maternal and umbilical venous blood were taken to measure T-Bil, GOT, GPT, gamma-GTP, LDH, and II, VII, X activity and HPT. There was no significant difference between these values in MK-treated and untreated groups. MK-4 concentrations were measured in the maternal and umbilical venous blood of 68 subjects. The level of MK-4 in umbilical venous blood was less than 0.1 ng/ml in 17 of 21 subjects not treated with MK-4 but it was over 0.1 ng/ml in 30 of 47 MK-4 treated subjects. However, no MK-4 was detected in 6 of 8 subjects who were treated for 1 day. The level of MK-4 in maternal blood was less than 0.1 ng/ml in 12 of 21 untreated subjects but it was 0.19-92.6 ng/ml in all of the 47 MK-4 treated subjects. The mean MK-4 concentration in cord blood as a percentage of that in maternal blood was 17.9%. These findings indicate that MK-4 is effectively transported from maternal to fetal blood through the placenta and its administration to pregnant women is useful in preventing melena neonatorum.     

Catecholamines in arterial and venous umbilical blood: placental extraction, correlation with fetal hypoxia, and transcutaneous partial oxygen tension

In 34 parturient women the levels of free epinephrine (E), norepinephrine (NE), and dopamine (D) were determined by a radioenzymatic method using maternal venous and umbilical arterial and venous blood. The study was conducted to investigate the relationship between fetal catecholamines and hypoxia, fetal heart rate (FHR), and transcutaneous pO2 (tcpO2). The placental catecholamine extraction rates were also calculated. Results The NE concentrations (10,200 pg/ml) and the E concentrations (1,120 pg/ml) in the fetal arterial blood were highly elevated with mean values increased 4-fold over umbilical vein values. Compared with the maternal venous blood, NE values were increased 20-fold, and E values 10-fold. Free D concentrations in fetal arterial blood (130 pg/ml) had risen 2.5-fold over maternal levels. These results suggest that the catecholamines measured in cord blood are of fetal origin and that the placenta has a high capacity for inactivation of free catecholamines. The placental extraction rate is 77 +/- 14% for NE, 76 +/- 16% for E, and 33 +/- 25% for D. The placental extraction rates for E and NE were virtually identical; in agreement with morphological studies they demonstrated absence of sympathetic innervation on the fetal side of the placenta. Highly significant correlations were found between fetal arterial NE concentrations and the 1-minute APGAR score, pH and base deficit in the umbilical artery and alterations of the FHR (deceleration area, baseline FHR). Further analysis of FHR alterations reveals that an increase in deceleration area without tachycardia is not correlated with an increase of fetal arterial NE concentration. A significant rise in NE was only found with additional tachycardia which is often associated with a loss of oscillation amplitude. Fetal arterial E concentrations were found to correlate with the fetal parameters indicating increased adrenal secretion of the hormone during fetal stress. However, correlation coefficients were lower than those obtained for NE. A significant effect of fetal hypoxia on arterial and venous D levels could not be demonstrated. Fetal tcpO2 varies between 0-25 mm Hg during the last two hours before delivery. In most cases tcpO2 was lower than the arterial pO2. Besides epidermal thickness and artifacts, skin perfusion is a major factor influencing the tcpO2 (transcutaneous arterial pO2 difference). Vasoconstriction of the cutaneous vessels induced by increased NE secretion during hypoxia may obviously produce a fall in tcpO2.(ABSTRACT TRUNCATED AT 400 WORDS)