Studies on the cortisol levels in maternal vein, umbilical artery, and umbilical vein classified according to the mode of delivery

We measured maternal venous(MV), umbilical arterial(UA), and umbilical venous(UV) cortisol levels of 180 pregnancies at term. In vacuum extraction cases, the cortisol levels of three individual samples were significantly higher than in other modes of delivery. In cesarean section delivery the cortisol levels of three individual samples were the lowest of all modes of delivery. The cortisol level of MV was higher than that of UA and UV in all deliveries. The cortisol levels of three samples showed no difference between the induced labor group and the spontaneous onset of labor group regardless of the delivery mode. In spontaneous vaginal delivery the cortisol levels of three individual samples were significantly higher in primipara than in multipara. Positive correlation was observed in all modes of delivery between the cortisol levels of MV & UA, MV & UV, and UA & UV. There was a negative correlation between the cortisol levels of MV and umbilical arteriovenous cortisol difference in multipara spontaneous vaginal deliveries. There was also a negative correlation between cortisol levels of MV and the umbilical arterial/venous ratio. These data suggest that the fetus may produce cortisol by itself and maternal cortisol may inflow to the fetus.     

Change of serum HPL level in maternal vein, umbilical cord vein and artery in mature and premature labour

The authors examined the possible role of HPL in the onset of labour. The HPL level of the maternal vein, the umbilical cord vein and artery was compared in vaginal mature (n = 16) and premature (n = 52) deliveries. The HPL concentration was also examined in mature (n = 18) and premature (n = 18) deliveries performed by caesarean section prior to the onset of labour. The results showed that: the serum HPL level in the maternal vein, the umbilical cord vein and artery was lower during the 33rd-36th and the 40th weeks in cases of vaginal delivery compared to elective caesarean section; The artery/vein ratio decreases during labour (A/V X 100 value), indicating that HPL metabolism in the fetus decreases during regular labour pains; The onset of premature labour and delivery was associated with lower HPL levels compared to normal pregnancy. The authors assume that the lower HPL level found in cases of vaginal delivery may be due to reduced placental perfusion, but they do not exclude the possible association of lower HPL concentrations in cases of premature delivery.     

Determinants of fetal and maternal atrial natriuretic peptide concentrations at delivery in man

Summary. Matched maternal venous (MV), umbilical artery (UA) and umbilical vein (UV) concentrations of atrial natriuretic peptide [ANP] were measured in 36 normotensive women at term delivery (23 vaginal, 13 caesarean) and 17 non-pregnant women in the first half of the menstrual cycle. MV [ANP] at caesarean section was similar to that in nonpregnant women, but UA and UV [ANP] were higher ( P <0.01 for both). UA, but not UV, [ANP] was markedly raised after vaginal delivery. Plasma concentrations of aldosteronce[ALD] were measured in 16 of the matched sets of samples. No statistically significant association was found between [ANP] and [ALD] in either maternal or fetal samples. Neither maternal nor fetal [ANP] correlated with serum Na⁺ or osmolality, haematoerit, blood pressure or heart rate.     

Determinants of fetal and maternal atrial natriuretic peptide concentrations at delivery in man

Matched maternal venous (MV), umbilical artery (UA) and umbilical vein (UV) concentrations of atrial natriuretic peptide [ANP] were measured in 36 normotensive women at term delivery (23 vaginal, 13 caesarean) and 17 non-pregnant women in the first half of the menstrual cycle. MV [ANP] at caesarean section was similar to that in non-pregnant women, but UA and UV [ANP] were higher (P less than 0.01 for both). UA, but not UV, [ANP] was markedly raised after vaginal delivery. Plasma concentrations of aldosterone [ALD] were measured in 16 of the matched sets of samples. No statistically significant association was found between [ANP] and [ALD] in either maternal or fetal samples. Neither maternal nor fetal [ANP] correlated with serum Na+ or osmolality, haematocrit, blood pressure or heart rate.     

Glucagon, insulin and glucose levels in maternal and imbilical cord plasma with studies of placental transfer.

Plasma immunoreactive glucagon, as well as insulin and glucose levels, was measured in 62 women and their infants following a term gestation vaginal delivery. Simultaneously obtained samples were drawn from the maternal antecubital vein (MV), umbilical vein (UV), and umbilical artery (UA). Forty-seven of these subjects were untreated (control) and 15 had received a maternal intravenous injection of 1 mg of glucagon within 40 minutes of delivery. It was shown that the umbilical cord glucagon levels were not different from the maternal levels in the control subjects (mean MU, 181.0; UU, 191.9; UA, 161.0 pg/ml). There was no correlation between the maternal and umbilical glucagon levels or the UV glucagon levels and the insulin or glucose concentrations. Neither the fetal sex, placental weight, or infant weight were correlated with the MV or UV glucagon concentration. Following the glucagon injection, the maternal plasma glucagon levels rose significantly, whereas the umbilical blood values did not change. These results suggest that glucagon does not significantly pass through the human term placenta.     

Serum dehydroepiandrosterone and cortisol concentration in the maternal-fetoplacental hormonal system in elective caesarean section and spontaneous vaginal delivery in the 28th to 36th and 40th weeks of pregnancy

The authors compared the serum DHAS and cortisol level in 53 vaginal deliveries with those of 21 caesarean sections prior to the onset of labour at the 28th to 36th weeks. They also compared 18 vaginal deliveries with 16 elective caesarean sections at the 40th week. The serum hormone concentrations were measured in the maternal vein, the umbilical vein and the umbilical artery. The results indicate that the serum DHAS and cortisol level was higher after vaginal delivery than after caesarean section in the maternal vein, umbilical vein and umbilical artery at the 28th to 36th and also at the 40th week. The authors suggest that, although the role of the fetal adrenal cortex is not so definitive as in the case of some species in the onset of labour, it may be presumed that the increase in adrenal cortical activity cannot be explained exclusively by maternal stress.     

Feto-maternal plasma oxytocin levels in normal and anencephalic pregnancies

In 4 women with anencephalic fetuses, the oxytocin level was measured in the maternal plasma in the second stage of labor and in the umbilical artery (UA) and umbilical vein (UV) by radioimmunoassay (RIA). In these cases, the mean maternal OT level was 13.4 +/- 8.0 microU/ml (mean +/- S.E.), which was not significantly different from the OT levels in cases of normal spontaneous birth and elective cesarean section. The UA and UV plasma OT levels in these cases were below the detectable level (less than 2 microU/ml), whereas in normal spontaneous births, they were 18.2 +/- 4.9 microU/ml and 12.2 +/- 2.3 microU/ml, respectively. The OT level in the UA was higher than that in the UV. There was no difference between the mean OT levels in patients with, versus those without contractions, but the plasma OT levels in the second stage of labor were higher than those in the first stage. In normal pregnancies the plasma OT concentration increased during parturition. These results suggest that placental transfer of maternal plasma OT to the fetal circulation is limited, and that in cases of anencephalic fetuses, maternal labor does not necessarily require fetal OT as a trigger or for its maintenance.     

Cyclic 3',5' -adenosine monophosphate in umbilical cord and maternal plasma before and after the onset of parturition.

Significant arteriovenous differences in cord cyclic 3',5'-adenosine monophosphate (cAMP) levels and between the maternal plasma (MP) and each cord vessel (mean umbilical artery [UA] greater than umbilical vein [UV] greater than MP) was observed. cAMP levels were significantly higher in the umbilical cord vessels and maternal plasma after vaginal delivery than they were following delivery by elective cesarean section before the onset of labor. The higher mean cAMP levels observed after parturition appeared to be more pronounced in the fetoplacental unit than in the maternal compartment. A significant positive correlation in cAMP levels between the UA and UV was also observed.     

Serum cortisol levels of maternal vein, umbilical artery, and umbilical vein classified by mode of delivery

We measured maternal venous (MV), umbilical arterial (UA), and umbilical venous (UV) cortisol levels of 180 pregnancies at term. The cortisol level of MV was higher than that of UA and UV in all deliveries. The cortisol levels of three samples had no difference between the induced labor group and the spontaneous onset of labor group regardless of delivery mode. In spontaneous vaginal delivery the cortisol levels of three individual samples were significantly higher in primipara than in multipara. The positive correlations were observed in any modes of deliveries between the cortisol levels of MV and UA, and MV and UA and UV. These data suggest that the fetus may produce cortisol by itself and maternal cortisol may inflow to the fetus.     

Maternal and fetal atrial natriuretic peptide levels at delivery from normal and growth retarded pregnancies.

OBJECTIVE: To determine whether circulating fetal levels of the vasodilator atrial natriuretic peptide (ANP) are reduced in pregnancies complicated by intrauterine growth retardation (IUGR). DESIGN: Prospective observational study. SETTING: University teaching hospital and research laboratory. SUBJECTS: 25 normal singleton pregnancies delivered at term by spontaneous vertex delivery (n = 16) or by elective caesarean section (n = 9), and a series of 14 singleton pregnancies complicated by IUGR. INTERVENTION: Measurement of ANP by radio-immunoassay in maternal venous, umbilical artery, and umbilical vein plasma from a series of normal, and IUGR pregnancies. MAIN OUTCOME MEASURES: Comparison of plasma ANP levels between the three groups; relation between fetal ANP, PO2 and pH. RESULTS: Mode of delivery did not influence either maternal, umbilical artery or umbilical vein plasma ANP levels in normal term singleton pregnancies. Umbilical vein ANP levels were significantly higher in the IUGR group when compared with normal pregnancies at term (mean 66 95%, CI 36-122 vs mean 37, 95% CI 29-47 pg/ml, P = 0.03) and were inversely related to umbilical artery pH (R2 = 65%; P = 0.003). CONCLUSIONS: These data suggest that umbilical vein ANP levels are elevated in pregnancies complicated by IUGR, and rise appropriately in response to the stress of acidosis. In the absence of any receptor or second messenger defect within feto-placental vascular smooth muscle, these data suggest that ANP is not directly implicated in the vascular pathophysiology of IUGR.     

The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction

OBJECTIVE: Our aim was to study the hemodynamic effects of betamethasone on fetuses with intrauterine growth restriction (IUGR) with absent or reversed end-diastolic (ARED) umbilical artery flow. STUDY DESIGN: Color/pulsed Doppler waveforms were obtained before and after intramuscular injections of betamethasone in 19 consecutive fetuses with IUGR/ARED and 6 control fetuses. Peak velocities and pulsatility index (PI) values were obtained from the umbilical (UA) and middle cerebral (MCA) arteries and intrahepatic umbilical vein (UV). RESULTS: Ten ARED fetuses developed transient positive umbilical end-diastolic flow after steroids, whereas nine fetuses showed persistent ARED. The persistent ARED subgroup demonstrated increased UA and UV peak velocities after steroids, which may indicate fetal hypertension. Fetal death (n=2) and severe acidosis (n=2) were confined to the subgroup with persistent ARED. CONCLUSION: Preterm IUGR/ARED fetuses exhibit divergent cardiovascular responses to prenatal steroids. Intensive Doppler-based fetal monitoring may identify a subset of fetuses prone to decompensation after maternal steroid administration.     

Studies on catecholamine and its metabolites in the evaluation of fetal distress]

To determine the usefulness of catecholamine (CA) levels in the evaluation of fetal distress during delivery, norepinephrine (NE), its intermediate metabolite 3,4-dihydroxyphenylethyleneglycol (DOPEG), and 3,4-dihydroxyphenylacetic acid (DOPAC), which is the main intermediate metabolite of dopamine (DA), were simultaneously measured in umbilical arterial and venous blood (UA, UV) and in maternal venous blood (MV). The correlations of these concentrations with blood pH and the 1-min. Apgar score were examined. Of the 124 subjects studied, 24 had elective cesarean section (CS), and 100 had vaginal delivery (VD), which was uncomplicated in 84 (ND) and complicated by fetal distress in 16 (FD). The results were as follows: 1. In the ND, FD and CS groups, UA-NE and UA-DOPEG levels were high, as follows: FD group greater than ND group greater than CS group and FD group greater than ND, CS group, respectively. 2. There were no significant differences between DOPAC levels in UA, UV and MV plasma and in FD, ND and CS groups. 3. In the ND group, higher UA-NE values were found in the group at UA-pH less than 7.20 than in those at UA-pH greater than or equal to 7.20, but UA-DOPEG values did not vary significantly with UA-pH. 4. In the ND group, higher UA-DOPEG values were found with Apgar score less than or equal to 7 than with Apgar score greater than or equal to 8, but UA-NE values did not vary significantly with the Apgar score.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mode of collection does not influence haematopoietic content of umbilical cord blood units from caesarean deliveries

BACKGROUND: Collection strategy is the first step for collecting good quality cord blood units. There are two main different techniques for collecting cord blood from the umbilical vein: in the delivery room while the placenta is still in the utero by midwifes and obstetricians, or in an adjacent room after placental delivery by cord blood bank trained personal. Our aim was to evaluate the benefits and disadvantages between the two different cord blood collection strategies in caesarean deliveries. METHODS: We retrospectively analysed data of cord blood units collected from caesarean deliveries for a 3-year period. Caesarean section was performed with a low uterine transversal incision in all patients according to common obstetrical practice. Cord blood collection was performed before or after placental delivery. RESULTS: Obstetrical and umbilical cord blood data was obtained from 253 caesarean deliveries. No statistically significant difference was observed for obstetrical variables or cord blood variables except for Hct and platelets. CONCLUSIONS: We conclude both methods produce comparable TNC, CD34 and CFU counts of cord blood units collected from caesarean sections. Before placental delivery collection avoids the financial investment that generates the presence of cord blood banking personal in the maternity ward.     

Leptin concentrations in the umbilical vein and artery. Relationship to maternal and neonatal anthropometry

OBJECTIVE: To determine the relationships between serum leptin levels in the umbilical vein (UV) and artery (UA) and the anthropometry of mothers and neonates. STUDY DESIGN: Blood was taken from 61 pregnant women who were admitted for delivery and from the umbilical vein and artery just before delivery of the placenta. Leptin level was measured by immunoradiometric assay. Comparisons between serum leptin concentrations in UVs and both maternal and neonatal anthropometry were made according to neonatal sex. RESULTS: Mean leptin UA and UV concentrations in female infants were significantly higher than those in male infants (both, P = .002). Leptin concentrations in UVs of the total infants were related to maternal body weight and body mass index preconceptionally as well as at birth, to neonatal birth weight, to gestational age, to Kaup index and to body fat content of the infants. CONCLUSION: A sex difference was observed not only in serum leptin concentrations UA and UV but also in the degree of significance between the relationship of cord leptin and both maternal and neonatal anthropometry. Also, the UA leptin level had a closer relationship to neonatal anthropometry, but the UV leptin level was more closely related to maternal anthropometry.     

Placental release of corticotrophin-releasing hormone across the umbilical circulation of the human newborn

This study attempted to determine the placental release of corticotrophin-releasing hormone (CRH) into the umbilical circulation, and the factors which affect it, by measuring venous and arterial levels for CRH across the umbilical circulation in labouring as well as non-labouring elective caesarean section patients. The relationship with measures of fetal oxygenation and acid-base status at birth was investigated also. Forty-eight patients were studied (term labour n = 30, term elective caesarean section n = 12, and preterm labour n = 6) with blood sampling from a clamped segment of cord after delivery of the fetus and from the cord at its insertion into the placenta after delivery of the placenta, with subsequent measurement of blood gases, pH, base excess, and CRH. For all patients, mean plasma CRH levels in the umbilical and placental vein (115+/-13 and 145+/-18 pg/ml) were higher than those from the corresponding artery (85+/-7 and 102+/-8 pg/ml, P<0.01 and P<0.05, respectively), indicating placental release of CRH into the fetal compartment. In addition, placental venous and arterial cord CRH levels were higher than those from the corresponding umbilical levels (P<0.01 and P<0.02, respectively) indicating continued placental release of CRH into blood within the placenta after clamping of the umbilical circulation and delivery of the fetus. While plasma CRH levels from respective cord vessels were all significantly higher in labouring patients at term versus elective caesarean section patients, there were no differences compared with preterm labouring patients. For all patients, CRH as measured in both the umbilical and placental vein showed a modest inverse correlation to base excess as measured in the umbilical artery, -0.31 and -0.33, respectively, both P<0.05. It is concluded that CRH is released by the placenta into the fetal compartment and is increased with both term and preterm labour, and with metabolic acidosis during labour, supporting a role in the endocrine events of labour and/or compensatory changes in uteroplacental blood flow.     

Activin A, inhibin A, inhibin B and parturition: changes of maternal and cord serum levels according to the mode of delivery

Objective To evaluate whether activin A, inhibin A, and inhibin B levels in maternal and umbilical artery serum change according to the mode of delivery.
Design Maternal and cord blood specimens were collected at term after spontaneous labour and vaginal delivery, or elective caesarean section.
Setting Universities of Pisa, Turin, Naples and Udine.
Population Forty–two healthy pregnant women, at 39–40 weeks of gestation, divided into two subgroups: group 1 vaginal delivery (   n = 21  ), were delivered of 10 female and 11 male infants; group 2 elective caesarean section (   n = 21  ), were delivered of 11 female and 10 male infants.
Main outcome measures Serum activin A, inhibin A, inhibin B concentrations in maternal and umbilical cord blood.
Results At vaginal delivery, maternal serum inhibin A and inhibin B levels were lower and activin A levels higher than at elective caesarean section. Maternal levels of activin A, inhibin A and inhibin B were constantly higher than in umbilical arterial blood, independent of the mode of delivery. No significant difference was observed in umbilical arterial serum levels of the three proteins between the two modes of delivery. Umbilical arterial serum activin A and inhibin A concentrations did not show a significant difference between male and female infants in either vaginal or caesarean section, but male infants showed inhibin B levels significantly higher than female, independent of the mode of delivery.
Conclusions In the presence of active labour, the human placenta secretes larger amounts of activin A and lesser amounts of inhibin A and inhibin B into the maternal circulation. Inhibin–related proteins in the fetal circulation do not show differences according to the mode of delivery, suggesting that they have a different method of production or metabolic rate compared with maternal activin and inhibins.     

Could adverse perinatal outcome be predicted from intrapartum umbilical vessels Doppler in women with abnormal cardiotocography?

ObjectivesTo evaluate the value of umbilical artery and umbilical vein Doppler study in predicting adverse perinatal events in low risk women with abnormal cardiotocography during labor.DesignProspective cohort study.SettingEmergency unit of obstetrics & gynecology department, Royal Commission hospital, El Gubail Industrial City, Saudi Arabia.PopulationSixty-six women with uncomplicated pregnancy were classified according to cardiotocography (CTG) findings during the active phase of labor into, 33 cases with normal CTG (group 1) and 33 cases with pathological CTG (group 2). Colour Doppler study of the umbilical artery (UA) and umbilical vein (UV) were performed for both groups and the results were correlated to perinatal outcome.Main outcome measuresMeconium stained amniotic fluid, emergency Cesarean deliveries for suspected fetal distress. Apgar score at 1 and 5 min, UA and UV cord blood pH, and the need for neonatal intensive care unit (NICU) admission.ResultsIn the pathological CTG group two (6.1%) cases had high UA Doppler indices with no adverse perinatal outcome, while 13 (39.4%) cases showed UV pulsations of them 12 (92.3%) cases underwent emergency cesarean section for fetal distress, 5 (38.4%) cases delivered babies with UV pH < 7.2.Normal UA Doppler indices and no UV pulsations were seen in all cases with normal CTG group with no adverse perinatal outcome.ConclusionUV Doppler study in combination with CTG monitoring as a part of the intra partum fetal surveillance in low risk pregnancy might give additional useful information about fetal condition and suspected intrapartum fetal hypoxia.     

Response of fetal acid--base balance to duration of second stage of labour.

Data from 4081 vaginal deliveries (no caesarean sections) were analyzed retrospectively (IBM 730/158) with regard to duration of second and "final stage" of labour and fetal outcome (acid-base balance and apgar scores). The average duration of the two periods amounted to 22.8+/-29.6 and 9.9+/-7.8 min. Mean pH (UA) was 7.268+/-0.084 and the acidotic risk (pH less than 7.20, pH less than 7.10) 13.4 and 1.6% respectively. The distribution of the Apgar-scores after 1 min was assessed: 0-3: 1.7%, 4-6: 5.4%, 7-10: 92.9%. The dependance of the time variables from parity was studied. Two samples (N1=1755, N2=1098) of uncomplicated term pregnancies were chosen according to 7 clinical selection criteria differing only in the presence of cord entanglements at birth. The association between the two time variables and parameters of the fetal acid-base balance in cord blood was evaluated using rank correlation- and polynomial regression analysis. Highly significant correlations (tau) were found between the variable time and actual pH in blood of the umbilical artery and vein as well as pCO2, BEECF and HbO2 in the umbilical vein. The association however is not very close and thus clinically not of great importance. The deltapH (UA & UV) pro 60 min of second (and "final") stage of labour was computed and amounted to -0.024 (-0.087) in blood of the umbilical artery and -0.036 (-0.115) in blood of the umbilical vein and -0.017 (-0.062) (UA) and -0.032 (-0.120) units (UV) in the sample with and without apparent cord entanglements at birth respectively. The response of fetal acid-base balance to cord compression during second stage of labour was assesses: The acidotic risk (pH less 7.2) was doubled: 14.5% (7.7%) and AV-differences of all variables were "opened" if cordcoilings were observed. Apgar scores were not significantly different. Moreover, the association between AV-differences of each parameter and the variable time was studied: it became evident that with passage of time AV-difference is "closed" (-0.052 AV DpH/60 min "final stage" of labour, N=1098) indicating time related impairment of placental function. From these observations and data of the literature the conclusion is drawn that second stage of labour should not exceed 45 min in any patient. Furthermore it is concluded that in cases without signs of impending fetal distress it seems to be possible to wait more than 20 (Multipara) or 30 min (Primipara) duration of "final stage" without increased risk of fetal peril measured in terms of acidemia and clinical depression. This is valid only in term pregnancies with the possibility of continuous monitoring of FHR, in cases with normal uterine activity, uneventful course of first stage of labour and cooperative, vigorous patients. The indications for termination of delivery by vaginal operations in cases without impending fetal distress are discussed.     

Unconjugated 17 beta-oestradiol and oestriol in maternal serum and in cord vein and artery blood at term and preterm delivery

The serum level of unconjugated 17 beta-oestradiol (E2) and oestriol (E3) in the maternal vein (MV), the umbilical vein (UV) and artery (UA) immediately after term (n = 34) and preterm (n = 74) labour was measured to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found. (1) The level of E2 and E3 increased equally in the MV, UV and UA serum from the 28th-32nd week to the 33rd-36th week of pregnancy. From the 33rd-36th week to the 40th week there was no change in the MV, but the value of E2 and E3 decreased significantly in the UV and UA serum. (2) The serum level of E2 in the MV was significantly higher than that in the UV and UA during every gestational period. In contrast, the serum concentration of E3 in the MV was significantly lower than that in the UV and UA. (3) The value of 'UA/UV X 100' of E2 and E3 was about 30% during the 28th-40th week. (4) A weak correlation was found between the MV serum level of E2 and E3 and UA serum concentrations. A strong correlation was found between the UV and UA serum levels of E2 and E3. The authors suggest that though there is a close connection between the fetal and the maternal organism, the fetus is still capable of maintaining its hormonal environment independently.     

The effect of parturition on umbilical blood plasma levels of norepinephrine

The norepinephrine concentration in 77 umbilical, arterial, and venous plasma samples, and in 31 simultaneous maternal plasma samples, was measured. The mean (+/- SEM) of 8.7 +/- 1.9 ng/ml in the umbilical artery was higher (P less than .001) than that of 3.6 +/- 0.9 ng/ml in the umbilical vein. In paired fetal-maternal venous samples the norepinephrine concentration of 3.8 +/- 1.7 ng/ml in the fetus was higher (P less than .05) than that of 0.3 +/- 0.1 ng/ml in the mother. Among the different types of vaginal deliveries the umbilical arterial norepinephrine concentrations were: 5.8 +/- 2.1 ng/ml in uncomplicated vaginal deliveries; 16.4 +/- 2.1 ng/ml in breech deliveries (P less than .05 as compared with uncomplicated vaginal deliveries); 8.8 +/- 2.5 ng/ml in vacuum extraction deliveries; and 0.8 +/- 0.3 ng/ml and 11.3 +/- 7.7 ng/ml in twin A and twin B deliveries, respectively. All these values were higher (P less than .001) than those after elective cesarean section, except that for twin A, which was lower (P less than .01) than that for twin B, indicating that labor and vaginal delivery induced activation of the fetal sympathoadrenal system.