断脐时机对母婴结局影响的研究

目的研究断脐时机对母婴结局的影响。方法选取阴道试产的健康足月初产妇随机分为三组,早断脐组(n=108)断脐时机为胎儿娩出即刻至60s,晚断脐1组(n=92)断脐时机为胎儿娩出60~120s,晚断脐2组(n=68)断脐时机为胎儿娩出120s或至脐带停止搏动。追踪至婴儿6月龄。结果三组产妇胎盘剥离时间、产后2h出血量比较,差异无统计学意义(均P0.05)。三组新生儿出生后第4天血红蛋白含量存在统计学差异,晚断脐2组显著高于早断脐组、晚断脐1组(均P0.05)。三组婴儿6月龄血清铁蛋白含量比较,差异有统计学意义(P0.05),晚断脐2组显著高于早断脐组、晚断脐1组(均P0.05)。结论胎儿娩出2min后或脐带停止搏动时断脐不影响分娩进程及产后出血,可提高新生儿血红蛋白水平和6月龄血清铁蛋白含量。     

低分子肝素联合硫酸镁、静脉营养治疗胎儿生长受限的效果及对围生儿结局的影响

目的探讨低分子肝素联合硫酸镁、静脉营养治疗胎儿生长受限的效果及对围生儿结局的影响。方法前瞻性纳入2018-01—2020-04间郑州大学第三附属医院收治的胎儿生长受限孕妇。依据治疗方法分为硫酸镁联合静脉营养治疗组(对照组)和低分子肝素联合硫酸镁、静脉营养治疗组(观察组)。比较2组孕妇的基线资料、胎儿生物测量指标(双顶径、头围、股骨长度、腹围)、脐动脉血流动力学指标(阻力指数、搏动指数、S/D值),以及围生儿结局。结果共纳入90例孕妇,每组45例。2组孕妇的基线资料差异无统计学意义(P>0.05)。治疗前2组胎儿的生物测量指标、脐动脉血流动力学指标差异均无统计学意义(P>0.05);治疗后2组胎儿的上述指标均优于对照组,且观察组优于对照组,差异均有统计学意义(P<0.05)。2组围生儿均成活,观察组新生儿胎龄、出生时体质量、胎盘质量、出生1 min Apgar评分均高于对照组,差异均有统计学意义(P<0.05)。结论低分子肝素联合硫酸镁、静脉营养治疗胎儿生长受限,有利于提高生长受限胎儿的疗效和确保围生儿的良好结局。     

孕早期超声所示胎盘位置对剖宫产后再生育妇女妊娠结局的影响

目的 探讨孕早期不同胎盘位置对剖宫产后再生育妇女妊娠结局及胎儿围产期结局的影响。方法 回顾性分析2021年6月至2022年6月于浙江省武义县第一人民医院行孕早期超声检查且住院分娩的347名剖宫产后再生育产妇的临床资料，根据孕早期超声检查所示胎盘位置不同分为前壁型胎盘组(前壁组，n=198)和后壁型胎盘组(后壁组，n=149)。比较两组产妇的一般资料、妊娠结局及胎儿围产期状况。结果 两组产妇的年龄、孕次、距前次剖宫产时间等一般资料均无显著性差异(P>0.05)。两组产妇的剖宫产比例、产褥感染、子痫前期及妊娠期糖尿病发生率比较均无显著性差异(P>0.05),但前壁组产妇的胎盘早剥、胎膜早破及产后出血发生率均显著高于后壁组(P<0.05)。两组产妇间低出生体重儿发生率比较无显著性差异(P>0.05),但前壁组产妇娩出巨大儿、胎儿宫内窘迫及胎儿出生时Apgar评分≤7分的发生率均显著高于后壁组(P<0.05)。结论 对于剖宫产后再生育妇女，孕早期胎盘位于子宫前壁者不良妊娠结局及不良围产儿状况的发生率较高，应引起关注。     

极低和超低出生体重儿脐静脉导管不同固定方法的比较

目的对比分析极低和超低出生体重儿脐静脉导管不同固定方法的效果。方法按入院时间将78例使用脐静脉导管的极低和超低出生体重儿分为两组。对照组(38例)按常规方法固定脐静脉导管;观察组(40例)采用改良法固定脐静脉导管。对比两组脐静脉导管留置时间、置管相关并发症发生率和非计划性拔管率。结果观察组脐静脉导管留置时间为(8.16±0.74)d,显著长于对照组的(6.21±1.02)d;医用粘胶相关性皮肤损伤发生率显著低于对照组(均P0.01);观察组非计划性拔管发生率与对照组比较,差异无统计学意义(P0.05)。结论改良脐静脉导管固定法可有效延长极低和超低出生体重儿置管时间,降低医用粘胶相关性皮肤损伤,且操作简便。     

辅助生殖技术致胎盘葡萄糖转运载体基因表达水平上调

目的探究经辅助生殖技术(ART)助孕足月分娩的新生儿与正常自然受孕足月分娩的新生儿的出生重量、胎盘重量、出生重量与胎盘重量比值及胎盘的葡萄糖转运载体基因表达是否存在差异。方法选择2014年8月至2015年1月在我院住院分娩的54例ART子代为ART组,同期住院分娩的100例自然妊娠子代为正常组。对两组出生体重、胎盘重量及出生体重与胎盘重量比值进行测量及统计分析,然后各组抽取20例样本,采用实时定量聚合酶链反应(RT-qPCR)方法检测两组新生儿胎盘组织中葡萄糖转运载体基因GLUT1、GLUT3、GLUT4及GLUT5mRNA的表达水平,采用免疫印迹检测(Western Blot)方法验证GLUT1和GLUT3的蛋白水平。结果 (1)ART组与正常组新生儿的出生体重、胎盘重量及新生儿体重与胎盘重量之比相比较,差异无统计学意义(P0.05);(2)与正常组GLUT1与GLUT3的mRNA表达水平相比,ART组胎盘中GLUT1和GLUT3的mRNA表达水平均显著高于正常组(P0.05);而两组新生儿胎盘GLUT4与GLUT5的mRNA表达水平相比较,差异无统计学意义(P0.05);(3)ART组GLUT1蛋白水平显著高于正常组(P0.05),而GLUT3蛋白水平在两组间无统计学差异(P0.05)。结论ART导致足月胎盘中葡萄糖转运载体基因GLUT1和GLUT3的表达增高,提示ART有可能会影响妊娠后期胎盘的葡萄糖转运功能。     

预注小剂量高渗氯化钠羟乙基淀粉40对剖宫产手术母婴的影响

目的 观察术前预充小剂量高渗氯化钠羟乙基淀粉40(HSH)对剖宫产产妇血流动力学及母婴血气、离子、丙二醛(MDA)和血浆超氧化物歧化酶(SOD)的影响.方法 200例择期行剖官术产妇,随机双盲均分为:HSH组(H组)和复方乳酸钠组(L组).监测并记录入室时(T0)、预充量输注完即刻(T1)、腰麻注药后5 min(T2)、胎儿娩出时(T3)、术毕(T4)的HR、BP、SpO2;同时采脐动、静脉血和产妇动脉血各5 ml测定血乳酸(Lac)、血细胞比容(Hct)、Na+、K+、血气及SOD活力和MDA浓度;记录新生儿生后1和5 min的Apgar评分并计算胎儿氧摄取率(ERO2).结果 与T0时比较,T2～T4时L组产妇SBP、DBP明显下降,HR明显增快(P<0.05).与H组比较,T2～T4时L组产妇SBP、DBP明显降低,HR明显增快(P<0.05);H组产妇动脉血PO2明显高于L组(P<0.05),Hct和Lac明显低于L组(P<0.05);H组新生儿脐动、静脉的PO2明显高于L组(P<0.05);与入室前比较,胎儿娩出时两组产妇动脉血SOD值明显降低(P<0.05);胎儿娩出时H组产妇动脉血、新生儿脐动脉血及脐静脉血SOD值均高于L组(P<0.05);H组新生儿脐动脉血及脐静脉MDA值低于L组(P<0.05).H组胎儿ERO2较L组明显升高(P<0.05).结论 剖宫产围术期,应用小剂量HSH扩容,能稳定母婴的血流动力学,更好地维持母婴内环境稳定,提高产妇和胎儿的安全性.     

绝经后骨质疏松症妇女血清痩素水平与骨密度的关系

目的 观察绝经后骨质疏松症妇女血清瘦素水平与骨密度(BMD)、骨矿含量(BMC)的相关性。方法 ELISA法检测32名绝经后骨质疏松症妇女(绝经组)和27名体重指数(BMI)相匹配的非绝经正常对照者(非绝经组)的空腹血清瘦素浓度,双能X线骨密度仪测定受试者腰椎BMD、BMC、T值、Z值。结果 绝经组和非绝经组的血清瘦素浓度分别为12.43±7.90ng/ml和11.76±4.42ng/ml,两组之间无差异;两组血清瘦素浓度均与体重、BMI和脂肪含量(Fat％)显著正相关,绝经组的瘦素水平与BMD及BMC无相关性,非绝经组瘦素浓度与BMDIL3和BMCL5相关(r=0.132,P<0.05;r=0.140,P<0.05),但调整BMI后瘦素浓度与BMD及BMC:的相关性消失(r=0.079,P>0.05;r=0.067,P>0.05)。结论成年妇女瘦素水平与体重、体脂及脂肪含量显著相关,瘦素不是绝经后妇女骨质疏松症的主要影响因素。     

肝硬化患者血清瘦素水平变化及临床意义

目的通过测定肝硬化患者血清瘦素水平,探讨肝硬化与瘦素的相关性,不同肝功能下、不同病因下血清瘦素水平与相关因素。方法选择肝硬化患者86例,对照组45例,分别测定肝功能、身高、体重等相关指标,并将肝硬化组患者进行Child-Pugh分级以及按照病因学分类。血清瘦素水平采用酶联免疫吸附试验(ELISA)法测定。结果肝硬化组患者血清瘦素水平明显高于对照组(P0.05);按Child-Pugh分级,随着肝功能的下降,血清瘦素水平逐渐升高;按病因学分类,乙型肝炎后肝硬化、原发性胆汁性肝硬化及酒精性肝硬化患者血清瘦素水平均高于健康对照组(P0.05)。结论肝硬化患者血清瘦素明显升高,与肝功能及肝硬化病因学等密切相关。     

中晚期胎儿肝区脐血流分布状态与胎龄及生长指标的相关性

目的 分析妊娠中晚期胎儿肝区脐血流分布状态与胎龄及生长指标的相关性。方法 对714胎胎龄17～40⁺⁶周发育正常胎儿行超声检查,记录胎儿生长指标,包括双顶径、头围、腹围、股骨长及体质量;测量胎儿脐静脉(UV)腹内段(D_UV)、门静脉窦(PS)起始段(D_PS)、静脉导管(DV)起始段(D_DV)内径及其相应最大血流速度V_UV、V_PS和V_DV,计算UV、DV、左门静脉(LPV)及右门静脉(RPV)血流量,即Q_UV、Q_DV、Q_LPV、Q_RPV;分析脐血流相关参数与胎龄及生长指标的相关性。结果 胎儿D_UV、D_PS、D_DV及V_UV、V_PS均与胎龄呈正相关(r=0.907、0.901、0.874、0.393、0.301,P均<0.001),V     

剖宫产术中异丙酚对新生儿的影响及其胎盘转移

目的 探讨剖宫产术中异丙酚对新生儿的影响及其胎盘转移情况.方法 拟行剖宫产术的足月初产妇60例,ASA Ⅰ或Ⅱ级,年龄23～31岁,体重59～89kg,身高156～169 cm,随机分为2组(n=30):全麻组(G组)和硬膜外麻醉组(E组).G组静脉注射异丙酚2 mg/kg和琥珀胆碱2 mg/kg快速诱导气管插管,行机械通气,局麻辅助下开始手术.胎儿娩出结扎脐带后立即抽取脐静脉(UV)、脐动脉(UA)血样各5 ml,经足背动脉取母体动脉(MA)血样5 ml,采用高效液相色谱法测定血浆异丙酚浓度(CUV、CUA和CMA);E组经L_(1,2)行硬膜外麻醉,给予2%利多卡因11～17 ml,控制感觉阻滞平面上界为T6～8.于入室5 min(T_0),切皮即刻(T_1)、新生儿娩出(T_2)和手术结束(T_3)时记录心率(HR)、脉搏血氧饱和度(SpO_2)和平均动脉压(MAP);记录分娩时间和给药结束到钳夹脐动脉、静脉的时间;胎儿娩出后1、5 min时行Apgar评分.结果 G组给药结束到钳夹脐动、静脉的时间短于E组(P<0.05),两组新生儿Apgar评分、各时点HR、SpO_2和MAP比较差异无统计学意义(P>0.05),两组均未见新生儿呼吸抑制发生,G组术后随访均未发生术中知晓.CMA、CUV和CUA分别为(1.4±0.4)、(0.86±0.25)、(0.70±0.22)μg/ml,CUV/CMA和CUA/CUV分别为0.61±0.11和0.80±0.10.结论 静脉注射异丙酚2 mg/kg用于剖宫产术麻醉效果满意,虽然易通过胎盘,且在胎儿体内代谢慢,但并未对新生儿产生不良影响.     

Relationship between leptin levels in maternal blood,amniotic fluid,arterial and venous cord blood and fetal growth

<正> Objective:To study the relationship between leptin concentration and fetal growth.Methods:Levels of leptin in maternal serum,amniotic fluid,arterial and venouscord blood of 65 normal parturients (gestational age 37-42weeks) were measured by ra-dioimmunoassay (RIA) method.At the same time,maternal blood lipids were detected.Neonates were divided into three groups:small for gestational age (SGA) group (n=10),appropriate for gestational age (AGA) group (n=45),large for gestational age(LGA) group (n=10).Statistical analysis was performed by t test,variance analysisand correlation analysis.Results:(1) There was no obvious correlation between leptin concentrations in ma-ternal serum and arterial/ venous cord blood,amniotic fluid,and also no correlationwith birth weight and placental weight (P>0.05).Maternal body mass index signifi-cantly correlated with birth weight and neonatal length and leptin levels in arterial andvenous cord blood (P<0.01).Leptin levels in arterial and venous cord blood positivelycorrelated significantly with placental and neonatal weight and body length (P<0.01)and negatively correlated with high density lipoprotein (P<0.01).There was no obvi-ous correlation between fetal gender and leptin concentrations in maternal serum,arteri-al and venous cord blood and amniotic fluid;(2) Leptin levels in arterial and venouscord blood,placental weight in LGA group were significantly higher than those in SGAand AGA group (P<0.05).Among three groups,leptin concentrations in maternalblood were significantly higher than those in arterial and venous cord blood (P<0.05).Conclusions:(1)Fetal leptin is synthesized in uterus,born of itself and placenta.Leptin levels in arterial and venous cord blood are related to the intrauterine growthpattern.It might positively regulate birth weight and body fat content.(2)Either mater-nal or fetal leptin was not correlated with fetal gender.There is no gender difference infetal leptin concentrations.     

Increased incidence of hypospadias in small-for-gestational age infants in a neonatal intensive-care unit

OBJECTIVE: To identify the incidence of hypospadias in children born prematurely and small-for-gestational age (SGA), and to compare this subgroup with infants of similar age and weight without hypospadias. PATIENTS AND METHODS: Records from the neonatal intensive-care unit (NICU) of a major metropolitan hospital active in labour and delivery were reviewed over a 3-year period, specifically examining newborns admitted with the diagnosis of SGA, defined as a birth weight of < 10th percentile for gestational age. In all, 154 patients were identified and their charts reviewed, recording the presence and severity of hypospadias, gestational age, birth weight, placental weight, cord length, cord vessels, maternal age, parity, multiple births, drug exposure and associated comorbidity. A control group of age- and weight-matched infants without hypospadias were also identified and compared. RESULTS: Of the 154 patients, 17 (11%) had hypospadias; the hypospadias was distal in nine, mid-shaft in four and proximal in four. The severity of hypospadias did not correlate with the degree of prematurity or weight for gestational age. Placental weight, fetal weight, fetal to placental weight ratio and cord length were all lower in the hypospadias group than in the control group, but the differences were not statistically significant. The maternal age was evenly distributed (median 32 years, range 20-43). Most mothers were multiparous and births were multiple in five of 17 (30%). Cryptorchidism (three) and inguinal hernia (three) were present in four of the infants. CONCLUSIONS: The incidence of hypospadias in SGA infants admitted to the NICU is > 10 times higher than that reported for the general population. There was a trend to lower placental and fetal weight in SGA infants with hypospadias than in the controls. This finding merits further evaluation using a larger population database and suggests that factors resulting in SGA infants occur at a critical point early in development, affecting both somatic and urethral development.     

Effects of Gestational Age, Maternal Diabetes, and Intrauterine Growth Retardation on Markers of Fetal Bone Turnover in Amniotic Fluid

Little is known about the dynamics of bone formation and bone resorption in utero, particularly the normal changes that occur throughout gestation and in clinical situations that result in low bone mass at birth. The objectives of this study were to describe the effects of gestational age on markers of fetal bone turnover, and to investigate whether the reported low bone mass at birth in small-for-gestational-age (SGA) infants and infants of diabetic mothers (IDMs) was associated with biochemical markers of decreased bone formation or increased bone resorption in utero. Bone formation and resorption were assessed by measurement of carboxyterminal propeptide of type I procollagen (PICP) and cross-linked carboxyterminal telopeptide of type I collagen (ICTP), respectively, in 201 amniotic fluid samples. These markers are by-products of type I collagen formation and degradation, respectively, and have been used in the assessment of bone metabolism ex utero. Both PICP and ICTP concentrations in amniotic fluid were inversely associated with gestational age (P < 0.0001). Amniotic fluid concentrations of PICP increased exponentially in relation to infant birthweight (P= 0.008), and SGA infants had lower amniotic fluid PICP concentrations than controls (P= 0.07). The presence of diabetes in the mother was not associated with alterations in amniotic fluid PICP or ICTP concentrations. Although maturational effects on clearance of bone markers from amniotic fluid cannot be excluded, these data are consistent with a high turnover of bone matrix early in fetal life, and a reduction in bone formation when fetal growth is compromised.     

Umbilical Cord Leptin Predicts Neonatal Bone Mass

Evidence is accumulating that the risk of osteoporosis in later life may be determined in part by environmental influences on bone development during intrauterine and early postnatal life. A potential role for fetal leptin in mediating these effects is suggested by animal studies showing that leptin influences prenatal osteoblast growth and development, and that fetal leptin concentrations are altered by changes in maternal nutrition. In a group of term human infants we reported previously that maternal birthweight, smoking, fat mass, and exercise during late pregnancy independently predict neonatal bone mass. To investigate the potential role of leptin in mediating these effects, we now relate leptin concentrations in umbilical venous serum to neonatal bone mass and body composition in 117 infants. There were strong positive associations between umbilical venous leptin concentration and each of whole body bone mineral contents (BMC) (r = 0.42, P ≤ 0.001) and estimated volumetric bone density (r = 0.21, P = 0.02); whole body lean mass (r = 0.21, P ≤ 0.024); and whole body fat mass (r = 0.60, P < 0.001). The associations with neonatal BMC and fat mass, but not with lean mass, were independent of associations that we have reported previously between cord serum insulin-like growth factor 1 (IGF-1) concentrations and neonatal body composition. Among the maternal determinants of neonatal bone mass, cord leptin explained the relationship with maternal fat stores, but not those with the mother’s own birthweight, smoking, or physical activity. We conclude that umbilical venous leptin predicts both the size of the neonatal skeleton and its estimated volumetric mineral density. In addition, among previously documented maternal determinants of neonatal bone mass in healthy pregnancies, maternal fat stores may mediate their effect on fetal bone accrual through variation in fetal leptin concentrations.Funding sources: Medical Research Council; Arthritis Research Campaign; National Osteoporosis Society; Wellbeing.     

Increased blood pressure but normal renal function in adult women born preterm

It has been suggested that children born small for gestational age may develop hypertension and renal dysfunction in adulthood due to impaired fetal kidney development. Very little information on this issue is available on children born preterm. The objective of this study was to investigate the relationship between birth weight, blood pressure, and kidney function in adult subjects who were born preterm or born small for gestational age (SGA). Study design: Subjects (n=50), all women born between 1966 and 1974, were evaluated at a mean age of 26±1.9 years. They were allocated to three groups: (1) born before gestational week 32 (n=15), (2) born full term with birth weight <2600 g (n=18) (SGA), and (3) controls, born full term with appropriate birth weight (n=17). Casual blood pressure, ambulatory 24-h blood pressure (ABPM), glomerular filtration rate (GFR), renal plasma flow (ERPF) and urinary albumin excretion were determined. Results: Preterms had significantly higher casual systolic and mean arterial blood pressure levels compared to controls (123±13 vs 110±7 mmHg, P<0.01, and 87±9 vs 79±6 mmHg, P<0.005, respectively). ABPM was not significantly different between the groups. When the number of systolic recordings >130 mmHg/subject during ABPM was calculated, the preterms had significantly more recordings above this value (P<0.05) as well as a significantly increased area under the curve >130 mmHg and >140 mmHg systolic (P<0.05) compared to the controls. SGA subjects were not significantly different from controls. There were no significant differences in GFR, ERPF or urinary albumin excretion between the three groups. Conclusion: Women born preterm seem to have a disturbance in blood pressure regulation in adulthood, a finding that is not observed for those born small for gestational age. Kidney function in early adulthood seems to be normal in subjects born preterm or small for gestational age. Received: 29 December 1999 / Revised: 13 June 2000 / Accepted: 15 June 2000     

Low birth weight,but not postnatal weight gain,aggravates the course of nephrotic syndrome

Clinical and animal studies have shown a higher risk of an aggravated course of renal disease in childhood after birth for babies small for gestational age (SGA). In addition relative “supernutrition” and fast weight gain in early infancy seem to support the development of later disease. In a retrospective analysis of 62 cases of idiopathic nephrotic syndrome treated between 1994 and 2004 at a university centre for paediatric nephrology, we related the course of disease to birth weight and to the weight gain in the first 2 years of life. Six children were born SGA (birth weight <−1.5 standard deviation score), and 56 were born as appropriate for gestational age (AGA). In all SGA children renal biopsy was performed, while only 55% of the AGA children underwent renal biopsy (P = 0.07), showing no difference in renal histology. In the SGA group, four of six patients developed steroid resistance (vs 12/56 AGA, P < 0.05). Of the SGA children, 83% needed antihypertensive treatment in the course of the disease compared to 39% of the AGA children (P = 0.07). The extent of weight gain between birth and 24 months of age did not influence the course of disease. In conclusion, we were able to find evidence for an aggravated course of idiopathic nephrotic syndrome in former SGA children. Independently of birth weight, weight gain in the first 2 years of life did not influence the course of disease.     

Elevated IGFBP-1 cause high bone turnover in growth-restricted monochorionic twins with discordant birth weight

OBJECTIVE: To test the hypothesis that low birth weight twins have a higher risk of osteoportotic fracture in later life, we investigated the association between fetal IGF axis and type-1 collagen markers of bone turnover in monochorionic (MC) twins with or without discordant birth weight of >or=20%. METHODS: Maternal and cord bloods were collected from gestational age matched MC twins of discordant (n = 16) and concordant birth weights (n = 16). The samples were assayed for cross linked carboxyl terminal telopeptide (ICTP, a marker of bone resorption) and pro-peptide (PICP, a marker of bone formation) of type I collagen, IGF-1, and IGFBP-1 by radio-immunoassay. RESULTS: The growth-restricted twins (IUGR) of discordant group had higher fetal IGFBP-1 and ICTP (P < 0.001) levels, while PICP (P < 0.001) was lower than the co-twins with normal weight (AGA). In contrast, cord blood levels of IGF-1, IGFBP-1, ICTP, and PICP in concordant twin pairs were comparable to AGA twins. The concordant and AGA twins had a positive correlation between ICTP and PICP levels (y = 23x - 711; r = 0.84; P < 0.001; n = 48) but no such association was found in IUGR twins. Instead, IGFBP-1 levels in IUGR twins had a negative association with PICP (r = 0.81; P < 0.001; n = 16) and a positive correlation with ICTP (r- = 0.51; P < 0.05; n = 16). No such association was found in concordant and AGA twins. CONCLUSION: These data suggest that growth-restricted twins had high bone turnover, due to elevated IGFBP-1. This association seems to be independent of maternal and genetic factors.     

Fentanyl concentration in maternal and umbilical cord plasma following intranasal or subcutaneous administration in labour

BackgroundThe effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother.MethodsA cohort study (n=30) was conducted to measure fentanyl concentrations in maternal plasma, and arterial and venous cord blood, among women administered either intranasal or subcutaneous fentanyl for labour pain relief. Maternal and cord blood samples were collected within 30 min of birth to determine the fentanyl plasma concentration and to assess relative neonatal exposure. Neonatal outcomes were assessed by Apgar scores, need for resuscitation and nursery admission.ResultsThirty paired samples were obtained from healthy parturients with uncomplicated term pregnancies. Highest observed umbilical venous and arterial concentrations were 0.71 ng/mL and 0.56 ng/mL, respectively, and fetal to maternal fentanyl plasma concentration ratios ranged between 0.23 and 0.73, indicating low fetal exposure. While the total intranasal fentanyl dose administered was significantly higher than the subcutaneous fentanyl dose, this did not result in a higher fetal to maternal ratio. All neonates in both groups had 5-min Apgar scores >7, two neonates required short-term stimulation and oxygen (unrelated to fentanyl) and no neonate was admitted to the nursery.ConclusionThis study is the first to examine fetal and maternal fentanyl concentrations after subcutaneous administration. This research supports the safe use of fentanyl for labour analgesia for women.     

Comparison between umbilical artery and vein endogenous digoxin-like immuno-active factor levels in normal and pre-eclamptic patients

Recent studies have pointed to the existence of an endogenous digoxin-like immuno-active factor (DLIF), which may be associated with hypertension and pre-eclampsia. The DLIF levels in the umbilical venous and umbilical arterial blood of neonates, as well as the maternal serum of primigravidas and multigravidas with and without pre-eclampsia, were determined by means of a commercially available radioimmunoassay kit, which is cross-reactive with DLIF, in 44 mothers and their babies in search for a possible placental, fetal or maternal origin of the DLIF. The mean placental and neonatal masses were significantly lower in the pre-eclampsia group than in the control group (P less than 0.01). However, the DLIF levels in the maternal serum, umbilical cord venous and umbilical cord arterial serum were statistically significantly higher in the pre-eclampsia group than in the control pregnant group (P less than 0.05). A very strong correlation was found between umbilical cord venous and arterial DLIF levels (r = 0.90; P = 0.001, Spearman rank-correlation coefficient). Although the mean DLIF level in cord arterial serum was lower than that of cord venous serum, statistical significance was not reached if the Bonferroni adjustment was applied to the P value.     

Higher Osteocalcin Levels and Cross-Links Excretion in Young Men Born with Low Birth Weight

As the result of accelerated growth, the final height of infants born with low birth weight (LBW) is near to the normal. Limited data are available about the bone density and bone turnover just after completion of skeletal development. We have investigated the bone turnover and bone density in 49 apparently healthy young LBW men (age 19–21 years; 21 born small for gestational age (SGA) and 28 appropriate for gestational age (AGA)) and in 16 age-matched controls. Bone mineral density of lumbar spine, femoral neck, and radius midshaft, the markers of calcium homeostasis, biochemical parameters of bone turnover as serum osteocalcin (OC), and urinary pyridinoline (PYD) and deoxypyridinoline (DPD) levels were measured. Bone mineral densities of LBW subjects were not altered. Serum calcium (SGA: 2.44 ± 0.15; AGA:2.41 ± 0.17, control: 2.25 ± 0.09 mmol/liter, P < 0.05), OC (SGA:23.4 ± 9.9; AGA:20.8 ± 7.6; control:13.3 ± 4.6 ng/ml, P < 0.01), total alkaline phosphatase (AP) (SGA:201 ± 61; AGA:193 ± 81, control:117 ± 34 IU/liter, P < 0.01), and urinary DPD/creat (ln.values: SGA:3.10 ± 0.48; AGA:3.17 ± 0.46; control:2.58 ± 0.57 nmol/mmol, P < 0.05) were higher, whereas fractional excretion of calcium (SGA:0.94 ± 0.470; AGA:1.03 ± 0.51, control:1.31 ± 0.75%, P < 0.05) was lower in both SGA and AGA groups. PTH and 25OHD were not different. Significant correlation was obtained between seCa, OC, AP, DPD and birth weight of the subjects, but feCa correlated inversely to the birth weight. It was concluded that the bone turnover of LBW men is accelerated, but well balanced in young adulthood. Further investigation is needed to describe the possible link between accelerated bone turnover and hormonal homeostasis of LBW subjects. Received: 30 November 1999 / Accepted: 9 September 2000 / Online publication: 22 December 2000