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.     

Cortisol levels in maternal venous and umbilical cord arterial and venous serum at vaginal delivery.

To provide evidence that the high levels of cortisol found in mixed cord serum at spontaneous delivery are derived from the fetus rather than the mother, arterial and venous cord samples were collected separately along with simultaneous maternal venous samples at term. In the group with spontaneous labor, the difference between umbilical arterial levels of cortisol (78.6 +/- 4.1 ng. per milliliter) exceeded venous levels (61.9 +/- 4.1 ng. per milliliter) (P less than 0.0001). In the group with induced labor, the arterial level (58.4 +/- 6.9 ng. per milliliter) did not differ significantly from the venous level (50.6 +/- 5.9 ng. per milliliter) (P greater than 0.05). In four cases where spontaneous rupture of the membranes occurred prior to induction, values were similar to those of the group with spontaneous labor. The arterial levels of the group with spontaneous labor exceeded those of the group with induced labor (P less than 0.02). These differences cannot be related to duration of labor, gestational age, or maternal cortisol concentration, none of which differed between the group with electively induced and spontaneous labor. The present data provide further evidence that a rise in fetal cortisol production independent of the mother precedes and is involved in the mechanism initiating the spontaneous onset of human labor.     

静脉导管、脐静脉和脐动脉及大脑中动脉血流检测对子痫前期胎儿预后分析

目的:探讨子痫前期(PE)胎儿静脉导管(DV)、脐静脉(UV)和脐动脉(UA)及大脑中动脉(MCA)血流检测对围生儿预后分析。方法:应用彩色多普勒超声检测PE胎儿的DV、UV和UA及MCA血流参数,并与相应孕周正常妊娠胎儿的血流测值进行对照分析,研究分析其与胎儿不良结局的关系。结果:28~31+6周及36周~分娩前,重度PE胎儿的DV、UV血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE与正常胎儿比较差异无统计学意义(P0.05)。32周~35+6周,PE胎儿的DV血流参数测值PLI、PVIV、PIV及Qdv/Quv随着PE严重程度呈上升趋势(P0.05)。28周~分娩前,重度PE胎儿UA血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE胎儿UA血流测值RI、PI、S/D与正常胎儿比较差异无统计学意义(P0.05),28~36周PE胎儿的MCA血流测值RI、PI、S/D与正常胎儿比较差异有统计学意义(P0.05)。PE胎儿DV、UV、UA血流测值与新生儿的出生体重、Apgar评分、脐动脉血氧饱和度、脐静脉p H值呈负相关。PE胎儿DV的PVIV、PIV,UV的Qdv/Quv,UA的PI、S/D和MCA的RI值与新生儿出生结局相关(P0.05)。结论:DV、UV血流频谱变化可反映PE胎儿宫内状况及预测出生不良结局,若结合UA、MCA血流频谱进行联合分析,将能更准确地评估胎儿的宫内状况。     

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.     

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.     

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.     

Maternal and fetal plasma levels of free corticosteroids in pathological deliveries.

Does intrauterine acidosis induce increased steroid secretion? The concentration of free steroids (CS) increases in both fetal and maternal plasma during labor and delivery. Fetal levels are higher after vaginal than after cesarean section. These differences may indicate an important role of the fetal adrenal gland in the induction of labor or they may reflect merely the fetal response to the stress of delivery. During incrased intrauterine stress steroid secretion is increased as shown here. We examined 41 mothers and their infants during pathological labor. Pathology was assessed from fetal acidosis and/or a clinically obstetric disease of the mother or fetus. The 41 cases included 9 cesarean sections, 8 forceps deliveries; 24 spontaneous deliveries of which 7 were premature. At the time of delivery the pH and CS level were determined in maternal and umbilical vessels in all cases. During spontaneous labor blood samples were also taken during the different stages of labour. A competetive protein binding assay with transcortin without fractionation of the steroids was used. Progesteron was determined by the same assay. The level of this hormone, however, remains unchanged and hence any changes reflect changes in CS. The levels of CS were correlated with the pH values and compared to previously obtained normal values. During pathological deliveries CS levels in both mother and fetus are normal as long as there is no acidosis (Fig. 1). If acidosis is present the CS level in the umbilical artery is usually higher than normal. In 13 out of 18 vaginal deliveries the CS level was above normal, in the other 5 at the upper limit of normal (Fig. 1 and 2). At the same time the a--v difference becomes smaller and sometimes even negative. No changes were noted in maternal and umbilical venous blood (Tab. I and II). Similar dependence on the pH was found for cesarean sections (Tab. III). In premature deliveries without acidosis in the umbilical artery the CS levels were lower in both mother and fetus (Tab. I). These results indicate that the fetal adrenal gland reacts to acidosis, i.e., intrauterine stress, with increased corticosteroid secretion. This rise depends on the pH of fetal blood and not on the type of delivery (Fig. 3).     

The concentration of endothelin in maternal vein, umbilical vein and artery of normal pregnancy and pregnancy-induced hypertension

The concentrations of endothelin (ET) in maternal vein (MV), umbilical vein (UV) and artery (UA) of normal pregnancy (N) and severe pregnancy-induced hypertension (sPIH) were measured to investigate the significance of ET in the maternal and feto-placental circulation of normal pregnancy and PIH. 1) The concentrations of ET (pg/ml blood: mean +/- S.E.M.) in MV of a normal non-pregnant group, 1st, 2nd and 3rd trimester of N were 1.00 +/- 0.19 (n = 2), 0.55 +/- 0.16 (n = 4), 0.45 +/- 0.14 (n = 4) and 0.89 +/- 0.09 (n = 10), respectively. The concentration of ET in MV of 3rd trimester of sPIH was 2.76 +/- 1.21 (n = 7), and significantly (p less than 0.05) higher than in MV of 3rd trimester of N. 2) The concentrations of ET in UV and UA of N and UV of sPIH were 1.53 +/- 0.05, 1.29 +/- 0.06, 2.12 +/- 0.46, respectively. The concentrations of ET in UV and UA of N were significantly (p less than 0.01) higher than in MV of N. 3) The concentrations of ET in MV of N and sPIH correlated significantly (p less than 0.05) with diastolic blood pressure of N (r = 0.53). It was concluded that the synthesis of ET during pregnancy was suppressed until the 2nd trimester, and that the increased ET in MV of sPIH might be one of the factors that caused the pathogenesis of PIH. And the high concentration of ET in UV and UA was supposed to operate play a role in feto-placental circulation.     

Melatonin levels in maternal plasma before and during delivery, and in fetal and neonatal plasma

In the present study, in order to clarify the diurnal changes in pregnant women, fetuses and neonates, pineal hormone (melatonin) was analyzed with a RIA Kit. Results: 1. The venous melatonin concentration at night was higher than during the day in healthy women and full term pregnant women without labor. 2. Melatonin concentrations in maternal venous blood (MV) (67.44 pg/ml) were significantly higher than in umbilical venous blood (UV) (37.78 pg/ml). 3. A distinct midnight peak of melatonin was observed in MV, and UV at delivery. 4. Significant correlations were observed between MV, UV or umbilical arterial blood (UA), but those were non linear. 5. In neonates on the first to fourth day after birth, no midnight peak was able to be clearly observed, but fluctuations were observed. These result indicate that there is a diurnal change in melatonin in full term pregnant women without labor and women in labor. And we suggest that the pineal gland of early neonates secretes melatonin, but no diurnal change in melatonin is established up to 4th day after birth.     

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.     

Perinatal glucose metabolism as an indicator for stress and hypoxia during different forms of delivery

In 82 term newborns divided into three groups (spontaneous delivery, caesarean section and vacuum extraction) we investigated umbilical artery pH, artery and vein glucose levels and calculated the veno-arterial difference of glucose. The three groups showed significant differences of artery and vein glucose levels. The highest umbilical artery (UA) and umbilical vein (UV) glucose levels were found after vacuum extractions (n = 13, UA: 98 mg/dl, UV: 104 mg/dl), the lowest levels were present in the group of caesarean section (n = 16, UA: 52 mg/dl, UV: 65 mg/dl). After spontaneous deliveries the intermediate levels were observed (n = 55, UA: 70 mg/dl, UV: 84 mg/dl). The mean of UA-UV-glucose difference was low after vacuum extractions and statistically different from the values after caesarean section and spontaneous deliveries. The mean of UA-pH did not show statistically significant differences in the three groups. The regression analysis between UA-pH and UA-UV-glucose difference revealed a highly significant dependency in the group of caesarean section (p less than 0.01) but no dependency after vacuum extraction. Significant dependency was also found in the group of spontaneous delivery (p less than 0.05).     

Simultaneous determination of seven unconjugated steroids in maternal venous and umbilical arterial and venous serum in elective and emergency cesarean section at term.

In order to assess specific gluco- and mineralocorticoid functions in both mother and fetoplacental unit in relation to the presence or absence of labor, serum levels of unconjugated aldosterone (A), corticosterone (B), deoxycorticosterone (DOC), progesterone (P), 17-hydroxyprogesterone (17-OHP), cortisol (F), and cortisone (E) were determined simultaneously. These levels were determined by specific radioimmunoassays in two groups of 24 paired maternal venous and umbilical arterial and venous samples obtained at term delivery by either elective (Group I, N = 8) or emergency (Group II, N = 8) cesarean section. In Group II, after spontaneous labor, mean maternal serum levels of all steroids investigated exceeded those found in Group I (not in labor). These increases were most pronounced (p less than 0.005) in F (74%) and DOC (106%) levels demonstrating stimulation of both the glucocorticoid (cortisol)--and the mineralocorticoid (aldosterone)--producing pathways of the maternal adrenals by spontaneous labor. Arteriovenous differences in umbilical steroid levels revealed in both groups the placental origin of P, 17-OHP, and E (p less than 0.05 to 0.005), with greater (more negative) mean AV differences after labor (Group II). The negative AV difference of DOC, B, A, and F found in Group I, however, decreased after labor and became even positive in the cases of B and F, reflecting the close relationship between spontaneous labor and the fetal adrenal's active production not only of the glucocorticoids B and F, but also, to a lesser extent, of the mineralocorticoids DOC and aldosterone.     

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.     

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.     

Differences in umbilical venous and arterial leptin levels by mode of delivery

OBJECTIVE: To investigate the differences in umbilical venous and arterial leptin levels by mode of delivery. METHODS: Subjects were 30 mothers who had elective cesarean deliveries and 34 mothers who had vaginal deliveries. Umbilical venous and arterial leptin levels were measured immediately after delivery. Maternal age, neonatal gender, neonatal birth weight, placental weight, and gestational duration were recorded. Inter- and intragroup comparisons were made in umbilical venous and arterial leptin levels and obstetric variables. Significant determinants of differences in umbilical venous and arterial leptin levels were investigated. RESULTS: Umbilical venous and arterial leptin levels were higher in the vaginal delivery group (n = 34) than in the cesarean group (n = 30) (P <.01). In the vaginal delivery group, umbilical venous leptin levels were significantly higher than arterial leptin levels (P <.001). These differences were still significant after adjustment for neonatal gender, neonatal birth weight, and placental weight. However, in the cesarean group, leptin levels did not differ between umbilical vein and artery. CONCLUSION: Placental leptin release is augumented during advanced labor.     

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.     

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.     

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)     

Lumbar epidural analgesia with bupivacaine in labor. Drug concentration in maternal and neonatal blood at birth and during the first day of life.

Lumbar epidural analgesia with bupivacaine was administered to 33 women for relief of pain during labor. At delivery blood samples were drawn from the umbilical cord vessels and from a maternal peripheral vein. Blood samples were also collected from the noenate and its mother, 1, 4, and 20 hours after delivery. Analyses of bupivaccaine concentrations were carried out in all samples with a gas-chromatographic technique. The drug concentration in the umbilical vein (UV) was usually higher than the corresponding umbilical artery value (UA), but with increasing time interval between the last bupivaccaine infection and delivery the UA/UV drug concentration ratio rose. After delivery the rate of drug decline in blood was similar in mother and newborn infant. The clinical condition of the infant was unrelated to the drug concentration in the umbilical cord vessels.     

The effect of diazepam on neonatal neurobehavioral response

Diazepam was administered I.V. in 10mg doses to 26 normal women in labor, and its blood concentration in the mother and newborn, Apgar score and acid-base status in umbilical cord blood were determined immediately after delivery. The effect of diazepam on the neurobehavioral response of the newborn was evaluated by using the early neonatal neurobehavioral scale (ENNS) by Scanlon et al. Diazepam was swiftly transported into fetal blood through the placenta, to attain a higher blood concentration in the umbilical vein (UV) than in the maternal vein (MV) at 1-2 min after administration. The UV blood concentration of diazepam was always higher than the MV blood concentration, irrespective of the time between administration and delivery. A comparison of the blood concentration in the umbilical vein and the umbilical artery (UA), showed that the UV blood concentration was higher until 30 min after administration, but roughly eqalled the UA blood concentration thereafter. In terms of mean values in all the patients, the blood concentration in the UV (506 +/- 245 ng/ml) was significantly higher than that in the MV (350 +/- 204 ng/ml) or the UA (394 +/- 142 ng/ml). No significant difference was detected between the diazepam-treated group and the control in respect to the Apgar score, acid-base status in cord blood, neonatal serum bilirubin or time required for restration of the newborn to body weight at birth. The ENNS test showed suppression of nearly all the response immediately after birth, with suppression of response to pinprick, rooting response and sucking response persisting until 8 hr after birth.(ABSTRACT TRUNCATED AT 250 WORDS)