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.     

Hormonal studies in pregnancy. I. Total unconjugated estrogens in maternal peripheral vein, cord vein, and cord artery serum at delivery.

The concentration of unconjugated total estrogens (primarily estrone, estradiol-17beta, and estriol) were measured by rapid radioimmunoassay method in serum samples from maternal peripheral vein, cord vein, and cord artery in normal pregnancies at delivery. The serum concentration of total free estrogens found in cord vein was four to five times higher than in maternal peripheral vein and cord artery. Levels obtained in maternal peripheral vein, cord vein, and cord artery were 47.8+/-1.8, 140.1+/-8.57, 31.8+/-2.15 ng. per millilitre (+/-standard error of the mean), respectively. These values are compared with those reported by others.     

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.     

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.     

Inhibin A,inhibin B and activin A concentrations in umbilical cord artery and vein

Activin A and inhibins (A and B) are growth factors expressed during pregnancy by the human placenta ,decidua and fetal membranes ,and by several fetal organs. They are secreted in both the maternal and the fetal circulations ,but the net contribution of the fetus to inhibins/activin A production is still unclear. In the present study we determined whether there was a difference in the serum concentration of activin A ,inhibin A and inhibin B between the artery and vein of the umbilical cord. Arterial and venous umbilical cord blood was obtained immediately before elective Cesarean section of 16 term infants from uncomplicated pregnancies. Inhibins and activin A levels were assayed by specific enzyme-linked immuno-sorbent assays. The paired t-test and linear regression analysis were used to calculate statistical significance. Inhibin A levels did not differ between the artery and vein of the umbilical cord. In contrast ,arterial inhibin B levels were significantly (p < 0.001) lower ,and activin A concentrations significantly (p < 0.05) higher than the respective venous concentrations. A significant correlation between arterial and venous levels of inhibin A (r = 0.591; p < 0.05) ,inhibin B (r = 0.749; p < 0.0001) and activin A (r = 0.571; p < 0.05) was found. The present findings suggest that the human placenta is the main source of inhibin B ,and the fetus of activin A ,in the umbilical cord. In light of the possible roles played by inhibin and activin in erythroid differentiation ,protection of neurons against brain injury and modulation of adrenal and pancreatic hormone release ,the present data may be of help in evaluating their changes in the umbilical cord when gestational diseases occur.     

Inhibin A, inhibin B and activin A concentrations in umbilical cord artery and vein.

Activin A and inhibins (A and B) are growth factors expressed during pregnancy by the human placenta, decidua and fetal membranes, and by several fetal organs. They are secreted in both the maternal and the fetal circulations, but the net contribution of the fetus to inhibins/activin A production is still unclear. In the present study we determined whether there was a difference in the serum concentration of activin A, inhibin A and inhibin B between the artery and vein of the umbilical cord. Arterial and venous umbilical cord blood was obtained immediately before elective Cesarean section of 16 term infants from uncomplicated pregnancies. Inhibins and activin A levels were assayed by specific enzyme-linked immunosorbent assays. The paired t-test and linear regression analysis were used to calculate statistical significance. Inhibin A levels did not differ between the artery and vein of the umbilical cord. In contrast, arterial inhibin B levels were significantly (p < 0.001) lower, and activin A concentrations significantly (p < 0.05) higher than the respective venous concentrations. A significant correlation between arterial and venous levels of inhibin A (r = 0.591; p < 0.05), inhibin B (r = 0.749; p < 0.0001) and activin A (r = 0.571; p < 0.05) was found. The present findings suggest that the human placenta is the main source of inhibin B, and the fetus of activin A, in the umbilical cord. In light of the possible roles played by inhibin and activin in erythroid differentiation, protection of neurons against brain injury and modulation of adrenal and pancreatic hormone release, the present data may be of help in evaluating their changes in the umbilical cord when gestational diseases occur.     

Neutralizing antibodies against herpes simplex virus in maternal and umbilical cord serum.

Thirteen Japanese with a full term pregnancy were studied to determine maternal and neonatal serum neutralizing antibodies against herpes simplex virus (HSV). The study included 10 healthy persons, 2 with herpes genitalis and one with herpes oralis. We found that the serum neutralizing antibody titers in neonates were almost identical or slightly higher as compared to those in the mother and such findings suggest, that in the neonate, the lack of certain immunological responses may be responsible for generalized herpes simplex virus infection.     

Magnesium determination in maternal and umbilical cord serum following tocolysis with magnesium supplement

We carried out a tocolysis in 14 women with and in 13 women without magnesium and determined the magnesium level in maternal and cord serum. The magnesium determination could not give a declaration about the role of magnesium in diagnostic and therapy of preterm delivery.     

Ca, Mg, Cu and Zn contents of the maternal and umbilical cord serum in pregnancy-induced hypertension

Calcium, magnesium, copper and zinc in the maternal and umbilical cord serum were measured in 106 patients suffering from pregnancy-induced hypertension (PIH) and 106 controls. Mean maternal serum values of Ca, Mg, Cu and Zn in the PIH group were 2.460 mmol/L, 0.839 mmol/L, 35.094 mol/L and 8.408 mumol/L,respectively and were compared with the corresponding Values of 2.765 mmol/L, 0.834 mmol/L, 31.486 mumol/L, and 9.657 mumol/L in the controls. The Ca and Zn levels were lower and Cu higher in the PIH group (P less than 0.05 or P less than 0.01). No significant difference was found in the four elements in umbilical cord serum between the PIH cases and controls, indicating that the fetus can maintain an adequate Ca, Mg, Cu and Zn homeostasis even in pregnancy-induced hypertension. However, PIH cases had a lower Ca level in maternal serum than in umbilical cord serum. This study suggests that maternal serum Ca, Cu and Zn are related to PIH, and Ca might have a causal role in the development of PIH.     

Occurrence of circulating immune complexes in the umbilical cord serum of mature newborn infants

Serum was taken both from maternal and umbilical cord blood from 28 term deliveries (37th till 41st gestational week) for quantitative estimation of circulating immune complexes. Aim of the study was to evidence the transfer of circulating immune complexes from maternal into fetal circulation system quantitatively. Concentration of immune complexes in umbilical cord serum was between 50 to 90 per cent of that in maternal serum.     

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.     

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.     

Measurement of blood flow in maternal pelvic artery and umbilical cord artery with the ultrasonic pulsed Doppler flow method

The maternal pelvic artery was detected with the B-mode, and volume of flow through it measured with the pulsed ultrasound Doppler device in the supine and left recumbent positions. The blood flow state and vascular resistance of the maternal pelvic artery and of the umbilical cord artery were investigated in gestosis and normal pregnancy. The volume of blood flow through the right maternal pelvic artery showed a tendency to increase after the posture was changed to the left recumbent position. The peak frequency (Fp) showed a tendency to increase in gestosis, particularly in the edema group. The spectral width (SWp)/Fp value showed a tendency to be lower in the edema group than in normal subjects, and showed a higher value in hypertension accompanied by proteinuria than in normal subjects. As an indication of peripheral vascular resistance, the pulsatility index (PI) in the maternal pelvic artery was determined, and resistance index (RI) in the umbilical cord artery was also determined. The PI showed a tendency to increase more in gestosis than in normal subjects, particularly in hypertension accompanied by proteinuria. The RI was higher in maternal hypertension accompanied by proteinuria than in normal pregnancy. The hematocrit and fibrinogen vales were slightly higher, though insignificantly, in gestosis than in normal subjects.     

Glucose gradients of maternal vein-umbilical vein and umbilical vein-umbilical artery in normally grown and growth-retarded fetuses.

The present study was designed to investigate the roles of maternal-fetal glucose transport and fetal glucose utilization in the regulation of fetal growth. Maternal venous blood, umbilical arterial and venous blood were sampled simultaneously in 60 full-term appropriate-for gestational age (AGA) fetuses and 48 small-for-gestational-age (SGA) fetuses. The cases were divided into four groups: group 1 consisted of 35 AGA fetuses, group 2 consisted of 25 AGA fetuses, group 3 consisted of 25 SGA fetuses, and group 4 consisted of 22 SGA fetuses. The mothers of group 1 and 3 were given 2.5% glucose in 0.9% normal saline and those of groups 2 and 4 by cesarean section received normal saline or Ringer's lactate at least one hour prior to delivery of the fetus SGA fetuses were found to have hypoglycaemia of umbilical venous blood, increased (maternal vein-umbilical vein) MV-UV and decreased UV-UA (umbilical vein-umbilical artery) glucose gradients, all of which disappeared after maternal glucose supplementation. However, hypoinsulinemia and lower insulin/glucose ratio in SGA fetuses persisted either with or without maternal parenteral glucose infusion. Increased MV-UV and decreased UV-UA glucose gradients suggests placental dysfunction and poor glucose utilization in SGA fetuses. The lower fetal insulin/glucose ratio may imply pancreatic dysfunction in SGA fetuses, which did not respond to glucose challenge from the maternal side. It seems that in SGA fetuses, placental dysfunction interferes with maternal-fetal transfer with resulting fetal hypoglycemia; on the other hand, pancreatic dysfunction leads to poor glucose utilization and retarded intrauterine growth. However, the mechanism that primarily accounts for pancreatic dysfunction in these fetuses remains to be resolved.     

基质金属蛋白酶9及其组织抑制物1的水平变化与胎膜早破发病的关系

目的探讨母血、羊水、脐血中基质金属蛋白酶9(MMP-9)及金属蛋白酶组织抑制物1(TIMP-1)的水平变化与胎膜早破发病的关系。方法采用双抗体夹心酶联免疫吸附法,动态检测58例胎膜早破患者(胎膜早破组)及38例正常孕妇(对照组)的母血、羊水、脐血中MMP-9及TIMP-1的水平,同时进行胎膜组织的病理检查,对合并绒毛膜羊膜炎的患者也进行相应的MMP-9及TIMP-1的水平检测。结果(1)胎膜早破组母血、脐血及羊水中MMP-9水平分别为(141·9±84·6)、(138·2±81·4)及(85·6±27·5)ng/L,其水平均明显高于对照组,两组比较,差异有统计学意义(P<0·05、P<0·05及P<0·01);胎膜早破组母血、羊水、脐血中TIMP-1水平分别为(378·1±220·2)、(44·6±24·0)及(257·2±98·8)ng/L,其水平均明显低于对照组,两组比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。(2)母血、羊水、脐血中MMP-9的水平随破膜时间的延长而升高,尤其破膜时间超过24h时升高更为明显;而TIMP-1则随破膜时间的延长而下降,尤其破膜时间超过24h时降低更为明显。(3)两组共合并绒毛膜羊膜炎患者15例,其中胎膜早破组13例(13/58,22%),绒毛膜羊膜炎患者的母血、脐血、羊水中MMP-9水平分别为(183·8±84·7)、(171·2±92·9)及(95·5±21·1)ng/L,其水平均明显高于非绒毛膜羊膜炎患者(81例),两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。绒毛膜羊膜炎患者的母血、羊水、脐血中TIMP-1水平分别为(269·7±144·4)、(32·1±16·6)及(210·6±81·9)ng/L,其水平均明显低于非绒毛膜羊膜炎患者,两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。(4)胎膜早破组的新生儿Apgar评分≤7分者,其母血、脐血、羊水中MMP-9水平分别为(234·4±79·4)、(222·1±120·1)及(108·5±42·2)ng/L,其水平均明显高于Apgar评分≥8分者,两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01);与之相反,胎膜早破组的新生儿Apgar评分≤7分者,母血、羊水、脐血中TIMP-1的水平分别为(225·3±121·7)、(25·2±15·8)及(181·7±135·2)ng/L,其水平均明显低于Apgar评分≥8分者,两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。结论MMP-9水平的异常升高及TIMP-1水平的显著下降,是胎膜早破发病的重要机制。MMP-9及TIMP-1的水平检测可作为一种新的生物学标志物用于胎膜早破并绒毛膜羊膜炎感染的诊断,尤其适用于亚临床感染状态的早期诊断,并有助于评估新生儿预后。     

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.