The effect of mild hypoxemia maintained for twenty-four hours on maternal and fetal glucose, lactate, cortisol, and arginine vasopressin in pregnant sheep at 122 to 139 days' gestation

Development and function of the fetal adrenal

The adrenal cortex undergoes multiple structural and functional rearrangements to satisfy the systemic needs for steroids during fetal life, postnatal development, and adulthood. A fully functional adrenal cortex relies on the proper subdivision in regions or 'zones' with distinct but interconnected functions, which evolve from the early embryonic stages to adulthood, and rely on a fine-tuned gene network. In particular, the steroidogenic activity of the fetal adrenal is instrumental in maintaining normal fetal development and growth. Here, we review and discuss the most recent advances in our understanding of embryonic and fetal adrenal development, including the known causes for adrenal dys-/agenesis, and the steroidogenic pathways that link the fetal adrenal with the hormone system of the mother through the fetal-placental unit. Finally, we discuss what we think are the major open questions in the field, including, among others, the impact of osteocalcin, thyroid hormone, and other hormone systems on adrenal development and function, and the reliability of rodents as models of adrenal pathophysiology.

Perinatal cortisol and blood glucose concentrations in bitches and neonatal puppies: effects of mode of whelping

The decision on how and when to assist whelping is crucial for the survival rate of puppies and health status of the dam. However, medical or surgical therapy in dystocia can impact both maternal and neonatal stress and glucose response differently. This study aims to compare perinatal cortisol and glucose among different modes of delivery in bitches and neonates. We analyzed 50 puppies derived from 27 healthy bitches. According to the condition at birth, bitches and their puppies were allocated into either a Eutocia Group (vaginal birth with no whelping assistance), Fetal Dystocia Group (whelping assistance with fetal manipulation), Maternal Dystocia Group (whelping assistance because of partial uterine inertia corrected by oxytocin administration), or Cesarean Section Group (fetal or maternal dystocia bitches subjected to C-section). Maternal blood cortisol and glucose concentrations were analyzed during the perinatal period (prepartum, intrapartum, postpartum, and 1 h after postpartum). Neonatal blood samples were collected within 5 min and 1 h after birth for assessment of cortisol and glucose. Maternal dystocia bitches had higher cortisol concentrations at postpartum than the Fetal Dystocia Group. At 1 h postpartum, the Cesarean Section Group had higher cortisol concentrations compared with fetal dystocia bitches. The Eutocia Group presented increased cortisol concentrations at intrapartum and postpartum, whereas fetal dystocia bitches had higher intrapartum cortisol concentrations than at 1 h postpartum. The Maternal Dystocia Group presented higher postpartum cortisol concentrations than at prepartum and 1 h postpartum. Maternal glucose had a progressive increase throughout peripartum and was higher during postpartum and at 1 h postpartum. C-section bitches had the highest blood glucose concentration. Neonatal cortisol concentrations at birth were higher than 1 h after birth. Fetal dystocia puppies had higher cortisol concentrations, whereas caesarian section puppies had lower cortisol levels. Fetal dystocia and C-section puppies had higher glucose concentrations than the Eutocia Group. In conclusion, maternal dystocia leads to high cortisol concentrations in bitches immediately postpartum, whereas only fetal dystocia causes increased neonatal cortisol concentrations. Moreover, fetal dystocia and C-section are hyperglycemic obstetrical conditions for neonatal puppies; on the other hand, only C-section causes hyperglycemia in bitches.

Changes in fetal lamb arterial blood gas and acid-base status with advancing gestation

To determine whether there are changes in blood gas and acid-base status with advancing gestation in the fetal lamb, similar to that reported in the human fetus, blood gas, acid-base, and blood metabolite values were measured in 447 control, arterial blood samples from 108 chronically instrumented fetal lambs between 103 and 146 days gestation. With advancing gestation, Po(2), pH, O(2) saturation, and O(2) content fell significantly, while Pco(2) and hemoglobin concentration increased. Blood glucose and lactate concentrations were unchanged, although the lactate level increased with decreasing Po(2), particularly when below ~13 mmHg. Multiple linear regression indicated that increasing fetal number was associated with decreased Po(2) and glucose level and increased pH, HCO(3)(-), base excess, and lactate concentration. Hemoglobin concentration was higher in female than male lambs. Overall, there was a linear relationship between glucose concentration and birth weight. It is concluded that in fetal lambs as in the human fetus, there are changes in blood gas and acid-base status with advancing gestation. This may be due to the decrease in fetal weight-normalized uterine and umbilical blood flows than occurs in these and other species as gestation proceeds. In addition, the reduced birth weight in twin and triplet lambs may be due to hypoglycemia rather than hypoxemia.

Dynamics of sleep-wake cyclicity across the fetal period in sheep (Ovis aries)

All adult mammals examined thus far exhibit sleep bout durations that follow an exponential distribution and wake bout durations that follow a power-law distribution. In altricial rodents such as rats and mice, exponential distributions of sleep bouts are found soon after birth, but the power-law distribution of wake bouts does not emerge until the third postnatal week. Also, both sleep and bouts consolidate across the early postnatal period. It is not known whether similar developmental processes occur in precocial species during the prenatal period. Here we characterize sleep-wake development in a precocial species, the domestic sheep (Ovis aries), from 114 to 148 days gestational age (DGA). Sleep and wake bout durations exhibited exponential distributions throughout the fetal period with some evidence of an emerging exponential-to-power-law transition for wake bouts toward the end of gestation. Both sleep and wake bouts consolidated in an orderly fashion across development and there was little evidence of circadian variation, even in the oldest subjects. These results indicate that similar patterns of sleep-wake organization are found prenatally in a precocial species as are found postnatally in altricial species. Data from more species are needed to fully realize the benefits of a developmental comparative approach for understanding the forces that have shaped the ontogeny and phylogeny of mammalian sleep.

Long-term hypoxia enhances cortisol biosynthesis in near-term ovine fetal adrenal cortical cells

This study was designed to determine the potential mechanism/mechanisms of previously observed enhanced fetal cortisol secretion following exposure to long-term hypoxia (LTH). Pregnant ewes were maintained at high altitude (3820 m) for approximately the last 100 days of gestation. Between the gestation days of 138 and 141, adrenal glands were collected from LTH and age-matched normoxic control fetuses. Cyclic adenosine monophosphate (cAMP), cortisol, and steroidogenic acute regulatory (StAR) protein were measured in response to adrenocorticotropic hormone (ACTH) stimulation. Cortisol responses to ACTH were also measured in the presence of the protein kinase (PKA) inhibitor H-89, proopiomelanocortin (POMC), or 22-kDa pro-ACTH. Cortisol output was higher in the LTH group compared to the control (P < .05), following ACTH treatment while the cAMP response was similar in both groups. Although PKA inhibition decreased cortisol production in both groups, however no differences were observed between groups. Western analysis revealed a significant increase in protein expression for StAR in the LTH group (P < .05, compared to control). Proopiomelanocortin and 22-kDa pro-ACTH did not alter the cortisol response to ACTH treatment. Results from the present study taken together with those of previous in vivo studies suggest that the enhanced cortisol output in the LTH group is not the result of differences in cAMP generation or PKA. We conclude that enhanced cortisol production in LTH adrenals is the result of enhanced protein expression of StAR and potential downstream signaling pathways.

Cerebral blood flow and metabolism in the developing fetus

The inaccessibility of the human fetal brain to studies of perfusion and metabolism has impeded progress in the understanding of the normal and abnormal systems of oxygen substrate supply and demand. Consequently, current understanding is based on studies in fetal animals or in the premature infant (ex utero fetus), neither of which is ideal. Despite promising developments in fetal magnetic resonance imaging (MRI) and Doppler ultrasound, major advances in fetal neurodiagnostics will be required before rational and truly informed brainoriented care of the fetus becomes feasible.

Adenosine A1 and A2a receptors modulate insulinemia, glycemia, and lactatemia in fetal sheep

Adenosine A(1) and A(2A) receptor subtypes modulate metabolism in adult mammals. This study was designed to determine the role of these receptors in regulating plasma levels of insulin, glucose, and lactate in 20 chronically catheterized fetal sheep (>0.8 term). In normoxic fetuses (Pa(O(2)) approximately 24 Torr), systemic blockade of A(1) receptors with DPCPX (n = 6) increased plasma concentrations of insulin, glucose, and lactate, but antagonism of A(2A) receptors with ZM-241385 (n = 5) had no significant effects. Intravascular administration of adenosine (n = 9) reduced insulin concentrations and elevated glucose and lactate levels. DPCPX (n = 6) augmented the glycemic and lactatemic responses of adenosine. In contrast, ZM241385 (n = 5) virtually abolished adenosine-induced hyperglycemia and hyperlactatemia. Isocapnic hypoxia (Pa(O(2)) approximately 13 Torr) suppressed insulinemia and enhanced glycemia and lactatemia, but only the hyperglycemia was blunted by blockade of A(1) (n = 6) or A(2A) (n = 6) receptors. We conclude that 1) endogenous adenosine via A(1) receptors depresses plasma concentrations of insulin, glucose, and lactate; 2) exogenous adenosine via A(2A) receptors increases glucose and lactate levels, but these responses are dampened by stimulation of A(1) receptors; and 3) hypoxia, which increases endogenous adenosine concentrations, induces hyperglycemia that is partly mediated by activation of A(1) and A(2A) receptors. We predict that adenosine, via A(1) receptors, facilitates at least 12% of glucose uptake and utilization in normoxic fetuses.

Effects of long term administration of KUR-1246, a selective beta(2)-adrenoceptor agonist, on pregnant sheep and their fetuses

OBJECTIVE

To evaluate the safety of KUR-1246 as a tocolytic agent, we examined the effects of its long term infusion on respiratory and cardiovascular systems and general metabolism in pregnant sheep and their fetuses.

DESIGN

Animal experiment with chronically instrumented ewes and their fetuses.

SETTING

Center for animal experiments, Hokkaido University School of Medicine, Japan.

SAMPLE

Eight Suffolk ewes at 117 to 120 days of gestation.

METHODS

At 120-124 days of gestation, ewes (n= 4) were infused intravenously for 24 hours with KUR-1246 at 0.03 microg/kg/minute, a dose that completely inhibits oxytocin-induced uterine contractions in pregnant sheep. The controls received saline instead (n= 4). Statistical comparisons were carried out by repeated-measures ANOVA followed by Dunnett's test.

MAIN OUTCOME MEASURES

Maternal and fetal values of heart rate, blood pressure, plasma electrolytes, glucose, insulin and non-esterified fatty acid levels, and blood gases and lactate level.

RESULTS

The maternal plasma levels of KUR-1246 increased and reached a plateau at 15 hours or later from the start of the infusion, whereas the fetal levels of it were below the lower limit of quantification (0.1 ng/mL) throughout the experiment. Significant differences over time between the ewes that had received with KUR-1246 and the controls were found for the following parameters: maternal heart rate, blood lactate, plasma glucose, and plasma insulin levels, and fetal plasma glucose and plasma insulin levels (P < 0.05). In the KUR-1246 treated ewes, significant changes from the pre-infusion value were detected in maternal blood lactate and fetal plasma glucose levels within 6 hours from the start of the infusion (P < 0.05). No significant differences were observed in other parameters in either ewes or fetuses.

CONCLUSION

The physiologic changes induced by a 24-hour infusion of KUR-1246 were transient and considered to be within the compensatory capacity in both pregnant ewes and their fetuses, suggesting that KUR-1246 is a potentially safe tocolytic agent for use by long term infusion.

Chronic hypoxia alters vasoconstrictive responses of femoral artery in the fetal sheep

The purpose of this study was to determine if mild hypoxia alters the responsiveness to vasoactive agents in the renal and the femoral arteries in the fetal sheep. Ten pregnant sheep were operated under halothane anesthesia at 116 to 124 days' gestation. A maternal tracheal catheter was placed for infusing compressed air (control group, n=5) or nitrogen (hypoxia group, n=5) starting on post operative day 6 and maintained for 5 days. Femoral and renal arteries were harvested from the fetus to study the constriction response to phenylephrine (PE 10(-9) to 10(-5)mol/L). To determine the involvement of nitric oxide as a modulator of vessel constriction, N-nitro-L-arginine methyl ester (L-NAME) was used at a concentration of 10 -4 mol/L in parallel chambers. In the hypoxia group, maternal PaO2 significantly decreased from a base-line of 110.4+/-1.4 to 80.5+/-1.6 (mmHg, p<0.01), fetal PaO2 significantly decreased from a baseline of 20.9+/-0.3 to 15.5+/-0.1 (mmHg, p<0.01). Hypoxia was associated with a significant increase in PE maximal response in the absence (184.5+/-6.6 vs. 146.2+/-4.3) and presence (166.9+/-6.3 vs. 145.0+/-4.5) of L-NAME, and a decrease in EC50 in the absence (6.0+/-1.1 vs. 27.0+/-4.1) of L-NAME of femoral arteries. However, there were no significant differences in PE maximal response and EC50 in the absence and presence of L-NAME of renal arteries. We concluded that mild chronic hypoxia seems to increase the fetal femoral artery response to PE, but not in the fetal renal artery. This observation is consistent with a redistribution of cardiac output away from the carcass.

Chronic maternal fluoxetine infusion in pregnant sheep: effects on the maternal and fetal hypothalamic-pituitary-adrenal axes

Depression during pregnancy is frequently treated with the selective serotonin reuptake inhibitor, fluoxetine (FX). FX increases serotonergic neurotransmission and serotonin plays a role in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis. We have therefore investigated the effect of chronic administration of FX to the pregnant ewe on the maternal and fetal HPA axes. Nineteen late-gestation sheep were surgically prepared for chronic study of the fetus. FX (n = 7, 98.5 microg/kg/d) or sterile water (control, n = 8) was administered to the ewe for 8 d by constant rate i.v. infusion with an initial FX bolus dose of 70 mg. Maternal and fetal plasma ACTH and cortisol concentrations were determined at 0700 h each day. Maternal plasma ACTH concentrations fell on infusion d 2, but no changes were observed in maternal plasma cortisol concentrations. Fetal plasma ACTH concentrations increased on infusion d 7, and fetal plasma cortisol concentrations increased on infusion d 6, 7, and 8 in the FX group. In addition, the regression coefficient for the relationship between fetal ACTH and cortisol levels was significantly greater in the FX group compared with the control group. Thus, maternal FX treatment increased fetal plasma cortisol concentration. These results are of particular interest in the context that exposure of the fetus to excess glucocorticoids at critical windows during development has been shown to increase the risk of poor health outcomes in later life.

Maternally administered dexamethasone at 0.7 of gestation suppresses maternal and fetal pituitary and adrenal responses to hypoxemia in sheep

Women who are at risk of preterm delivery are treated with antenatal steroids to facilitate fetal lung maturation. During this period, there is a potential for fetal or maternal hypoxemia to occur. Fetal responses to hypoxemia in sheep are well documented. However, less is known regarding maternal responses to hypoxemia. Therefore, we determined the effects of dexamethasone (DM) on maternal and fetal responses to hypoxemia in sheep. Ewes received four i.m. injections of DM or saline at 12-h intervals beginning at 103 d of gestation. Samples for ACTH, cortisol, and glucose were collected at 0900 h. At 105 d of gestation, hypoxemia was induced for 1 h by maternal nitrogen gas inhalation. Samples for ACTH, cortisol, and glucose were collected at 15-min intervals before, during, and after the hypoxemia challenge. Fluorescent microspheres were administered to the mother and the fetus before and during hypoxemia to measure organ perfusion. DM suppressed basal fetal and maternal cortisol and ACTH concentrations but increased glucose levels. DM also increased fetal but not maternal blood pressure. In control subjects, hypoxemia elevated fetal and maternal cortisol and ACTH concentrations. These responses were obliterated by DM. Hypoxemia increased blood pressure in DM-exposed fetuses but not in control subjects. In addition, hypoxemia decreased fetal adrenal vascular resistance in saline but not DM fetuses or ewes from either treatment group. In summary, maternal administration of a low dose of DM at 0.7 of gestation suppresses maternal and fetal adrenal function and changes fetal responses to hypoxemic stress to resemble those observed later in gestation.

Use of umbilical artery base excess: algorithm for the timing of hypoxic injury

Intrapartum asphyxia is responsible for only a small proportion of cerebral palsy cases, although obstetricians are often held accountable. Umbilical cord pH and blood gas values provide valuable information regarding the status of the infant at birth; base excess determination quantifies the magnitude of metabolic acidosis, the putative risk factor for central neurologic injury. Human and animals studies have confirmed normal values of base excess before labor, and consistent rates of base excess change in relation to the degree of fetal hypoxemia or heart rate patterns. Thus, the combination of assumed base excess values before labor and measured values after birth, together with an assessment of degrees of fetal hypoxemia during labor, permits an interpolation of fetal base excess values throughout the course of labor. Because threshold levels of base excess (eg, -12 mmol/L) have been associated with an increased risk of neonatal neurologic injury, this approach provides a framework for the assessment of fetal heart rate tracings during labor and, potentially, the timing of hypoxic/ischemic injury.

Effect of maternal fluoxetine administration on uterine blood flow, fetal blood gas status, and growth

Clinical depression, diagnosed in 5-15% of women during pregnancy, increases the risk of negative pregnancy outcomes including an increased incidence of low birth weight newborns and preterm delivery. Fluoxetine, a selective serotonin reuptake inhibitor, is often prescribed to treat depression due to its efficacy, high margin of safety, and mild side effects. However, fluoxetine initially increases plasma serotonin concentration, and serotonin causes uterine vasoconstriction in sheep, which could result in fetal hypoxemia. To assess fetal fluoxetine effects, late-gestation pregnant sheep were surgically prepared for the measurement of blood gases, heart rate, blood pressure, and uterine artery blood flow (n = 29). Ewes received a 70-mg bolus i.v. infusion of fluoxetine over 2 min in 10 mL of sterile water followed by continuous infusion at a rate of 100 microg/min for 8 d (n = 14), or continuous infusion of sterile water (n = 15). Transient decreases in uterine artery blood flow, fetal PO(2), and oxygen saturation were observed within the first 15 min after fluoxetine exposure, which did not return to normal values by 24 h. Fetal pH decreased and PCO(2) increased over the first 4 h with a return to normal by 24 h. However, there were no differences in uterine artery blood flow, blood gas status, or cardiovascular measures between the control and fluoxetine group over the rest of the 8-d infusion period. Thus, fluoxetine exposure during pregnancy has transient effects on fetal status that may be of developmental consequence if they occur repetitively.

Delayed neuronal migration of protein kinase Cgamma immunoreactive cells in hippocampal CA1 area after 48 h of moderate hypoxemia in the near term ovine fetus

The brain is uniquely sensitive to disturbances in energy and oxygen supply, particularly during the early stage of life. Since hypoxemia can indirectly activate the intracellular messenger protein kinase C (PKC), we studied the PKCgamma-immunoreaction in the fetal hippocampal CA1 region of naive (n=4), instrumented control (n=7), and instrumented hypoxemic fetuses (n=14), at a mean gestational age of 127 days. Forty-eight hours of mild to moderate hypoxemia, were followed by a 48-h recovery period. Hypoxemia resulted in an increase in carotid blood flow (137% of control), and a shift towards a higher percentage of high-voltage electrocortical activity. After recovery, the fetal brain was fixated by perfusion of both carotid arteries, sectioned and immunostained for PKCgamma. The distribution of PKCgamma-immunoreactive cells was significantly changed after 48 h of hypoxemia in that the migration of cells (from the ventricular region towards the stratum pyramidale) was delayed (p<0.01) compared to naive and instrumented control animals. In contrast to the distribution, the relative total optical density of PKCgamma-ir cells and fibres in the CA1 hippocampal area was not significant different between the animal groups. We conclude that hypoxemia delayed migration of PKCgamma-ir cells, without neuronal degeneration.

Fetal and maternal adaptations to chronic hypoxia: prevention of premature labor in response to chronic stress

Both mother and fetus have the remarkable ability to adapt to conditions of chronic hypoxia during the course of gestation. One of these adaptations appears to be mechanisms that prevent premature delivery despite the chronic stress of hypoxia. Our studies in the chronically hypoxic sheep revealed that the fetal adrenal is less responsive to ACTH stimulation. This in turn may prevent a premature rise in cortisol that would normally trigger labor and delivery. In the rat, the myometrium is affected with a decrease in contractile sensitivity to oxytocin following chronic hypoxia. This response is mediated by a significant reduction in myometrial oxytocin receptors. Our preliminary studies have also suggested that this blunting of myometrial responsiveness also occurs in the chronically hypoxic sheep. Taken together, these data indicate an adaptive response by both mother and fetus to prevent preterm delivery in the face of a chronic stress.

Contractile activity of the uterus prior to labor alters the temporal organization of spontaneous motor activity in the fetal sheep

Contractile activity of the uterus before the onset of labor (uterine contractures) has been described in a number of species and provides a powerful source of repeated stimulation for the fetus throughout much of gestation. To understand how fetal behavior responds to this dynamic aspect of the intrauterine environment, we investigated the effects of uterine contractures on the temporal organization of spontaneous motor activity in the fetal sheep during the last fifth of gestation. Eleven fetuses were instrumented on 113-116 days of gestation (dGA). Electromyogram (EMG) activity was recorded from flexor and extensor muscles in the fetal forelimbs and hindlimbs, and from the uterus. Pooled limb EMG activity from 2300 hr to 0700 hr on 118, 125, 132, and 139 dGA before, during, and after uterine contractures was spectral analyzed to detect and quantify the cyclic organization in fetal motor activity. There was strong evidence of cyclic organization in fetal motor activity (CM) at each gestational age, similar to what has been described in the fetal rat and human. There was no evidence of developmental changes in the baseline spectral measures of CM. The most prominent feature of the response of CM to uterine contractures was a transient decrease in irregularity at 118-132 dGA. The strength of CM increased during contractures at 125 and 132 dGA, and a slight acceleration of CM during contractures was detected at 118 and 139 dGA. The results demonstrate that the stimulation associated with contractures influences an important source of complexity in early behavioral organization. The results are consistent with speculation by others that uterine contractures might induce transient cerebral hypoxemia in the fetus, and suggest that conditions established in the first few minutes of sustained uterine activity constitute the effective perturbation of CM.

Role of nitric oxide in the regulation of cerebral blood flow in the ovine foetus

1. Our aim was to determine the role of nitric oxide (NO) in regulating cerebral blood flow (CBF) in foetal sheep under conditions of both hypoxaemia and normoxaemia. 2. Aseptic surgery was performed on 11 pregnant sheep at 125 +/- 1.1 days of gestational age (g.a.) when foetal vascular catheters were implanted for the measurement of CBF using coloured microspheres. Additionally, each ewe was prepared for one of two procedures for inducing foetal hypoxaemia; either an adjustable clamp was placed around the maternal common internal iliac artery to reduce uterine blood flow, or a catheter was implanted into the maternal trachea for insufflation of N2. At 131 +/- 0.3 days g.a., in control foetuses (n = 5), CBF and cerebral vascular resistance (CVR) were measured under basal (normoxaemic) conditions and after 3h of hypoxaemia. In other foetuses (n = 6) CBF and CVR were measured under basal conditions and after 3 h of hypoxaemia; in these foetuses NO synthesis was inhibited with N-nitro-L-arginine (NOLA) between 2-3 h of hypoxaemia. 3. In the hypoxaemia experiments foetal SaO2 and PaO2 were reduced (P < 0.05) in both control and NOLA-treated foetuses, from normoxaemic values of 69.5 +/- 2.1% and 23.8 +/- 1.0 mmHg, respectively, to 29.3 +/- 1.0% and 14.6 +/- 0.4 mmHg during the period of hypoxaemia. In control foetuses, CBF (mL/min) was increased by 82.7% during hypoxaemia; in NOLA-treated foetuses CBF increased by 55.3%, which was less (P < 0.05) than in control foetuses. In control foetuses CVR (mmHg)/ mL/min) was reduced by 43.5% during hypoxaemia, whereas in NOLA-treated foetuses there was no significant change. 4. In five of the 11 foetuses, the role of NO in regulating CBF under basal (normoxaemic) conditions was determined at 132 +/- 0.3 days g.a. Cerebral blood flow and CVR did not significantly change from basal values after NOLA-treatment. 5. We conclude that in foetal sheep NO plays an important role in regulating cerebral vascular tone and hence CBF during hypoxaemia, but its contribution during normoxaemia is less apparent.

Fetal circulatory responses during maternal bleeding

The purpose of this study was to investigate the fetal circulatory responses during maternal hemorrhage. Five pregnant goats with fetuses with a mean gestational age of 132 +/- 2 days were used. The maternal blood was withdrawn at 350 ml/h for 2 hours (e.g. 700 ml, 11.9 ml/kg maternal weight) and reinfused at the same speed. During maternal bleeding, maternal arterial pressure (MAP) gradually decreased. As a result of this maternal hypotension, fetal arterial pO2 and pH decreased, and PCO2 increased. After the reinfusion, fetal pO2 recovered but pH and PCO2 did not recover. Fetal arterial pressure (FAP) increased and heart rate (FHR) decreased during maternal bleeding and returned to the control level, after the reinfusion. Fetal arginine vasopressin (AVP) concentration increased to 401.2 +/- 318.5 pg/ml at the maximum bleeding. There were significant positive correlation between AVP concentration and FAP, and negative correlation between AVP and FHR during maternal bleeding. Therefore, we concluded that 700 ml maternal bleeding for 2 hours resulted the decrease in fetal pH, pO2, and FHR, and increase in PCO2, FAP, and AVP concentration. Fetal pH, PCO2, and AVP did not return to the control level in spite of reinfusion.

Growth deficient fetuses with absent or reversed umbilical artery end-diastolic flow are metabolically compromised

Controversy continues regarding the clinical relevance of absent or reversed umbilical artery blood flow during diastole. The purpose of this study was to characterize the blood gas and lactate measurements of growth deficient fetuses with absent (ADF) or reversed (RDF) umbilical artery (UA) diastolic flow. In a descriptive study from February 1988 through October 1991, 42 consecutive structurally and karyotypically normal growth deficient fetuses identified to have either ADF or RDF diastolic flow in the UA were studied. Heparinized blood specimens were obtained from them and the pH, PCO2, PO2 and lactate measured. Fourteen of these specimens were obtained from the umbilical vein by cordocentesis and 28 at the caesarean delivery of non-labouring patients. Statistical analyses were performed using Fisher's exact test, Student t-test and linear correlation. All measured parameters in fetuses with ADF or RDF undergoing cordocentesis were significantly abnormal compared to gestational age corrected norms. Both the mean venous and arterial pH of fetuses with RDF were significantly lower than that of fetuses with ADF. With few exceptions, preoperative maternal oxygenation failed to correct the fetal hypoxaemia associated with either ADF or RDF. In the setting of severe fetal growth deficiency secondary to uteroplacental dysfunction, ADF and RDF are clinically reliable indicators of fetal compromise as determined by the umbilical blood gases. RDF is associated with a greater impairment of placental gas exchange than ADF.

Swallowing of lung liquid and amniotic fluid by the ovine fetus under normoxic and hypoxic conditions

OBJECTIVE

The lungs of the mammalian fetus secrete large volumes of fluid daily. The purpose of this study was to estimate the fraction of the lung liquid that is swallowed as it exits the fetal trachea versus that which enters the amniotic fluid under normoxic and hypoxic conditions.

STUDY DESIGN

In chronically catheterized fetal sheep at 119 to 133 days' gestation the volume of fluid swallowed by the fetus was monitored five times per day for three consecutive 24-hour periods: control, hypoxia, and recovery. The Na+, K+, and Cl- concentrations of the swallowed fluid, lung liquid, and amniotic fluid were measured simultaneously. The fraction of the swallowed fluid that originated from the lungs or amniotic fluid was calculated from 24-hour average compositions and the assumption that the fetus swallowed only amniotic fluid and lung liquid.

RESULTS

During the control, hypoxia, and recovery periods the fetuses swallowed 264 +/- 43 (SE), 92 +/- 23, and 271 +/- 24 ml/kg of fetal weight per day, respectively. As determined from Cl- concentrations, this swallowed fluid was composed of 17.7% +/- 2.7%, 24.8% +/- 5.8%, and 11.9% +/- 3.4% lung liquid, respectively, with the remainder being amniotic fluid. Throughout the three 24-hour observation periods there was an inverse relationship between the net 24-hour swallowed volume and the fraction of the swallowed fluid that originated from the lungs. Calculations based on Na+ concentrations yielded essentially the same results with slightly more scatter, whereas calculations based on K+ concentrations were unreliable.

CONCLUSIONS

(1) Chloride concentrations provide the best of the three index values for a compositional analysis of fluids swallowed by the fetus. (2) Under normoxic conditions around 18% of swallowed fluid is derived from the fetal lungs. (3) On the basis of published fluid secretion rates for the fetal lung, an average of 50% of the liquid that exits the fetal trachea is swallowed and the rest mixes with the amniotic fluid.

The ovine fetal sympathoadrenal response to the maternal administration of methamphetamine

OBJECTIVE

We hypothesized that maternally administered methamphetamine would alter fetal sympathoadrenal activity.

STUDY DESIGN

Six chronically catheterized near-term pregnant ewes received an intravenous bolus injection of methamphetamine (1.25 mg/kg). Maternal and fetal arterial blood gas values, glucose, insulin, lactate, and catecholamines were measured in the control period and at 15, 30, 60, 90, 120, and 180 minutes after methamphetamine.

RESULTS

Fetal PO2 decreased from 21.4 +/- 1.9 mm Hg at control measurement to 15.3 +/- 3.3 mm Hg after 60 minutes (p < 0.05). Fetal pH declined from 7.35 +/- 0.014 at control to 7.29 +/- 0.024 after 180 minutes. Fetal plasma glucose rose from 15.3 +/- 2.4 mg/dl at control to peak at 51.2 +/- 6.8 mg/dl at 120 minutes. Insulin levels increased from a control of 40.5 +/- 8.06 to a peak of 128 +/- 46 microIU/ml at 180 minutes (p < 0.05). Lactate levels increased from a baseline of 33.5 +/- 2.0 mg/dl to 92.3 +/- 22.8 mg/dl at 180 minutes. Fetal catecholamines rose from a baseline of 153 +/- 20.2 pg/ml for epinephrine and 226 +/- 18.5 pg/ml for norepinephrine to maximum values of 518 +/- 87.3 and 661 +/- 59.3 pg/ml at 15 minutes (p < 0.05), declining thereafter.

CONCLUSIONS

Maternal administration of methamphetamine is associated with a short-term increase in circulating fetal catecholamines followed by hyperglycemia, lactacidemia, and hyperinsulinemia. These findings suggest that the alteration of fetal sympathoadrenal activity may contribute to the various perinatal complications associated with methamphetamine use.

Changes in ovine fetal adrenocortical responsiveness after long-term hypoxemia

This study tested the hypothesis that in the fetus long-term hypoxemia induces premature adrenocortical maturation and augments adrenal responsiveness to adrenocorticotropin hormone (ACTH). Pregnant ewes were exposed to high altitude (3,820 m) from 30 to 120 days gestation, when surgery was performed. Maternal arterial pressure of O2 (PaO2) was maintained at approximately 60 Torr by N2 infusion through a tracheal catheter. Fetal PaO2 was significantly lower in the hypoxemic (21 +/- 0.2 Torr) vs. normoxic (26 +/- 0.4 Torr) fetuses (P < 0.01). Between 125 and 140 days, basal ACTH and cortisol concentrations were similar in both groups. To assess changes in adrenal responsiveness, we challenged the fetuses with ACTH (100 ng/kg body wt, iv bolus) at 126 and 136 days. At 126 days, after ACTH challenge, fetal plasma ACTH peaked at similar values (275 +/- 43 and 250 +/- 26 pg/ml) in normoxic and hypoxemic fetuses, respectively. Plasma cortisol subsequently increased to 84 +/- 8 and 44 +/- 6 ng/ml in these groups. At 136 days, after ACTH challenge, plasma ACTH peaked at 379 +/- 57 and 336 +/- 21 pg/ml in normoxic and hypoxemic fetuses, respectively. Although plasma cortisol concentration in normoxic fetuses increased to 180 +/- 21 ng/ml, levels in hypoxemic fetuses only reached 62 +/- 12 ng/ml (P < 0.05 compared with normoxic). Catecholamine concentrations were not significantly different between the two groups. These data do not support the hypothesis that adrenocortical maturation occurs prematurely, augmenting adrenal responsiveness to ACTH after exposure to long-term hypoxemia. Rather, the ability of the fetus to respond to an ACTH challenge is blunted.

Corticotropin and cortisol responses to corticotropin-releasing factor in the chronically hypoxemic ovine fetus

OBJECTIVE

The purpose of this study was to determine if mild hypoxemia (approximately 25% below normal) of at least 5 days' duration alters corticotropin and cortisol responses to corticotropin-releasing factor.

STUDY DESIGN

We studied 14 (hypoxemic, n = 5; normoxemic, n = 9) fetuses of 135 +/- 1 (mean +/- SEM) days' gestational age. Fetuses were placed in the experimental group if arterial PO2 was < or = 16 mm Hg for 5 days. In normoxemic animals arterial PO2 was > or = 17 mm Hg. Plasma hormone responses were compared by analysis of variance.

RESULTS

Resting corticotropin levels were not different (hypoxemic 26 +/- 5 pg/ml, normoxemic 29 +/- 12 pg/ml), and corticotropin-releasing factor (530 +/- 30 ng/kg) increased (p = 0.01) corticotropin levels similarly in both groups. Basal plasma cortisol levels (hypoxemic 20 +/- 10 ng/ml, normoxemic, 30 +/- 7 ng/ml) were not significantly different. Both groups had similarly increased (p < 0.01) plasma cortisol levels after corticotropin-releasing factor administration.

CONCLUSION

Mild hypoxemia lasting 5 days does not significantly alter corticotropin and cortisol responses to corticotropin-releasing factor in the late-gestation ovine fetus.

Oxytocin given in a pulsatile manner to the ewe at 120 to 140 days' gestational age increases fetal sheep plasma cortisol

A single intravenous injection of oxytocin into pregnant sheep (123 to 144 days' gestational age) causes a bout of myometrial activity and an increase in fetal plasma corticotropin levels. We hypothesized that a sustained increased frequency of myometrial contractures accelerates the normal increase in fetal adrenal secretion in sheep in the last 3 weeks of gestation. To test this hypothesis, pulses of saline solution (group 1, 9 ewes and 10 fetuses) or oxytocin (group 2, 11 ewes and 12 fetuses) 600 or 960 microU/kg/min for 5 of every 30 minutes were infused into the maternal jugular vein for 6 days beginning at day 128 +/- 2 (mean +/- SD) days' gestational age. Total myometrial activity increased to 160% of baseline in group 2 by day 6. Myometrial activity did not change throughout the study in group 1. Maternal plasma cortisol concentrations did not rise during oxytocin infusion when compared with their own baselines (group 2) and were not different from concentrations in saline-infused ewes (group 1). By day 4 of oxytocin administration fetal plasma cortisol concentrations had risen significantly above baseline in group 2 (p less than 0.05). Fetal plasma cortisol concentrations did not rise in group 1. Corticotropin levels were not elevated in the fetal carotid arterial plasma of either group. A small but significant decrease occurred in fetal carotid arterial PO2 in group 2 by day 6 but not in group 1. In conclusion, increased myometrial activity produced by pulsed oxytocin is accompanied by increased fetal plasma cortisol concentrations, demonstrating that long-term alteration of myometrial activity affects fetal adrenal function over several days at this critical period of gestation.

Elevated fetal plasma lactate produces polyhydramnios in the sheep

In human fetuses with hemolytic diseases such as erythroblastosis fetalis, hydrops fetalis or polyhydramnios often develops. The mechanism(s) that produces these fluid imbalances is unknown, although lactate concentrations have been reported to be elevated in hydropic human fetuses with erythroblastosis. In this study we explored the role of lactate in producing fetal fluid imbalances. In seven near-term fetal sheep, we infused 5 mol/L sodium lactate at a rate of 10 mmol/hr for 3 days. Fetal plasma lactate rose by 6.0 +/- 1.0 (mean +/- SE) mmol/L above control. Fetal plasma osmolality and Na+ increased slightly, Cl- decreased, and bicarbonate rose in proportion to the Cl- decrease. Fetal renal lactate excretion was 1.1 +/- 0.3 mmol/hr while Na+ excretion was 10.6 +/- 1.9 mEq/hr. Fetal urine flow increased by 1.9 +/- 0.4 L/day and the urine remained hypotonic relative to fetal plasma throughout the infusion. Amniotic fluid lactate and Na+ rose during the infusion period and remained elevated during a 24-hour recovery period. Amniotic plus allantoic fluid volume at autopsy was 5.3 +/- 0.8 L compared with a normal of 0.5 to 1.0 L. There was little evidence of fetal edema. In summary, a moderate sustained elevation in fetal plasma lactate concentration appears to be a powerful osmotic agent for fetal accumulation of fluid from the maternal compartment over a period of days. This may be the primary mechanism whereby hydrops fetalis or polyhydramnios develops in severely anemic human fetuses.

Cocaine in pregnancy: the effect of maternal administration of cocaine on the maternal and fetal pituitary-adrenal axes

The effects of cocaine on the maternal and fetal pituitary-adrenal axis in vivo during pregnancy have not been reported. Six pregnant ewes and their fetuses underwent instrumentation at 113 to 119 days' gestation. Ewes were assigned to receive an intravenous bolus injection of vehicle or cocaine (0.5, 1.0, or 2.0 mg.kg-1) at 124 to 136 days' gestation. Maternal arterial blood gases, fetal pH and fetal PCO2 were unchanged after injection of cocaine or vehicle. After administration of 2.0 mg.kg-1 cocaine, arterial fetal PO2 fell 3.2 +/- 1.72 mm Hg (p less than 0.05) at +5 minutes, returning to baseline by +15 minutes. Maternal and fetal adrenocorticotropin levels rose within 5 minutes after the highest cocaine dose (p less than 0.05). There was a significant (p less than 0.05) increase in maternal cortisol at all doses of cocaine and in fetal cortisol at +15 minutes after the 2.0 mg.kg-1.

Fetal and maternal endocrine responses to prolonged reductions in uterine blood flow in pregnant sheep

To examine the effects of sustained (48-hour) hypoxemia on fetal and maternal adrenocorticotropic hormone concentrations and on maternal progesterone, uterine blood flow was reduced in eight sheep at day 128 of pregnancy by means of an adjustable Teflon clamp placed around the maternal common internal iliac artery. Control measurements were made in four animals in which the vascular clamp was not adjusted. Fetal PaO2 fell from 20.6 +/- 1.1 mm Hg (mean +/- SEM) to 16.6 +/- 0.6 mm Hg within 1 hour after application of the clamp and remained suppressed during 48 hours. There was a transient acidemia at 1 to 2 hours that had corrected by 8 hours. Fetal adrenocorticotropic hormone levels rose from 24 +/- 6 to 1320 +/- 205 pg/ml at 2 hours but decreased by 16 hours. Measured by high-pressure liquid chromatography, more than 95% of immunoreactivity corresponded to adrenocorticotropic hormone1-39. Fetal cortisol levels rose by 6 hours and remained elevated through 48 hours. Maternal adrenocorticotropic hormone, cortisol, and progesterone levels were unchanged during the study period. We conclude that fetal hypoxemia-acidemia after restriction of uterine blood flow provokes fetal adrenocorticotropic hormone release, but the elevation in adrenocorticotropic hormone is not sustained. However, the level of fetal cortisol rises progressively, consistent with fetal adrenal activation.

Vasopressin in dehydrated and rehydrated ponies

Six pony mares deprived of water for 24 hours showed significant increases in plasma vasopressin (2.8 pg/ml) and osmolality (9 mosmol/kg). When water was made available the ponies drank rapidly (5 of 6 drank to satiety within 90 seconds) and corrected their fluid deficits precisely. Vasopressin did not return to predehydration levels until osmolality did after 15 minutes of access to water. The horse differs from rodents and humans, but is similar to pigs in that vasopressin levels do not fall before osmolality returns to normal. Oropharyngeal factors, therefore, may not be as important in vasopressin release in horses as in other species.