[Importance of the simultaneous measurement of the gases and pH of the umbilical vein blood at birth, especially in case of fetal distress. (Study of 160 cases)].
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Objective:To analyze the relationship between abnormality of fetus and its partal methodMethod:Analyze such relative factors as aminiotic fluid contamination,abnormal umbilical cord and compare them with their apgar scores in fetus who were given birth by cesarrean sectionResult:500 cases with intrauterire fetus distress receive cesarrean section according to fetus supervision,348% show aminiotic contamination,36% show abnormal umbilical cord,96% suffer new born suffocationAll the above have close relationshipAmiotic fluid contamination and suffocation of newborn are more common in 41～46 weeks and +42 weeks group than in 37～40 weeks groupCo~nclusion:Vaginal delivery can be tried under supervision for those with abnormal OCT 37～40 +6 weeks and clear aminotic fluid without high pregnancy factorAs for syndrom of hypertension pregnancy or prolonged pregnancy combined with extra less aminiotic fluid,cesarren section should be done if OCT show positive reaction
Abnormality
Apgar score
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To investigate the changes of umbilical cord and the vasoactive substance in umbilical vein in intrahepatic cholestasis of pregnancy.By HE staining method we analyzed the pathologic change of umbilical cord of 25 women with intrahepatic cholestasis of pregnancy (ICP) and fetal distress (ICP fetal distress group), 25 ICP women without fetal distress group (ICP control group) and 27 normal pregnancies (control group). The nitric oxide synthase (NOS) and endothelin-1 (ET-1) were detected in human umbilical vein endothelial cells (HUVEC) by immunohistochemistry method. Umbilical vein total bile acid (TBA) and NOS and ET-1 were measured.(1) A remarkable high TBA level was found in umbilical vein in ICP, and it was higher in ICP fetal distress group (19.0 +/- 2.3) micromol/L than in ICP control group (9.0 +/- 1.7) micromol/L (P < 0.05); it was higher in ICP control group than the control group (4.4 +/- 1.5) micromol/L (P < 0.05). (2) A significant difference was found in the endotheliocytes of umbilical vein in ICP fetal distress group compared with ICP control group. The ratio of cells with pathological changes in ICP fetal distress group (92%, 23/25) was higher than ICP control group (68%, 17/25; P < 0.05). The occurrence of the pathological changes was associated with TBA. (3) The expression of eNOS in ICP fetal distress group 0.09 +/- 0.06 was lower than in ICP control group 0.21 +/- 0.08 (P < 0.05), and it was lower in ICP control group than in control group 0.47 +/- 0.07 (P < 0.05). In contrast, the expression of ET-1 in ICP fetal distress group 0.49 +/- 0.08 was higher than in ICP control group 0.32 +/- 0.07 (P < 0.05), and it was higher in ICP control group than control group 0.14 +/- 0.06 (P < 0.05). The expression of inducible nitric oxide synthase (iNOS) in ICP fetal distress group 0.20 +/- 0.04 and ICP control group 0.21 +/- 0.05 was lower than in control group 0.26 +/- 0.04 (P < 0.05), but no significant difference was found in ICP fetal distress group and ICP control group (P > 0.05). (4) The expression of eNOS, iNOS and ET-1 was correlated with umbilical vein TBA in ICP (r1 = -0.88, r2 = -0.45, r3 = 0.9; P < 0.01), respectively.High level of TBA in ICP is harmful to the umbilical vein endothelium, which is correlated with the raised expression of ET-1, and the decreased expression of eNOS,and iNOS in human umbilical cord endothelium cells. All these changes of umbilical vein may be associated with the occurrence of fetal distress in ICP.
Cholestasis of pregnancy
Umbilical artery
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We measured maternal venous (MV), umbilical arterial (UA) and umbilical venous (UV) cortisol levels of 180 pregnancies at term, and investigated especially cases of fetal distress and neonatal asphyxia. No fetal distress and no neonatal asphyxia cases followed spontaneous vaginal deliveries (94), cesarean sections (18) or breech extractions (6). In cesarean section delivery, the cortisol levels of three individual samples were lower than in other modes of deliveries. The cortisol level of the umbilical artery was significantly higher than that of the umbilical vein in spontaneous vaginal delivery and cesarean section delivery. When spontaneous vaginal deliveries were classified into the fetal distress group and no fetal distress group, the cortisol levels of the umbilical artery and umbilical vein in the former group were significantly higher than those in the latter group. Furthermore, regardless of fetal distress there were significant positive correlations between the cortisol levels of MV & UA, MV & UV, and UA & UV. In addition, as the cortisol level of the maternal vein increased, the umbilical arterial-venous cortisol ratio (UA/UV) gradually approached 1.0. These data suggest that in fetal distress or neonatal asphyxia, the fetus may produce cortisol for itself independent of the mother.
Umbilical artery
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Umbilical artery
Venous blood
pCO2
Fetoscopy
Fetal circulation
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Summary The influence of differences of birth time upon umbilical cord acid‐base and blood gas status was studied in 46 women. Fetal umbilical vein/?H was significantly lower when either on view to end of delivery times or distending the perineum to end of delivery times were prolonged.
Fetal weight
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Objective This study investigated the relationship between umbilical vein diameter and cord length and fetal outcome in low-risk pregnancies (fetuses appropriate for gestational age [AGA]). Methods A prospective cohort study of 39 singleton pregnant women aged 19–44 years at between 38+0 and 41+6 weeks of gestation was conducted. Case demographics, umbilical vein diameter measured by prenatal ultrasound, postnatal birth weight, gender, 1- and 5-minute Apgar scores, blood gas analysis, and umbilical cord length were recorded. Fetuses with a fetal weight in the 10–90th percentile according to week of gestation were accepted as AGA. Results The mean age of the pregnant women was 27.5±5.3 years. 33% (13/39) of the pregnant women were nulliparous. There was no statistically significant correlation between umbilical vein diameter and other variables in correlation analysis (p>0.050). Umbilical cord length and umbilical vein lactate level were found to have a statistically negative and significant correlation (r=-0.418; p=0.015); however, no other pregnancy outcomes were found to have a significant correlation. There was no statistically significant difference between the median values of umbilical vein diameter and cord length by gender (p=0.076 and 0.181, respectively). Conclusion In conclusion, this study found no relationship between umbilical vein diameter and cord length and fetal weight and pregnancy outcome in low-risk 38.0–41.6-week pregnancies (AGA fetuses). However, the obtained results still need to be confirmed by larger series.
Apgar score
Demographics
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Objective To explore the possible mechanism of perinatal hypoxia by detecting the levels of cholyglycine(CG) in maternal serum and fetal umbilical cord serum in intrahepatic cholestasis of pregnancy(ICP).Methods The subjects included twenty-nine pregnant women with ICP and their newborns,twenty-nine healthy pregnant women and their newborns as normal controls.The levels of CG in maternal serum and fetal umbilical vein serum were measured by radioimmunoassay respectively.Results ① The concentrations of CG both in serum of pregnant women with ICP and in their fetal umbilical cord serum were higher significantly than those of controls(P0.01);② A positive correlation in CG level between maternal serum and fetal umbilical cord serum in ICP group(rs=0.772,P0.001) existed;③ In control group,the concentration of CG in fetal umbilical cord serum was higher than that in maternal serum(P0.001).This state reversed in ICP,in which CG level in maternal serum was higher than that in fetal umbilical cord serum significantly (P0.001);④ The incidences of fetal distress and neonatal asphyxia were all higher in ICP than those in controls(24.1%vs 3.4%,P0.05).In ICP group, significantly higher umbilical cord serum CG concentration was found in hypoxic fetuses as compared with fetuses without hypoxia,(P0.01).Conclusion The high maternal concentration of bile acids in ICP could cause accumulation of these compounds in her fetus, and this may be one of the mechanisms of fetal anoxia in ICP.
Cholestasis of pregnancy
Hypoxia
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