Manchanda R, Vora M, Gruslin A
Department of Obstetrics and Gynecology, University of Ottawa, Ontario, Canada.
J Perinatol. 1999 Oct-Nov;19(7):479-82. doi: 10.1038/sj.jp.7200254.
To determine whether fetal erythropoietin (Epo) concentrations are increased in pregnancies extending beyond 41 weeks' gestation and whether this is influenced by the presence of meconium-stained amniotic fluid.
Epo concentrations were measured in 116 fetal umbilical cord blood samples from otherwise uncomplicated pregnancies between 37 to 43 weeks' gestation during the period of October 1996 to October 1997. An enzyme-linked immunosorbent assay kit was used to measure Epo. Maternal demographics and birth outcomes including Apgar score, cord blood pH, and base deficit were obtained. Fetuses born between 41 and 43 weeks' gestation (post-term) were compared with matched controls born between 37 and 40 weeks' gestation (term). In addition, both post-term and term fetuses with meconium-stained amniotic fluid were compared with matched controls without meconium.
Post-term fetuses without meconium had significantly higher Epo levels compared with term fetuses (mean +/- SEM: 50.6 +/- 6.5 versus 29.5 +/- 3.3 mIU/ml, p = 0.002). When matched for gestational age, fetuses with meconium-stained amniotic fluid had significantly greater Epo concentrations compared with controls without meconium (post-term, 80.7 versus 50.6 mIU/ml; term, 61.4 versus 29.5 mIU/ml; p < 0.05). However, no significant difference in Epo levels was found between post-term fetuses with meconium and term fetuses with meconium (80.7 +/- 15.7 mIU/ml versus 61.4 +/- 12.8 mIU/ml, respectively). Mean cord blood pH and base deficit values for all groups were within normal clinical range.
Cord blood Epo concentrations were significantly increased in pregnancies extending beyond 41 weeks. Irrespective of gestational age, meconium-stained amniotic fluid was associated with a significant rise in Epo. High Epo levels in these pregnancies imply subacute or chronic fetal hypoxia. Close clinical monitoring of post-term fetuses and those with meconium-stained amniotic fluid is warranted.
确定妊娠超过41周时胎儿促红细胞生成素（Epo）浓度是否升高，以及这是否受羊水胎粪污染的影响。
1996年10月至1997年10月期间，对116例孕37至43周、无其他并发症的胎儿脐带血样本进行Epo浓度检测。采用酶联免疫吸附测定试剂盒检测Epo。获取产妇人口统计学资料及出生结局，包括阿氏评分、脐血pH值和碱缺失。将孕41至43周出生的胎儿（过期产儿）与孕37至40周出生的匹配对照胎儿（足月儿）进行比较。此外，将羊水胎粪污染的过期产儿和足月儿与无胎粪污染的匹配对照进行比较。
无胎粪污染的过期产儿Epo水平显著高于足月儿（均值±标准误：50.6±6.5对29.5±3.3 mIU/ml，p = 0.002）。在孕周匹配时，羊水胎粪污染的胎儿Epo浓度显著高于无胎粪污染的对照胎儿（过期产儿，80.7对50.6 mIU/ml；足月儿，61.4对29.5 mIU/ml；p < 0.05）。然而，有胎粪污染的过期产儿与有胎粪污染的足月儿之间Epo水平无显著差异（分别为80.7±15.7 mIU/ml对61.4±12.8 mIU/ml）。所有组的平均脐血pH值和碱缺失值均在正常临床范围内。
妊娠超过41周时脐带血Epo浓度显著升高。无论孕周如何，羊水胎粪污染均与Epo显著升高有关。这些妊娠中Epo水平升高意味着胎儿亚急性或慢性缺氧。对过期产儿和羊水胎粪污染的胎儿进行密切临床监测是必要的。
