Ramin S M, Porter J C, Gilstrap L C, Rosenfeld C R
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235.
J Clin Endocrinol Metab. 1991 Jul;73(1):182-6. doi: 10.1210/jcem-73-1-182.
The relationship of plasma concentrations of arginine vasopressin (AVP), ACTH, cortisol, and PRL in the human fetus to mode of delivery and acid-base status has been investigated in 91 term pregnancies consisting of 4 groups based on mode of delivery, type of anesthesia, and use of ephedrine prophylaxis for maternal blood pressure control. Infants delivered vaginally after uncomplicated labors had higher umbilical cord plasma concentrations of AVP, ACTH, and cortisol than infants delivered without labor. Use of ephedrine, an alpha-agonist, during regional anesthesia was associated with elevated plasma AVP and ACTH concentrations compared to those in women receiving general anesthesia. At the time of delivery, 12 infants had acidemia (pH less than 7.20), as judged by pH of umbilical arterial blood. Their plasma AVP, ACTH, and cortisol levels did not differ from those of infants delivered by uncomplicated vaginal delivery, but were greater than those of infants delivered by cesarean section under general anesthesia. Moreover, in infants with acidemia, plasma concentrations of AVP and ACTH were significantly correlated, but PRL levels were unaffected by mode of delivery or acidemia. Elevated umbilical cord plasma concentrations of AVP, ACTH, and cortisol characterize term vaginal deliveries and are associated with intrauterine stress, demonstrating activation of the fetal hypothalamic-pituitary-adrenal axis and suggesting that AVP is important in ACTH release in the human fetus; however, PRL does not appear to be an important stress hormone.
在91例足月妊娠中，基于分娩方式、麻醉类型以及是否使用麻黄碱预防控制产妇血压，将其分为4组，研究了人胎儿血浆中精氨酸加压素（AVP）、促肾上腺皮质激素（ACTH）、皮质醇和催乳素（PRL）的浓度与分娩方式和酸碱状态之间的关系。顺产的婴儿脐带血浆中AVP、ACTH和皮质醇的浓度高于未经历分娩的婴儿。与接受全身麻醉的女性相比，区域麻醉期间使用α-激动剂麻黄碱与血浆AVP和ACTH浓度升高有关。分娩时，根据脐动脉血pH值判断，12例婴儿存在酸血症（pH值小于7.20）。他们的血浆AVP、ACTH和皮质醇水平与顺产婴儿的水平没有差异，但高于全身麻醉下剖宫产婴儿的水平。此外，在酸血症婴儿中，血浆AVP和ACTH浓度显著相关，但PRL水平不受分娩方式或酸血症的影响。足月阴道分娩的特征是脐带血浆中AVP、ACTH和皮质醇浓度升高，且与宫内应激有关，表明胎儿下丘脑-垂体-肾上腺轴被激活，提示AVP在人胎儿ACTH释放中起重要作用；然而，PRL似乎不是一种重要的应激激素。
