Department of Perinatology, University Medical Centre, 100 3584 CX Utrecht, The Netherlands.
Pediatr Res. 2010 Nov;68(5):374-80. doi: 10.1203/PDR.0b013e3181ef7780.
In complicated labor, neonatal outcome may depend not only on the extent of fetal asphyxia and acidosis but also on the effects on the fetal cardiovascular system of reactive oxygen species (ROS) generated during the ischemia-reperfusion (I/R) associated with repeated compressions of the umbilical cord. This study tested the hypothesis that maternal treatment with clinical doses of the antioxidant allopurinol in the setting of fetal asphyxia would reduce oxidative stress in the fetal cardiovascular system. The hypothesis was tested in chronically instrumented fetal sheep in late gestation by investigating the effects of maternal treatment with therapeutic doses of allopurinol or vehicle on the fetal cardiovascular system during and after episodes of I/R. The latter were produced by repeated, measured compressions of the umbilical cord. The data show that maternal treatment with allopurinol helped maintain umbilical blood flow and it reduced fetal cardiac oxidative stress after I/R of the type associated with clinically relevant acidemia and repetitive fetal heart rate decelerations. The data support the hypothesis tested and suggest that maternal treatment with allopurinol may offer plausible clinical intervention in the management of perinatal asphyxia in complicated labor.
在复杂的分娩过程中，新生儿的结局可能不仅取决于胎儿窒息和酸中毒的程度，还取决于在与脐带反复压迫相关的缺血再灌注（I/R）过程中产生的活性氧（ROS）对胎儿心血管系统的影响。本研究检验了以下假设：在胎儿窒息的情况下，母体用临床剂量的抗氧化剂别嘌呤醇治疗，将减轻胎儿心血管系统中的氧化应激。通过在妊娠晚期对慢性仪器化胎儿羊进行研究，检验了这一假设，即在 I/R 期间和之后，母体用别嘌呤醇或载体进行治疗对胎儿心血管系统的影响，I/R 通过反复、有测量的脐带压迫产生。研究数据表明，母体用别嘌呤醇治疗有助于维持脐血流，并且在与临床相关的酸中毒和反复胎儿心率减速相关的 I/R 后降低胎儿心脏的氧化应激。这些数据支持了所测试的假设，并表明在复杂分娩过程中，母体用别嘌呤醇治疗可能为围产期窒息的管理提供合理的临床干预。
