Daisy S. McCann

The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor

The relationships among maternal anxiety, selected stress-related biochemical factors, and progress in three defined phases of labor were determined for 32 married, normal, primigravid women, 20 to 32 years of age. Comparisons of plasma epinephrine, norepinephrine, and cortisol in third-trimester pregnancy, during labor, and after delivery are provided. At the onset of Phase 2 of labor (3 cm. of cervical dilatation), self-reported anxiety and endogenous plasma epinephrine are significantly correlated. With the deletion of subjects to control for the effect of medications, higher epinephrine levels are significantly associated with lower uterine contractile activity at the onset of Phase 2 and with longer labor in Phase 2 (3 to 10 cm. of cervical dilatation). The relationship between epinephrine and progress in labor is explained by an adrenoreceptor theory.

Endocrine and Cardiovascular Responses During Phobic Anxiety

&NA; In vivo exposure therapy for phobias is uniquely suited for controlled studies of endocrine and physiologic responses during psychologic stress. In this study, exposure therapy induced significant increases in subjective anxiety, pulse, blood pressure, plasma norepinephrine, epinephrine, insulin, cortisol, and growth hormone, but did not change plasma glucagon or pancreatic polypeptide. Although the subjective and behavioral manifestations of anxiety were consistent and intense, the magnitude, consistency, timing, and concordance of endocrine and cardiovascular responses showed considerable variation.

Anxiety and epinephrine in multiparous women in labor: Relationship to duration of labor and fetal heart rate pattern

Abstract The duration of labor in multigravid subjects in phase 1 labor at term (from 3 to 6 cm of cervical dilatation; mean duration = 2.7 hours) was significantly related to measures of plasma epinephrine and norepinephrine obtained at the onset of the phase (n = 50). Epinephrine was significantly related to observer ratings of subject stress and the scores from the three dimensions of our self-report Labor Anxiety Inventory. The fetal heart rate pattern in phase 2 labor (7 to 10 cm of cervical dilatation; mean duration = 1.2 hours) was significantly related to phase 1 measures of epinephrine, observed stress, and two of the anxiety dimensions (n = 44 to 47). The results provide support for the hypotheses that, under normal clinical conditions, several types of patient anxiety are related to catecholamine levels and that anxiety and epinephrine are related to duration of labor and fetal well-being. The results suggest that medical/nursing evaluation and management of patient anxiety should include a self-report measure of three dimensions of anxiety (coping, safety, and pain), which are relatively independent of observed physical stress and which may relate to maternal labor progress as well as fetal heart rate pattern.

Endogenous plasma epinephrine and norepinephrine in last-trimester pregnancy and labor

Plasma epinephrine and norepinephrine concentrations during labor and immediately after delivery were compared to those of the third trimester in 21 uncomplicated pregnancies of married primigravid women, 20 to 32 years old. Third-trimester catecholamine concentrations were similar to those of normal, nonpregnant subjects; samples were obtained under identical conditions. Compared to third-trimester levels, significant elevations of plasma epinephrine and norepinephrine were found in three phases of labor (at 3 to 5 cm. and 9 to 10 cm. of cervical dilatation and immediately after delivery). Epinephrine values returned to normal within three to 21 minutes after delivery; norepinephrine values remained high or continued to rise in this time interval. Maternal analgesia and anesthesia influenced plasma catecholamine levels.

Relationship of psychological factors in pregnancy to progress in labor.

A prospective study of 32 normal, married primigravidas was conducted to determine the relationship between psychological factors in the third trimester of pregnancy and progress in two defined phases of labor. Data were analyzed for the total group and with five subjects deleted to control partially for the effect of medications. Psychological variables measured in pregnancy had significant correlations with variables measured at the onset of phase two labor. Conflict concerning the acceptance of pregnancy showed the most significant relationships to the phase two labor variables with correlations of .39 with anxiety. .59 with plasma epinephrine. –.70 and –.52 with two adjacent Montevideo units, and .58 with length of labor in phase two (3–10 cm cervical dilation). Other pregnancy variables which significantly correlated with the labor variables were identification of a motherhood role, history of psychological counseling or psychiatric treatment, the trait scale of the State-Trait Anxiety Inventory, and fears related to helplessness, pain, loss of control, and loss of self-esteem. Several psychological variables measured in pregnancy also correlated significantly with length of labor in phase three and type of delivery. The results demonstrate that specific psychological factors in pregnancy are predictive of progress in labor.

Maternal psychological and physiologic correlates of fetal-newborn health status

Data were obtained from 32 primigravid women in pregnancy and in labor. Anxiety in labor, measured by a self-report inventory, and plasma epinephrine were significantly correlated with the fetal heart rate pattern in active-phase labor (3 to 10 cm of cervical dilatation). The fetal heart rate pattern was significantly correlated with Apgar scores at 1 and 5 minutes. Conflict in the acceptance of pregnancy, measured in prenatal interviews, predicted anxiety and epinephrine levels in labor and the 5-minute Apgar score.

Renin, cortisol, and aldosterone during transcendental meditation.

&NA; The effects of transcendental meditation (TM) on plasma renin activity (PRA) and plasma concentrations of aldosterone, cortisol, and lactate were studied by measuring these variables before, during, and after 20‐30 min of meditation. Subjects, who rested quietly rather than meditating, served as controls. There were no differences in the basal values for these variables between meditators and controls, but controls, in contrast to meditators, showed a significant increase in cortisol between the first (A) and second (B) samples of the control period. PRA increased slightly (14%) but significantly (p < 0.03) during TM, but not during quiet rest in controls. Cortisol decreased progressively (after sample B) throughout the experiment to the same degree in both groups. Aldosterone and lactate did not change. The data do not support the hypothesis that TM induces a unique state characterized by decreased sympathetic activity or release from stress, but do suggest that meditators may be less responsive to an acute stress.

In vivo platelet aggregation and plasma catecholamines in acute myocardial infarction

In vivo platelet aggregation assessed with the Filtragometer and potential correlates were compared among (1) patients with acute myocardial infarction (AMI), (2) normal controls, (3) patients with acute chest pain in whom AMI was eventually ruled out (ROMI), and (4) chronic outpatients (Cardiac Clinic group) with a history of myocardial infarction and/or angina pectoris. The measure was independent of sex, age, platelet count, immediate food intake, serum cholesterol, and triglyceride levels. The AMI group showed higher in vivo platelet aggregation than any of the other three groups (p less than 0.01). Least in vivo aggregation was seen in the normal group. Despite lack of correlation with the platelet aggregation measure, plasma epinephrine and norepinephrine showed statistically significant differences between the AMI and each of the other three groups. Our data support an association between platelet function and AMI, although not necessarily a cause and effect relationship.

Urinary catecholamines and mitral valve prolapse in panic-anxiety patients

Free norepinephrine and epinephrine were measured in two consecutive 12-hour urine collections gathered during normal activity and sleep from 23 panic-anxiety patients and 9 normal subjects. Mitral value prolapse (MVP) was found in 7 of 20 patients who had echocardiograms. Mean nighttime norepinephrine and epinephrine excretion in panic-anxiety patients without MVP was significantly higher than that of control subjects, and was significantly higher than that of anxiety patients with MVP. In the daytime, all groups had higher catecholamine (CA) levels, but the differences between the groups were less pronounced. Medication significantly relieved symptoms and was associated with decreased CA levels. Elevated basal CA levels may characterize the subgroup of panic-anxiety patients who do not have MVP.

Circadian fluctuation of plasma epinephrine in supine humans

Previous studies have demonstrated circadian fluctuations of systemic catecholamines in man. However, methodological differences and conflicting results with epinephrine are apparent. In the present study, plasma and urinary epinephrine and norepinephrine and plasma cortisol were studied in healthy young adult males over 24 hr with 20 min plasma sampling and EEG monitoring of sleep. Plasma epinephrine did not have a circadian variation in supine subjects. Urinary epinephrine levels and small urinary circadian variations were increased by normal posture and activity. Sleep and sleep stage were not associated with different plasma epinephrine levels, and no ultradian fluctuation was observed. Levels of norepinephrine and cortisol were normal. Based on all studies to date, it appears that basal plasma epinephrine has either a very small amplitude or no circadian rhythm, but that changes in posture and activity or the rest/activity cycle may modify this pattern.