Pentti Jouppila

The effect of caffeine on placental and fetal blood flow in human pregnancy

The effects of maternal ingestion of two cups of coffee were investigated in 20 pregnancies during the last trimester. Maternal serum caffeine and epinephrine concentrations after 30 minutes were significantly elevated as compared with the fasting values (p less than 0.01). The intervillous placental blood flow decreased almost significantly (p less than 0.05). The fetal umbilical vein blood flow was unchanged. In patients with hypertensive pregnancy in the series there was reduced intervillous blood flow initially, and these values did not change after the maternal caffeine intake. The decrease of placental blood supply and increased maternal serum epinephrine levels associated with maternal coffee ingestion may be potential perinatologic risks, and more investigation about caffeine effects in human pregnancy is needed.

Ultrasonographic and Biochemical Markers of Human Fetal Cardiac Dysfunction in Placental Insufficiency

Background— Placental insufficiency may lead to fetal cardiovascular compromise. We sought to determine whether ultrasonographic parameters of fetal cardiovascular function correlate with umbilical arterial levels of biochemical markers of myocardial dysfunction and damage in placental insufficiency. Methods and Results— In 48 fetuses with placental insufficiency, umbilical artery blood was obtained at delivery for assessment of N-terminal peptide of proatrial natriuretic peptide (NT-proANP) and cardiac troponin-T (cTnT). Group 1 fetuses (n=12) had normal NT-proANP and cTnT serum concentrations. Group 2 fetuses (n=25) showed increased NT-proANP (>1145 pmol/L) and normal cTnT values. Group 3 fetuses (n=11) had increased NT-proANP and cTnT (>0.10 ng/mL) levels. The ultrasonographic parameters of fetal cardiovascular function were compared between the groups. Pulsatility indices for veins of the ductus venosus, left hepatic vein, and inferior vena cava correlated significantly with NT-proANP levels. In group...

INTERVILLOUS BLOOD FLOW IN NORMAL AND COMPLICATED LATE PREGNANCY MEASURED BY MEANS OF AN INTRAVENOUS 133XE METHOD

Abstract. Intervillous blood flow (IVBF) was measured intravenously with a new quantitative 133Xe method in 50 normal and 74 complicated late pregnancies between the 35th and 42nd weeks. The distribution of individual flow rates seemed to be fairly wide in both the normal and the pathological groups. The mean rate of IVBF in normal pregnancies was 140 ml/100 ml of intervillous space/min. The lowest mean flow values were observed in pregnancies complicated by diabetes mellitus (class B‐E), cholestasis of pregnancy and severe pre‐eclampsia, a highly significant difference (p<0.001) from the mean IVBF observed in normal pregnancies. The significance of the results in the different groups has been discussed in detail. This method may open up a new diagnostic area in the management of high‐risk pregnancies.

A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis

Objective To determine whether treatment of bacterial vaginosis (BV) with vaginal clindamycin affects pregnancy outcome.

Elimination and metabolic effects of ethanol in mother, fetus, and newborn infant☆

Abstract Ethanol was infused in 6 mothers from 90 min. to 3½ hours prior to delivery. The placental transfer and elimination as well as clinical and metabolic effects of ethanol in the mother, fetus, and newborn infant were studied. After 30 min. of infusion, a lower blood alcohol level was measured in the fetus than in the mother. After 60 min. this concentration gradient disappeared. Elimination in the newborn infant was approximately twice as slow as in the mother. Acid-base balance, blood glucose, and serum insulin levels in mother, fetus, or newborn infant did not show any conclusive changes due to ethanol infusion. A prolonged second stage of labor and a transient tendency to muscular hypotonia in the infants were found, but no significant untoward effects to the mothers were recorded.

Effect of maternal cigarette smoking on 3,4-benzpyrene and N-methylaniline metabolism in human fetal liver and placenta☆

Abstract The effect of maternal cigarette smoking on the metabolism of 3,4-benzpyrene (BP) and N -methylaniline (MA) was studied in human fetal liver and placenta. Maternal cigarette smoking apparently had no effect on fetal hepatic drug metabolism. Placentas from smokers, unlike those from nonsmokers, were able to metabolize BP both in the first half of pregnancy and at term. The critical duration of gestation for the appearance of the effect of cigarette smoking seemed to be about 10–11 wk. Metabolism of MA by placental homogenates was very low during the pregnancy, and maternal cigarette smoking had no effect on it. No correlation was established between the level of BP hydroxylase activity in the fetal liver and the level of BP hydroxylase activity in the placenta of the same mother. The fetal hepatic and placental BP hydroxylase systems were shown to differ in their response to maternal cigarette smoking, their subcellular location and their kinetic characteristics.

Increased vascular resistance in the descending aorta of the human fetus in hypoxia

Summary. Blood velocity waveforms from the fetal thoracic aorta, obtained by a combination of real‐time and Doppler ultrasound and a spectral analyser, detected a total end‐diastolic block in the curve in nine pregnancies with chronic fetal hypoxia. Simultaneous cardiotocographic recordings were normal except in one patient. These findings suggest that hypoxia causes an increase of peripheral vascular resistance in the tissues distal to the thoracic aorta and that this change appears earlier than pathological changes in the cardiotocogram. The potential clinical value of this technique justifies further research.

Placental transfer and fetal metabolism of diazepam in early human pregnancy

Abstract The rate of placental transfer and the ability of fetal tissues in vitro to metabolize diazepam was studied. The maternal blood level of diazepam increased rapidly following an intramuscular injection (5 mg.), and the drug crossed the placenta without delay. Up to 6 hours the cord blood levels of diazepam were about twice as high as those found in maternal blood. The peak concentrations in fetal tissues were obtained at one hour; the fetal liver and brain diazepam level remained quite unchanged during 6 hours. In 48 hours 86 per cent of the dose was recovered in maternal urine. Neither the premature placenta, term placenta, fetal brain, nor fetal small intestine metabolized diazepam. A constant enzyme activity metabolizing about 3 per cent of added diazepam was found in the fetal liver supernatant.

Randomized Trial of a Single Repeat Dose of Prenatal Betamethasone Treatment in Imminent Preterm Birth

BACKGROUND. A single dose of prenatal betamethasone treatment decreases neonatal morbidity rates when administered within 7 days before preterm delivery. A single repeat dose or booster dose of betamethasone before delivery has been proposed to be effective, but its efficacy has not been subjected to a randomized, blinded trial. METHODS. Women with imminent delivery before 34.0 gestational weeks were eligible if they remained without delivery for >7 days after a single course of betamethasone. After stratification, a single repeat dose of betamethasone (12 mg) or placebo was administered. The primary outcome was survival without respiratory distress syndrome or severe intraventricular hemorrhage (grade 3 or 4). RESULTS. A total of 249 mothers had been enrolled by the time the study was discontinued. All of the 159 infants in the betamethasone group and 167 in the placebo group were born before 36 weeks of gestation. The intact survival rate was unaffected and was lower than anticipated, because the gestational age-adjusted incidence of respiratory distress syndrome was higher than the population incidence. The requirement for surfactant therapy in respiratory distress syndrome was increased in the betamethasone group. According to posthoc analysis of the data for 206 infants who were delivered within 1 to 24 hours, the betamethasone booster tended to increase the risk of respiratory distress syndrome and to decrease intact survival rates. CONCLUSIONS. According to this study, a single booster dose of betamethasone just before preterm birth may perturb respiratory adaptation. These results caution against uncontrolled use of a repeat dose of glucocorticoid in high-risk pregnancies.

Fetal cardiac function and ductus arteriosus during indomethacin and sulindac therapy for threatened preterm labor: A randomized study

OBJECTIVE The purpose of this randomized study was to evaluate the effects of indomethacin (10 patients) and sulindac (10 patients) given for 4-days on the fetal cardiac function and ductus arteriosus in pregnancies complicated by threatened premature labor between 28 and 32 gestational weeks. STUDY DESIGN By use of pulsed color Doppler techniques the pulsatility index in fetal ductus arteriosus was calculated. Peak systolic velocities in the fetal ascending aorta and pulmonary trunk were also measured. By M-mode echocardiography both ventricular inner end-diastolic and end-systolic diameters were measured and ventricular fractional shortenings were calculated. Tricuspid valve regurgitation was evaluated by pulsed and color Doppler techniques. The ultrasonic examinations were made before and 4, 24, 48, and 72 hours after the start and 24 hours after the end of medication. RESULTS Indomethacin significantly decreased the mean pulsatility index in fetal ductus arteriosus 4 hours after the beginning of medication. This decrease became greater later during medication, and it was associated with a significant increase in both ventricular inner end-diastolic diameters and with a significant decrease in right ventricular fractional shortening. The mean pulsatility index in the fetal ductus arteriosus increased to control values at 24 hours after the end of medication. Sulindac significantly decreased the mean pulsatility index in fetal ductus arteriosus only 24 hours after the beginning of medication. All other mean pulsatility index values did not differ from control values. Other cardiac parameters remained unchanged during sulindac treatment. CONCLUSION Indomethacin has a significant reversible constrictive effect on the fetal ductus arteriosus that is associated with secondary changes, especially in the right ventricle. Sulindac seems to have only a mild and transient constrictive effect on the fetal ductus arteriosus.