Properties of a lactate-induced relaxation in human placental arteries and veins

Methylglyoxal enhances sodium nitroprusside-induced relaxation in rat aorta

The concentration of methylglyoxal (MGO), a metabolite of glucose, increases in plasma of type II diabetic patients as well as in tissues of hypertensive rats. We have previously shown that MGO inhibited noradrenaline (NA)-induced smooth muscle contraction in rat aorta. However, the effect of MGO on relaxing responses in isolated blood vessel remains to be clarified. Thus, we examined if MGO affects acetylcholine (ACh)- or sodium nitroprusside (SNP)-induced vasodilation on NA (100 nM)-induced pre-contraction in rat thoracic aorta. Treatment of endothelium-intact aorta with MGO (420 microM, 30 min) did not change ACh (1 nM - 3 microM)-induced endothelium-dependent relaxation. In contrast, treatment of endothelium-denuded aorta with MGO shifted the concentration-response curve for SNP (0.1 - 300 nM) to the left. MGO increased reactive oxygen species (ROS) production in smooth muscle on analysis of protein carbonylation. Anti-oxidant agents such as tempol (10 microM), catalase (5000 U/mL), and nitric oxide synthase inhibitor, N(G)-nitro-L-arginine methylester (100 microM) had no effect on MGO-induced enhancement of SNP-induced relaxation. However, iberiotoxin (100 nM), a large-conductance Ca(2+)-activated K(+) (BK(Ca))-channel inhibitor, significantly prevented the effect. The present study revealed that MGO enhanced SNP-induced relaxation in a ROS-independent manner via in part opening smooth muscle BK(Ca) channels.

Fetal scalp and cord blood lactate

Lactate measurements have been evaluated in intrapartum fetal surveillance for some 30 years. However, it was not until reliable, handheld, microvolume devices were launched during the 1990s that lactate became a clinical option. Retrospective data suggest that lactate determinations in fetal scalp blood are better than pH for predicting severe neonatal morbidity. A randomised controlled trial comparing these two measurements found lactate to be more favourable in clinical practice in terms of less sampling failure and reduced time from the decision to do a fetal scalp blood sample to the clinician receiving the result. At present, a large multicenter randomised control trial is in progress in Sweden to compare lactate and pH measurement for the clinical management of suspected fetal compromise. Main end-points in the study are metabolic acidemia or pH <7.00 in cord arterial blood at delivery. Results are likely to be available in 2-3 years time.

Low umbilical artery vascular flow resistance and fetal outcome

BACKGROUND

An abnormally high [above mean + 2 standard deviations (SD)] umbilical artery (UA) pulsatility index (PI) indicates impaired fetal outcome, whereas the impact of an "abnormally" low (below mean -2 SD) PI is unknown.

METHODS

Perinatal outcome was compared between cases with a UA PI less than mean -2 SD (group A: high-risk cases selected from a database, n = 330; group B: unselected cases, n = 39) and unselected controls (group C) with a PI within mean +/- 2 SD (n = 863) at Doppler velocimetry. Groups B and C were retrieved from a population-based sample. The unpaired t-test, Mann-Whitney U-test, chi(2)-test and Fisher's exact probability test were used for statistical comparisons with a two-tailed p < 0.05 being significant.

RESULTS

No significant differences were found between group A vs. group C and group B vs. group C regarding perinatal mortality, Apgar scores at 1, 5 or 10 min, or arterial or venous cord blood pH. Postterm pregnancy in group A carried no additional risk. For obvious reasons, operative delivery and neonatal intensive care were more common in group A than in group C, but no such differences were found between groups B and C. The mean birthweight was 3.7% higher in group B than in group C (p = 0.049).

CONCLUSIONS

Deeming a UA PI below the lower reference limit as "abnormally" low is a statistical definition that was not reflected by a biological imperfection. Instead, a low UA PI promoted fetal growth.

Measurement of interstitial lactate during hypoxia-induced dilatation in isolated pressurised porcine coronary arteries

Lactate is formed in the coronary arterial wall and in the myocardium as a consequence of ischaemia and infarction. We combined direct measurement of coronary artery diameter and interstitial arterial wall lactate concentration ex vivo in order to ascertain the possible role of lactate in hypoxia-induced vasodilatation. The wall of porcine coronary arteries, precontracted during an intraluminal pressure of 40 mmHg by addition of prostaglandin F2alpha, was cannulated using a microdialysis catheter, and exposed to hypoxia for 60 min, followed by 45 min of reoxygenation. The exchange fraction of [14C]lactate over the microdialysis membrane increased from 0.38 +/- 0.04 to 0.52 +/- 0.05 (P < 0.001) during the study period. Coronary artery diameter increased by 15.5 +/- 2.0 % (n = 20) during hypoxia (P < 0.001, compared to normoxic controls) and interstitial lactate concentration rose from 1.07 +/- 0.21 to 2.50 +/- 0.40 mmol x l(-1) during hypoxia (P < 0.01) and was unchanged in controls. The increase in coronary artery diameter correlated with the increase in interstitial lactate concentration in the period between 30 and 60 min of hypoxia (r = 0.62; P = 0.02). Dichloroacetate (10(-5) M), an agent that reduces lactate generation by activating pyruvate dehydrogenase, abolished hypoxia-induced lactate production, but caused a further increase in coronary arterial diameter (30.2 +/- 4.4 %, n = 9; P < 0.001 vs. hypoxia and no dichloroacetate). Under control conditions, the addition of L-lactate (10(-3)-10(-2) M) increased dose-dependently coronary arterial diameter by 22.0 +/- 4.2 % (n = 5) and interstitial lactate concentration from 0.52 +/- 0.04 to 5.70 +/- 0.66 mmol x l(-1) (P < 0.001). There was a correlation between the increase in coronary artery diameter and interstitial lactate concentration (r = 0.60; P = 0.02). The present observations represent the first direct measurements of metabolites by microdialysis in a blood vessel wall. The lactate concentration may affect, but is not essential for, hypoxia-induced vasodilatation in porcine coronary arteries.

The metabolic, catecholamine and cardiovascular effects of exercise in human sympathetic denervation

The cardiovascular and metabolic responses to supine leg exercise were measured in 9 healthy subjects (controls) and in 19 subjects with two primary forms of autonomic failure (11 with peripheral sympathetic denervation [pure autonomic failure; PAF], 8 with central sympathetic failure [multiple system atrophy; MSA]). With exercise, blood pressure increased in controls and fell markedly in subjects with PAF and MSA. Blood pressure returned to baseline in controls, but remained low in the PAF and MSA groups. With exercise, heart rate increased more in controls than the PAF and MSA groups. Resting plasma noradrenaline concentrations in controls and in subjects with MSA were similar, but were lower in subjects with PAF. With exercise, plasma noradrenaline concentrations increased in controls and were unchanged in subjects with PAF; there was no significant increase in the MSA group. Resting plasma lactate, pyruvate and lactate/pyruvate ratios were similar in all three groups. With exercise, lactate concentrations increased until 2 minutes post exercise in all groups. Pyruvate concentrations after 9 minutes' exercise were higher in controls than in the PAF group but were similar to the MSA group; thereafter, concentrations increased similarly in all groups. The lactate/pyruvate ratio increased until 2 minutes post exercise in all groups. Resting plasma free fatty acids, and beta-hydroxybutyrate were similar in all groups. Plasma glycerol concentrations in control and MSA subjects were similar; concentrations were lower in PAF subjects. With exercise, plasma free fatty acids and glycerol concentrations remained unchanged in all groups; beta-hydroxybutyrate concentrations decreased less in control subjects than in PAF and MSA subjects. In conclusion, there were similar concentrations of plasma free fatty acids, glycerol and beta-hydroxybutyrate in control, PAF and MSA subjects; this could indicate up-regulation of beta-receptors in AF, or that sympathetic activity plays a smaller role in lipolysis. Plasma lactate and pyruvate concentrations increased similarly in all groups, despite marked differences in BP; this suggested an impairment of production or clearance of lactate in AF. A role for lactate-induced vasodilatation, not compensated for by sympathetic vasoconstriction, remains speculative.

Lactate measurements in scalp and cord arterial blood

Lactate has been measured to evaluate fetal metabolic acidosis for some decades. However, not until the past few years have reliable lactate meters become available for bedside obstetric practice. The new technology, which requires only 5 microl blood, has reduced the sampling failure rate of fetal scalp blood to almost nil. A growing body of evidence has also shown lactate to be good at predicting neonatal outcome.

Differential expression of lactate dehydrogenase isozymes (LDH) in human placenta with high expression of LDH-A(4) isozyme in the endothelial cells of pre-eclampsia villi

To evaluate the role of LDH isozymes in the human placenta during the third trimester, placentae were obtained from patients with normal pregnancy and pre-eclampsia. LDH-A(4)isozyme was immunolocalized primarily in the fetal endothelial cells while LDH-B(4)isozyme was predominantly present in syncytiotrophoblasts. This distinct cellular expression pattern of LDH isozymes was confirmed in HUVE and JEG cells. In addition to demonstrating the presence of five LDH isozymes in the placenta, zymograms showed that there was predominant activity of LDH-A(4)isozyme in HUVE cells and high activity of LDH-B(4)in JEG cells. Quantitative studies of LDH by agarose gel electrophoresis and Northern analysis in patients concluded that LDH-A(4)isozyme was increased in pre-eclampsia. The LDH-A(4)isozyme activity increased (P< 0.01) approx 1.6-fold in pre-eclampsia but there was no difference in the LDH-B(4)isozyme activity between placentae from normal compared to pre-eclampsia pregnancy. The level of LDH-A mRNA was increased (P< 0.05) approx twofold in pre-eclampsia. We conclude that the LDH-A gene in the endothelial cells of the placenta within the fetal microvasculature is increased in pre-eclampsia, probably as a result of hypoxia. LDH-A(4)isozyme activity and gene expression in placental endothelial cells, therefore, is a marker for the endothelial pathology seen in pre-eclampsia.

Alterations in relaxation to lactate and H(2)O(2) in human placental vessels from gestational diabetic pregnancies

We determined whether alterations in the mechanism of relaxation to H(2)O(2) potentially contribute to the enhanced prostaglandin-mediated contractile response to H(2)O(2) and posthypoxic reoxygenation seen in human placental vessels of pregnancies with gestational diabetes mellitus (GDM). Isolated placental arteries and veins from GDM and uncomplicated full-term pregnancies were precontracted with prostaglandin F(2alpha) (PO(2) 35-38 Torr) and then exposed to lactate (1-10 mM), arachidonic acid (0.01-10 microM), nitroglycerin (1 nM-1 microM), forskolin (0.01-10 microM), or H(2)O(2) (1 microM-1 mM + 10 microM indomethacin). The rates of tissue H(2)O(2) metabolism by catalase and nitrite production were measured. The relaxation to lactate was reduced in GDM placental arteries and veins by 54-85 and 66-80%, and the relaxation to H(2)O(2) was inhibited by 80-94% in GDM placental veins compared with vessels from uncomplicated full-term pregnancies. H(2)O(2) caused only minimal relaxation of placental arteries. Responses to other relaxing agents were not altered in the GDM placental vessels. Diabetic vessels showed rates of nitrite production that were increased by 113-195% and rates of H(2)O(2) metabolism by catalase that were decreased by 44-61%. The loss of relaxation to H(2)O(2) and lactate (mediated via H(2)O(2)), perhaps as a result of the inhibition of catalase by nitric oxide, may explain the previously reported enhancement of prostaglandin-mediated contractile responses to H(2)O(2) and posthypoxic reoxygenation seen in GDM placental vessels.

Roles for NAD(P)H oxidases and reactive oxygen species in vascular oxygen sensing mechanisms

Observations that physiological levels of O2 control the rates of production of reactive O2 species by systems including NAD(P)H oxidases and that certain of these species have signalling mechanisms that regulate vascular tone has resulted in consideration of these systems in processes that mediate the sensing of changes in P(O2). Evidence exists for the participation of hydrogen peroxide-dependent regulation of prostaglandin production and soluble guanylate cyclase activity, resulting from the metabolism of peroxide by cyclooxygenase and catalase, respectively, in P(O2)-elicited signalling mechanisms that regulate vascular force generation. A microsomal NADH oxidase whose activity is controlled by the redox status of cytosolic NAD(H) appears to function as a P(O2) sensor in bovine pulmonary and coronary arteries where changes in O2 levels control the production of superoxide anion-derived hydrogen peroxide and a cGMP-mediated relaxation response. Interactions with nitric oxide and superoxide anion, and the activity of glutathione peroxidase appear to influence the function of these O2 sensing systems, and some of these interactions, along with the activation of other oxidases, may contribute to alterations in P(O2) sensing mechanisms under pathophysiological conditions that affect vascular function.

Influence of glutathione peroxidase on coronary artery responses to alterations in PO2 and H2O2

Our previous work suggests that relaxation of endothelium-removed bovine coronary arteries (BCA) to posthypoxic reoxygenation is mediated by NADH oxidase-dependent superoxide anion-derived H2O2 and cGMP. The purpose of this study was to investigate if altering BCA GSH peroxidase activity by enhancing its activity with a GSH peroxidase-mimetic (0.1 mM Ebselen) or by inhibiting its activity with an inhibitor of GSH peroxidase [10 mM mercaptosuccinic acid (MS)] causes a selective modulation of responses to exogenously (1 microM-1 mM H2O2) and endogenously generated (reoxygenation and 1-10 mM lactate) H2O2. Ebselen inhibited and MS enhanced all of the responses that are thought to be mediated by H2O2, without having significant effects on relaxation to hypoxia or a nitric oxide donor [1 nM-10 microM S-nitroso-N-acetylpenicillamine (SNAP)]. Thus enhancement of BCA GSH peroxidase activity with Ebselen inhibits relaxation to reoxygenation, lactate, and H2O2, whereas inhibition of GSH peroxidase with MS causes potentiation of responses thought to be mediated by H2O2 in BCA. Inactivation of catalase by pretreatment of BCA with 3-amino-1,2,4-triazole (50 mM, 30 min) inhibited relaxation to H2O2 and the potentiation by MS. Whereas the actions of these probes are not consistent with a role for oxidation of GSH in the relaxation to H2O2, their effects are potentially a result of modulating the metabolism of H2O2 by endogenous catalase, which is thought to mediate the stimulation of the cytosolic or soluble form of guanylate cyclase.

Role of lactate measurements during labor

Lactate can safely and easily be determined in fetal scalp and umbilical artery blood with a new microvolume (5 microliters) lactate meter. Comparison between lactate and pH in scalp blood revealed a significant correlation (r = -0.43; P < .001). In a management trial where scalp lactate was compared to scalp pH, the lactate group underwent significantly more successful blood sampling procedures and fewer number of scalp incisions per blood sampling attempt. The mode of delivery and neonatal outcome were similar in patients managed with lactate and those using pH. Lactate concentration in umbilical artery blood had the same predictive properties as pH or base deficit in relation to poor neonatal outcome. Our data suggest that this method for lactate determination is robust and feasible and is suitable as a tool for fetal monitoring. Additional clinical management trials will be required to define the clinical usefulness of this method and how it should be combined with other modalities for fetal monitoring.

Isolated human chorionic vascular reactivity: technical considerations for fresh preparations

1. Sixty chorionic vascular rings from normal term placentas were immersed in an organ bath for isometric tension recording to study (A) the contractile response to 120 mM of potassium chloride (KCl) after adjustment and equilibration to 1-5 g of passive tension; and (B) the concentration-response curve to KCl after adjustment and equilibration to the optimal passive tension. 2. Adjustment to 4 g of passive tension elicited the maximal (P < 0.007) and the latest (P < 0.006) KCl-induced contraction among arterial rings. Venous rings showed the greatest contraction when adjusted to 3 g, but the differences were not significant except when compared to 1 g of passive tension (P < 0.03). 3. The EC50 for chorionic arteries and veins was 14.2 and 25.7 mM, respectively (P < 0.003). The maximal contraction was already obtained with 40 mM of KCl. 4. Our results suggest that (A) the optimal passive tension for fresh human chorionic arteries is 4 g; (B) chorionic venous reactivity is less influenced by the initial tension; and (C) the optimal concentration of KCl to be used as a contracting agent of these tissues is 40 mM.

Association between a low umbilical artery pulsatility index and fetal distress in labor in very prolonged pregnancies

OBJECTIVE

To investigate the association between fetal, umbilical and uterine circulatory changes and adverse perinatal findings in very prolonged pregnancies.

STUDY DESIGN

44 women proceeding to 43 completed weeks of gestation with the intention of a trial of vaginal delivery were studied prospectively with ultrasound Doppler velocimetry. An intensified fetal surveillance was routinely commenced at 42 weeks and only uncomplicated pregnancies were allowed to proceed. The endpoint perinatal measures were oligohydramnios, fetal meconium release, fetal distress in labor and birth asphyxia. Flow variables in different groups were compared with the Mann-Whitney U test, Student's unpaired t-test, Wilcoxon signed-rank matched-pairs test, Fisher's exact test and contingency table analysis, and a two-tailed P value <0.05 was considered statistically significant.

RESULTS

The umbilical artery pulsatility index was significantly lower in cases of fetal meconium release (n=12) and fetal distress (n=7). The umbilical venous flow velocity was significantly lower in cases of meconium, and the fetal aortic volume flow significantly higher in cases of fetal distress. No significant flow changes were found in connection with oligohydramnios (n=5) and birth asphyxia (n=2). Uterine flow was not significantly affected in any group.

CONCLUSIONS

In very prolonged pregnancies, fetal distress in labor was not associated with an increased placental vascular resistance. In contrast to previous reports, the umbilical artery pulsatility index was low in cases of fetal distress and meconium release. The etiology is unknown, but a subclinical fetal hypoxia might have triggered a vasodilation of placental vessels. Vasodilation at an unchanged volume flow could also explain the decrease of umbilical venous flow velocity. The increased aortic volume flow indicates an increase of cardiac output in fetuses later developing distress in labor.

Simultaneous measurements of lactate and blood flow during hypoxia and recovery from hypoxia in a localized region in the brain of the anesthetized rabbit

We observed simultaneous changes in lactate level and regional blood flow (rBF) in the brain of the anesthetized rabbit by using localized proton magnetic resonance spectroscopy (1H MRS) and laser Doppler flowmetry. The volume of interest of 0.5 ml for 1H MRS contained mostly thalamic nuclei. During hypoxia peak area for lactate increased up to 57% of that from N-Acetylaspartate. While the rBF increased during hypoxia up to 260% of the control, oxygen delivery (rBF x arterial oxygen content) decreased. In the normoxic recovery period following hypoxia, the rBF recovered slowly and a consequent overshoot of oxygen delivery was observed. The multiple and stepwise linear regression analyses revealed that the averaged decrease in oxygen delivery during hypoxia was the most significant independent variable for the increase in lactate during hypoxia (correlation coefficient; r2 = 0.68) and also that the increase in lactate during hypoxia was the most significant independent variable for the time for half-recovery of rBF (r2 = 0.75). These results suggest that the increase in lactate during hypoxia is due to the deficiency of oxygen delivery and that the increase in lactate during hypoxia prolongs the period of enhancement of rBF during recovery from hypoxia.

Lactate in cord blood and its relationship to pH and catecholamines in spontaneous vaginal deliveries

The interrelationships between lactate and pH, nonadrenaline (NA), adrenaline (A) and dopamine (DA) were investigated in cord artery (CA) and vein (GV) blood at delivery. Sixty consecutive, spontaneous, vaginal deliveries with fetuses in cephalic presentation were assessed. Median gestational age at delivery was 40 weeks (range, 35-43). There were significant correlations between lactate and pH (P < 0.01), NA (P < 0.01), A (P < 0.05) and arterio-venous NA (P < 0.05) and DA differences (P < 0.01) in CA blood, while no variable correlated significantly to lactate in CV blood. The higher levels both of lactate and of catecholamines in CA blood are probably fetally derived. Dividing the material into high and low lactate subgroups (cut-off level, 75th percentile) showed a high lactate level to be associated with lower pH and higher catecholamine levels in CA blood, though the relationship was only statistically significant for pH. The levels both of catecholamines and of lactate were lower than those reported for cases of fetal distress, and reflect the lower level of fetal stress in the present series of normal deliveries. The low level of fetal stress and the differences in turnover rates between catecholamines and lactate might obscure their causal relationships, vis-a-vis fetal adaptation to extrauterine life during the course of parturition.

Mechanism of lactate-induced relaxation of isolated rat mesenteric resistance arteries

1. The effects of the sodium salt of the weak acid lactate on tension and intracellular pH (pH1) were studied in rat mesenteric small arteries mounted on a wire myograph. Sodium lactate was substituted iso-osmotically for sodium chloride. 2. At a concentration of 50 mM, both L- and D-stereoisomers of lactate markedly relaxed arteries preconstricted with noradrenaline (NA) within 10 min. The concentration-response relationship for L-lactate showed that the NA contracture was relaxed by 50% at approximately 26 mM. L-Lactate did not, however, relax arteries preconstricted with high-K+(45 mM) solution. 3. L-Lactate did not alter extracellular pH (pHo) but caused a small but significant decrease in pH1, measured using the pH-sensitive fluorochrome, 2',7'-bis(carboxyethyl)-5-(6)-carboxyfluorescein (BCECF). Relaxation to L-lactate was unaffected when this change in pHi was offset by the simultaneous addition of NH4Cl to the solution. 4. Sodium pyruvate (50 mM) caused a significant intracellular acidosis but did not relax arteries preconstricted with NA. 5. L-Lactate-induced relaxations were unaffected by removal of the endothelium or when the synthesis of nitric oxide (NO) was inhibited by 10(-4) M N omega-nitro-L-arginine methyl ester (L-NAME). 6. The potassium channel blockers glibenclamide (10 microM), 4-aminopyridine (3 mM) and tetraethylammonium chloride (10 mM) did not affect L-lactate-induced relaxation in arteries preconstricted with NA. Inhibition of guanylate cyclase with Methylene Blue, or cyclooxgenase with indomethacin, also did not affect relaxation to L-lactate. 7. The Rp stereoisomer of adenosine-3',5'-cyclic monophosphothioate (Rp-cAMPS), an analogue of cAMP which inhibits competitively stimulation of protein kinase A, reduced significantly L-lactate-induced relaxation at a concentration of 25 microM. Rp-cAMPS also significantly reduced forskolin-induced relaxation of the NA contracture. 8. It is concluded that L-lactate-induced relaxation in this vascular bed is pHi-1 endothelium-, and nitric oxide-independent. It is not mediated by inhibition of voltage-gated Ca2+ channels, opening of K+ channels, prostacylin or cyclic GMP. cAMP may however play a role in L-lactate-induced relaxation.

Mechanism of butyrate-induced vasorelaxation of rat mesenteric resistance artery

1. The vasorelaxant effect of the sodium salt of the short chain fatty acid, butyrate, on preconstricted rat small mesenteric arteries (mean inner diameter approximately 300 microns) was characterized. Isometric force development was measured with a myograph, and intracellular pH (pHi) was simultaneously monitored, in arteries loaded with the fluorescent dye BCECF in its acetomethoxy form. Sodium butyrate (substituted isosmotically for NaCl) was applied to arteries after noradrenaline (NA) or high K+ contractures were established. 2. Arteries preconstricted with a concentration of NA inducing an approximately half maximal contraction were relaxed by 91.5 +/- 6.3% by 50 mmol l-1 butyrate. This concentration of butyrate did not, however, cause a significant relaxation of contractures to a maximal (5 mumol l-1) NA concentration, and also failed to relax significantly contractures stimulated by high (45 and 90 mmol l-1) K+ solutions. Contractures elicited with a combination of NA (at a submaximal concentration) and 45 mmol l-1 K+ were, however, markedly relaxed by butyrate. 3. Investigation of the concentration-dependency of the butyrate-induced relaxation of the half maximal NA response revealed an EC50 for butyrate of approximately 22 mmol l-1. 4. Sodium butyrate (50 mmol l-1) caused pHi to decrease from 7.25 +/- 0.02 to 6.89 +/- 0.08 (n = 4, P < 0.001). However, the vasorelaxant effect of butyrate on the submaximal NA contracture was not significantly modified when this fall in intracellular pH was prevented by the simultaneous application of NH4Cl. 5. Butyrate-induced relaxation was also unaffected by endothelial denudation and inhibition of NO synthase with N omega-nitro-L-arginine methyl ester (100 mumol l-1). 6. The relaxation of the NA contracture by 50 mmol l-1 sodium butyrate was abolished in arteries pretreated with the cyclic AMP antagonist Rp-cAMPS (25 mumol l-1). 7. We conclude that the butyrate-induced relaxation of the NA contracture is independent of intracellular acidification. The ability of Rp-cAMPS to abolish the butyrate relaxation indicates that stimulation of the cyclic AMP second messenger system may play an important role in mediating this effect.

Absence of relaxation to lactate in human placental vessels of pregnancies with severe preeclampsia

OBJECTIVE

Our objective was to determine whether the observed relaxation to lactate and other agents in placental vessels of normal pregnancies is altered in severe preeclampsia.

STUDY DESIGN

Isolated placental arteries and veins from women with severe preeclampsia and uncomplicated term pregnancies were precontracted with prostaglandin F2 alpha under 5% oxygen and 5% carbon dioxide with the balance nitrogen (Po2 35 to 38 torr) and then exposed to lactate (1 to 10 mmol/L, pH 7.4, n = 8 to 15), arachidonic acid (0.01 to 10 mumol/L, n = 6 to 13), nitroglycerin (1 nmol to 1 mumol/L, n = 4 to 12), or forskolin (0.01 to 10 mumol/L, n = 6 to 9). The response to lactate was also examined in placental vessels from appropriate-for-gestational-age preterm deliveries (n = 8) for comparison with a similar group with severe preeclampsia (n = 8). The t test and analysis of variance statistics were used.

RESULTS

Relaxation to lactate was markedly inhibited in both placental arteries and veins of women with severe preeclampsia compared with vessels from uncomplicated term or preterm pregnancies. Responses to the other relaxing agents were not altered in the severely preeclamptic vessels.

CONCLUSIONS

In severe preeclampsia absence of lactate-induced dilatation of placental vessels may contribute to the fetal complications associated with impaired blood flow and vasospasm.