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Al-Saleh I, Alsabbahen A, Shinwari N, Billedo G, Mashhour A, Al-Sarraj Y, Mohamed GED, Rabbah A. Polycyclic aromatic hydrocarbons (PAHs) as determinants of various anthropometric measures of birth outcome. THE SCIENCE OF THE TOTAL ENVIRONMENT 2013; 444:565-78. [PMID: 23314068 DOI: 10.1016/j.scitotenv.2012.12.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/08/2012] [Accepted: 12/09/2012] [Indexed: 05/25/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental contaminants that are known to induce oxidative stress. There have been several reports about the link between PAH exposure and complications in pregnancy. This cross-sectional study was conducted to: (1) measure the levels of benzo(a)anthracene (BaA), chrysene (Ch), benzo(b)fluoranthene (BbF), benzo(a)pyrene (BaP), and dibenzo(a,h)anthracene (DBahA) in placentas and maternal and -umbilical cord blood obtained at delivery from 1578 women between June 2005 and 2006 in the area of Al-Kharj, Saudi Arabia; (2) assess their influence on various anthropometric measures of birth outcome taking into consideration the carcinogenic properties of these PAHs; and (3) determine the degree of PAH-related oxidative DNA damage and birth outcome. Among the five tested PAHs, only BaP was carcinogenic; therefore, the levels of the other four probable or possible carcinogenic PAHs (BaA, Ch, BaF, and DBahA) were summed as ∑4-PAHs. Levels of 1-hydroxypyrene (1-HP) were determined in maternal urine samples as a biomarker of PAH internal dose. Urinary cotinine (COT) was measured as an index of smoking. The following markers of oxidative stress were selected: malondialdehyde (MDA) in cord (C-MDA) and maternal (M-MDA) serum and 8-hydroxy-2-deoxyguanosine (8-OHdG) in maternal urine. None of the tested PAHs was found in maternal or cord blood. However, all five PAH compounds were detected in placentas; Ch was the highest (6.582 μg/kg dry wt.), and BaA was the lowest (0.236 μg/kg dry wt.). The mean concentration of urinary 1-HP found in this study was 0.216 ± 0.856 μg/g Cr. After adjusting for gestational age and other confounding variables, regression models revealed an inverse relationship between placental weight, cord length and placental BaP. A similar trend was observed between cord length and ∑4-PAHs in placental tissues. Urinary 1-HP, though, cannot be used as an unequivocal biomarker of PAH exposure, but it can be an appropriate indicator of exposure to environmental tobacco smoke (ETS). The data demonstrate that ETS exposure (as measured by urinary COT) may adversely affect birth outcome as shown by reduced head circumference, birth weight, and birth length, as well as increased cephalization index. The positive relationship between 8-OHdG levels and 1-HP in urine provides evidence of an oxidative stress mechanism. Although this study provides no direct evidence of an association between PAH exposure and DNA damage, increased oxidative stress in the form of lipid peroxidation significantly affected various birth measures. Therefore, there is a need for studies regarding PAH exposure and its associated biological effects to determine the extent of potential fetal damage as well as possible long-term effects, such as cancer.
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Affiliation(s)
- Iman Al-Saleh
- Environmental Health Section, Biological & Medical Research Department, King Faisal Specialist Hospital & Research Centre, PO Box: 3354, Riyadh, Saudi Arabia.
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Khaw KS, Ngan Kee WD, Chu CY, Ng FF, Tam WH, Critchley LAH, Rogers MS, Wang CC. Effects of different inspired oxygen fractions on lipid peroxidation during general anaesthesia for elective Caesarean section. Br J Anaesth 2010; 105:355-60. [PMID: 20576633 DOI: 10.1093/bja/aeq154] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During general anaesthesia (GA) for Caesarean section (CS), fetal oxygenation is increased by administering an inspired oxygen fraction (Fi(o(2))) of 1.0. However, it is unclear whether such high Fi(o(2)) will increase oxygen free radical activity. METHODS We randomized 39 ASA I-II parturients undergoing elective CS under GA to receive 30% (Gp 30), 50% (Gp 50), or 100% (Gp 100) oxygen with nitrous oxide and sevoflurane adjusted to provide equivalent minimum alveolar concentration. Baseline maternal arterial blood before preoxygenation and maternal arterial, umbilical arterial and venous blood at delivery were sampled for assays of the by-product of lipid peroxidation, isoprostane, and for measurement of blood gases and oxygen content. RESULTS Maternal and umbilical isoprostane concentrations were similar among the three groups at delivery, despite significantly increased maternal and fetal oxygenation in Gp 100. However, paired comparisons of maternal delivery vs baseline concentration of isoprostane showed an increase at delivery for all groups [Gp 30: mean 342 (sd 210) vs 154 (65) pg ml(-1), P=0.016; Gp 50: 284 (129) vs 156 (79) pg ml(-1), P=0.009; Gp 100: 332 (126) vs 158 (68) pg ml(-1), P<0.001]. The magnitude of increase was similar in all three groups and independent of the Fi(o(2)) or duration after induction. CONCLUSIONS GA for CS is associated with a marked increase in free radical activity in the mother and baby. The mechanism is unclear but it is independent of the inspired oxygen in the anaesthetic mixture. Therefore, when 100% oxygen is administered with sevoflurane for GA, fetal oxygenation can be increased, without inducing an increase in lipid peroxidation.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Lipid peroxidation and biochemical parameters in maternal pre-delivery and post-delivery plasma. Biologia (Bratisl) 2010. [DOI: 10.2478/s11756-009-0223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Onan A, Kurdoglu M, Sancak B, Bukan N, Yildirim M. Lipid peroxidation in nuchal cord cases: implication for fetal distress. J Matern Fetal Neonatal Med 2009; 22:254-8. [PMID: 19089774 DOI: 10.1080/14767050802556034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine whether nuchal cord affects fetal lipid peroxidation and cord arterial blood gases, and thus to determine whether lipid peroxidation can show intrapartum distress. METHODS Pregnant women giving birth to a baby with nuchal cord (n = 32) formed the study group and others without this condition made up the control group (n = 36). The maternal malondialdehyde levels (MDA) before and after delivery as well as fetal umbilical cord MDA and arterial blood gases were measured in both the groups. RESULTS Mean cord MDA level was higher in the study group (p < 0.02) and was significantly higher than maternal MDA level after birth within the same group (p = 0.007). Cord blood gases as well as neonatal and labour characteristics showed no difference, except for variable decelerations, which were 2.2 times more common in the study group. Correlations between maternal MDA levels before and after delivery, umbilical cord MDA and arterial blood gases were non-significant in the nuchal cord group. CONCLUSIONS During delivery, nuchal cord increases lipid peroxidation without causing significant fetal acidemia. Level of lipid peroxidation may be a more sensitive indicator of intrapartum distress than results of acid-base studies.
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Affiliation(s)
- Anil Onan
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
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Lipid peroxidation and biochemical parameters in umbilical cord blood of well-adapted term newborns. Biologia (Bratisl) 2009. [DOI: 10.2478/s11756-009-0055-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Khaw KS, Wang CC, Ngan Kee WD, Tam WH, Ng FF, Critchley LAH, Rogers MS. Supplementary oxygen for emergency Caesarean section under regional anaesthesia. Br J Anaesth 2008; 102:90-6. [PMID: 19011261 DOI: 10.1093/bja/aen321] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Controversy still exists if the administration of supplementary oxygen to patients having emergency Caesarean section (CS) under regional anaesthesia is beneficial or potentially harmful. Therefore, in a prospective double-blinded study, we randomized patients having emergency CS under regional anaesthesia to receive either air or 60% oxygen until delivery and compared the effects on fetal oxygenation and lipid-peroxidation in the mother and baby. METHODS We recruited 131 women having emergency CS under regional anaesthesia. Either 21% (air group) or 60% oxygen (oxygen group) was administered using a Venturi-type facemask until delivery. We compared the oxygen exposure duration, umbilical arterial (UA) and venous (UV) blood gases and oxygen content, and plasma concentration of 8-isoprostane. Subanalysis was performed according to whether or not fetal compromise was considered present. RESULTS Data from 125 patients were analysed. For the oxygen group vs the air group, there were greater values for UA PO(2) [mean 2.2 (SD 0.5) vs 1.9 (0.6) kPa, P=0.01], UA O(2) content [6.6 (2.5) vs 4.9 (2.8) ml dl(-1), P=0.006], UV PO(2) [3.8 (0.8) vs 3.2 (0.8) kPa, P<0.0001], and UV O(2) content [12.9 (3.5) vs 10.4 (3.8) ml dl(-1), P=0.001]. There was no difference between the groups in maternal, UA, or UV 8-isoprostane concentration. Apgar scores and UA pH were similar between the groups. Similar changes were observed regardless of whether fetal compromise was considered present (n=37) or not (n=88). CONCLUSIONS Breathing 60% oxygen during emergency CS under regional anaesthesia increased fetal oxygenation with no associated increase in lipid-peroxidation in the mother or fetus.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
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Abstract
BACKGROUND Periventricular-intraventricular hemorrhage, necrotizing enterocolitis, chronic lung disease and retinopathy of prematurity have been referred to as oxygen radical diseases (ORD) because they are thought to be related to excess oxidant stress relative to anti-oxidant defenses in premature infants. 8-Isoprostane is a product of lipid peroxidation that can be used as a measure of free radical exposure or injury. The aim of the present study was to determine whether fetal oxidant stress is associated with adverse effects in preterm infants. METHODS Mothers delivering at gestational age <37 weeks were recruited. Umbilical arterial and venous cord blood samples were collected and 8-isoprostane levels measured. Levels of 8-isoprostane in cord blood were correlated with maternal and perinatal variables, neonatal mortality, and the development of one or more ORD. RESULTS Umbilical cord venous, but not arterial, 8-isoprostane levels were associated with mortality and the development of one or more of the ORD. After controlling for gestational age, for each unit change in the log value of 8-isoprostane in venous cord blood the odds of mortality were 12 (95% confidence interval [CI]: 1-223) and oxygen radical disease were 2.7 (95%CI: 1-7.2). Isoprostane levels were not related to gender, method of delivery, use of maternal magnesium or steroids, pregnancy-induced hypertension, or delivery room resuscitation. CONCLUSION Oxidant stress in utero may be an important determinant of mortality and morbidity in preterm infants. Elevated umbilical venous isoprostane levels suggest that oxidative injury to maternal and placental tissues predispose to adverse neonatal outcomes.
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Affiliation(s)
- Barry Weinberger
- Division of Neonatology, Department of Pediatrics, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
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Rogers MS, Wang CC, Lau TK, Xiao X, Zhou XG, Fok TF, Chu KO, Pang CP. Relationship between Isoprostane Concentrations, Metabolic Acidosis, and Morbid Neonatal Outcome. Clin Chem 2005; 51:1271-4. [PMID: 15976110 DOI: 10.1373/clinchem.2004.047241] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael Scott Rogers
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Mocatta TJ, Winterbourn CC, Inder TE, Darlow BA. The effect of gestational age and labour on markers of lipid and protein oxidation in cord plasma. Free Radic Res 2004; 38:185-91. [PMID: 15104212 DOI: 10.1080/10715760310001646048] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There are many potential sources of reactive oxidants around the time of birth and pre-term infants are considered to be particularly vulnerable to oxidative injury. To gain insight into these processes, we have measured biomarkers of lipid and protein oxidation in umbilical cord plasma and related concentrations to mode of delivery and gestational age. Protein carbonyls were measured by ELISA and malondialdehyde (MDA) by HPLC after reaction with thiobarbituric acid, for 54 pre-term (< or = 36 weeks gestational age) and 43 term infants. Protein carbonyls were significantly lower in pre-term (median for < 32 weeks gestational age 0.048nmol/mg protein) than in term infants (0.105 nmol/mg, p = 0.004), and were unrelated to mode of delivery. In contrast, MDA concentrations were higher in the very pre-term (<32 weeks gestation) group (2.47 compared with 1.83 microM for term infants, p < 0.0001). MDA concentrations were higher in infants who were born with labour compared with elective caesarean section. Pre-eclampsia in the mother was associated with higher cord blood MDA concentrations. The MDA results are consistent with other studies of this marker and could be interpreted as indicating increased oxidative stress associated with prematurity and labour. However, the lower protein carbonyls in pre-term infants would lead to an opposite interpretation. More information is needed on the source and fate of these and other biomarkers before drawing strong conclusions on how they reflect oxidative stress in this and other clinical situations.
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Affiliation(s)
- Tessa J Mocatta
- Department of Pathology, Christchurch School of Medicine and Health Sciences, P.O. Box 4345, Christchurch, New Zealand
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Aksoy U. Prenatal color Doppler sonographic evaluation of nuchal encirclement by the umbilical cord. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:473-477. [PMID: 14595737 DOI: 10.1002/jcu.10211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The aim of this study was to assess whether Doppler flow velocimetry of the fetal middle cerebral and umbilical arteries is affected by nuchal encirclement by the umbilical cord (nuchal cord) in the prenatal period. PATIENTS AND METHODS The position of the fetal umbilical cord was assessed on color Doppler sonography in pregnant women who were referred to our radiology department between September 14, 1998, and January 14, 2000. Pulsatility and resistance indices and the ratio of peak systolic blood flow velocity to diastolic velocity of the umbilical arteries and middle cerebral arteries of all fetuses were prospectively obtained with Doppler flow velocimetry. The fetuses were categorized into 2 groups: group 1 consisted of fetuses without sonographic evidence of nuchal cord and group 2 of fetuses with sonographic evidence of nuchal cord. The results were statistically analyzed with independent-groups t test. A p value of less than 0.05 was considered significant. RESULTS During the study period, 230 pregnant women underwent sonographic examination of the fetus, and 68 fetuses were delivered. The sonographic examinations were performed at 24-41 weeks' menstrual age. Of the 46 fetuses in group 1, 1 fetus had nuchal cord at delivery; of the 22 fetuses in group 2, 4 did not have nuchal cord at delivery. The sensitivity of color Doppler sonography in detecting nuchal cord was 95% (18 of 19 fetuses), the specificity was 92% (45 of 49), the negative predictive value was 98% (45 of 46), and the positive predictive value was 82% (18 of 22). No statistically significant differences in middle cerebral artery or umbilical artery Doppler flow velocimetry values were detected between the 2 groups. CONCLUSIONS Color Doppler sonography is a sensitive and specific method of diagnosing nuchal cord, but fetal middle cerebral artery and umbilical artery Doppler flow velocimetry values are not affected by the presence of nuchal cord in the prenatal period.
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Affiliation(s)
- Umit Aksoy
- Department of Radiology, Uludag University School of Medicine, Zafer Sokak Korukent Sitesi B/5, Fethiye/Bursa 16140, Turkey
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Rogers MS, Ip YW, Qin Y, Rogers SM, Sahota D. Relationship between umbilical cord morphology and nuchal cord entanglement. Acta Obstet Gynecol Scand 2003; 82:32-7. [PMID: 12580837 DOI: 10.1034/j.1600-0412.2003.820106.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether tightening of nuchal cord entanglement is more likely to occur where normal cord coiling is absent and there is deficient Wharton's jelly. The study was carried out in the delivery suite of a university teaching hospital, using a prospective matched controlled-pairs survey. METHODS Midwives identified index cases with nuchal cord entanglement at the time of delivery. The next delivery of equivalent gestation (+/- 1 week) without cord entanglement was taken as the control. Only singleton pregnancies with cephalic presentation undergoing spontaneous labor were studied. Placental insertion, nuchal entanglement (tight or loose), length, presence of knots, umbilical coiling index (UCI), and the amount of Wharton's jelly were recorded. RESULTS Longer cords were more frequent amongst male infants and were predisposed towards entanglement. There were no significant differences in the amount of Wharton's jelly, or in the UCI between tight and loose nuchal cord groups. The only measurement that differed significantly was the total cord length, with shorter cords predisposed towards tightening. CONCLUSION Whilst nuchal cord entanglement amongst male babies is frequently associated with long and straight umbilical cords, tightening is more likely to occur if the cord is of short or normal length. Neither low UCI nor low percentage of Wharton's jelly are predisposed towards tightening of cord entanglement.
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Affiliation(s)
- Michael S Rogers
- Departments of Obstetrics & Gynecology, Chinese University of Hong Kong.
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Qin Y, Lau TK, Rogers MS. Second-trimester ultrasonographic assessment of the umbilical coiling index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:458-463. [PMID: 12423482 DOI: 10.1046/j.1469-0705.2002.00846.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine the relationship between gestational age and the ultrasonic measurement of umbilical coiling index (UCI), and to assess the ability of second-trimester ultrasonic measurements of UCI to predict the true UCI, determined at birth. SUBJECTS/METHODS Five hundred and thirty-one consecutive women with uncomplicated pregnancies, booking for delivery with a singleton pregnancy, were recruited during a routine second-trimester fetal morphology scan. Multiple ultrasonographic measurements of the intercoil distance were performed between two to three coils of the umbilical cord, along its entire visible length. Three hundred and seventy-four patients (70%) were followed until delivery when the true UCI was measured. RESULTS An adequate portion of umbilical cord for assessment of coiling was visualized in 99% of cases. Adequate ultrasonographic visibility rates for the fetal, middle and placental regions of the cord were different. All three regions of the umbilical cord could only be visualized adequately in 10% of cases, and two regions were visible in 75%. The UCI progressively decreased along the cord from the fetal insertion to the placental insertion. The mean decrease in UCI with increasing gestational age was similar in all parts of the cord before the 23rd week (160 days) of pregnancy, and plateaued off after this point, except in measurements performed near the fetal insertion. The sensitivity of second-trimester ultrasound examination for predicting hypercoiling at birth was 17.3% and for predicting hypocoiling was 9.1%. DISCUSSION Whilst UCI can be measured easily and reliably in the second trimester these estimates do not accurately reflect the UCI at term. Our original assumption that umbilical coiling does not alter after the initial formation of coils in the first trimester is incorrect; mixed patterns occurred in about 25% of cases. These patterns develop during the second and third trimesters, presumably due to snarls in the cord, and influence the final coiling number and therefore the relationship between the two measurements of UCI.
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Affiliation(s)
- Y Qin
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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Khaw KS, Wang CC, Ngan Kee WD, Pang CP, Rogers MS. Effects of high inspired oxygen fraction during elective caesarean section under spinal anaesthesia on maternal and fetal oxygenation and lipid peroxidation. Br J Anaesth 2002; 88:18-23. [PMID: 11883375 DOI: 10.1093/bja/88.1.18] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Oxygen supplementation is given routinely to parturients undergoing Caesarean section under regional anaesthesia. While the aim is to improve fetal oxygenation, inspiring a high oxygen fraction (FIO2) can also increase free radical activity and lipid peroxidation in both the mother and baby. In this prospective, randomized, double-blind study, we investigated the effect of high inspired oxygen fraction (FIO2) on maternal and fetal oxygenation and oxygen free radical activity in parturients having Caesarean section under spinal anaesthesia. METHODS Forty-four healthy parturients were randomized to breathe either 21% (air group) or 60% oxygen (oxygen group) intraoperatively via a ventimask. Maternal arterial blood was collected at 5-min intervals from baseline until delivery, and umbilical arterial and venous blood was collected at delivery. We measured blood gases and the products of lipid peroxidation (8-isoprostane, malondialdehyde (MDA), hydroperoxide (OHP)) and purine metabolites. RESULTS At delivery, the oxygen group had greater maternal arterial PO2 [mean 30.0 (SD 6.3) vs 14.2 (1.9) kPa; mean difference 15.8 kPa, 95% confidence interval 12.9-18.7 kPa, P<0.001] and greater umbilical venous PO2 [4.8 (1.0) vs 4.0 (1.4) kPa; mean difference 0.8 kPa, 95% confidence interval 0.0-1.5 kPa, P=0.04] compared with the air group. Maternal and umbilical plasma concentrations of lipid peroxides (8-isoprostane, MDA, OHP) were greater in the oxygen group than in the air group (P<0.05). CONCLUSIONS We conclude that breathing high FIO2 modestly increased fetal oxygenation but caused a concomitant increase in oxygen free radical activity in both mother and fetus.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, China
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Rogers MS, Murray HG, Wang CC, Pennell CE, Turner A, Yan P, Pang CC, Chang AM. Oxidative stress in the fetal lamb brain following intermittent umbilical cord occlusion: a path analysis. BJOG 2001; 108:1283-90. [PMID: 11843392 DOI: 10.1111/j.1471-0528.2001.00297.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the relative contribution of cord occlusion length intervals between occlusions and experimental duration on oxidative stress in the fetal lamb brain. DESIGN Acute, partially exteriorised fetal lambs with intermittent total cord occlusion. SETTING The Vivarium of Westmead Hospital, University of Sydney, Australia and The Chinese University of Hong Kong. MAIN OUTCOME MEASURES Arterio-venous differences in the concentration of organic hydroperoxides, measured in paired samples of carotid arterial and jugular venous blood, as an index of oxidative stress in the brain. METHODS Thirty-two fetal lambs were exposed to graded hypoxia, induced by intermittent total umbilical cord compression of 30 seconds, 60 seconds and 90 seconds duration, occurring every minute for a total of 27 occlusions over 81 minutes. Three sham experiments were also performed. In addition to organic hydroperoxides, carotid arterial blood samples were also assayed in 15 animals (two sham) for oxygen saturation, pH, hypoxanthine, xanthine and urate concentrations. A causal model for oxidative stress was defined: occlusions leading to hypoxia with a rise in hypoxanthine; reperfusion during intervals between occlusions leading to the accelerated production of xanthine and uric acid and the generation of oxygen free radicals, which in turn, are responsible for the rise in lipid peroxidation. Path analysis was performed to assess the strength of the relationships between these variables and the cord occlusion length, the interval between occlusions and the duration of the experiment. RESULTS Sham experiments showed no change in organic hydroperoxide production. Following 30-second umbilical cord occlusions a sixfold drop in mean organic hydroperoxides was observed between carotid arterial and jugular venous levels. In contrast, following occlusions of 60 seconds duration (or longer) a median 20-fold increase in organic hydroperoxide production was observed. Path analysis revealed a strong indirect pathway from occlusion length --> hypoxanthine --> urate and weak positive pathways from oxygen saturation --> urate and from interval between occlusions --> urate. After accounting for these pathways reflecting oxidative stress, a strong direct path remained from time from first occlusion --> organic hydroperoxide production. CONCLUSIONS Peroxidation of lipids in the brain occurs under conditions of severe hypoxia and reperfusion associated with intermittent umbilical cord occlusions of 60 seconds or longer. The path analysis supported the causal model as originally defined, with the exception that the indirect pathway via pH was found to be trivial.
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Affiliation(s)
- M S Rogers
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories
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Qin Y, Wang CC, Kuhn H, Rathmann J, Pang CP, Rogers MS. Determinants of umbilical cord arterial 8-iso-prostaglandin F2alpha concentrations. BJOG 2000; 107:973-81. [PMID: 10955428 DOI: 10.1111/j.1471-0528.2000.tb10399.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the concentration of 8-isoPGF(2alpha) in cord blood as a measure of oxidative stress during labour, and to compare them with other established parameters of in vivo lipid peroxidation and with the acid-base status of the newborn. METHOD Umbilical cord arterial and venous blood samples were collected from 81 singleton term deliveries for determination of 8-isoPGF(2alpha), malondialdehyde and organic hydroperoxides. In addition, metabolites derived from the oxidative metabolism of purines during hypoxia-reoxygenation and routine cord blood of oxygen saturation, pH, pO2, pCO2, HCO3 and base excess were measured. RESULTS Arterial concentrations of 8-isoPGF(2alpha) were significantly higher in cases with fetal distress, tight nuchal cord (P < 0.001), the umbilical coiling index, and male sex (P < 0.05) (R2 = 0.48). No correlation was found with any parameter of acid-base status. In arterial and venous blood the concentrations of organic hydroperoxides and hypoxanthine significantly correlated with the fetal nuchal cord (P < 0.001) (R2 = 0.26 and 0.16, respectively). CONCLUSION Our findings indicate that 8-isoPGF2(alpha) in cord arterial blood is a suitable parameter to quantify a possible oxidative stress in the fetus during labour. Measurements of the F2-isoprostane concentrations in cord blood at labour provide a clinically useful method to assess the perinatal outcome.
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Affiliation(s)
- Y Qin
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong
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Qin Y, Wang CC, Lau TK, Rogers MS. Color ultrasonography: a useful technique in the identification of nuchal cord during labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:413-417. [PMID: 10976484 DOI: 10.1046/j.1469-0705.2000.00113.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare the accuracy of intrapartum ultrasound with and without color Doppler for identification of nuchal cord displacement during labor. METHODS 180 normal pregnant women, admitted in labor, or for induction to labor, were examined independently by two researchers, using either conventional real-time gray-scale imaging or color Doppler imaging. A repeat examination was performed by the other researcher using the other ultrasound modality. Nuchal cord displacement was classified as either negative, definite or suspicious. Nuchal cord at birth was classified as either tight or loose. RESULTS Sixty-two (34%) cases examined using the two ultrasound imaging modalities presented with nuchal cord at delivery. The sensitivity of color Doppler was 96.8%. The accuracy of color Doppler in detecting nuchal cord during labor was significantly better (P < 0.05) than gray-scale imaging alone. The results of a restricted sequential t-test analysis of 53 un-tied pairs showed an overall preference in favor of color Doppler assessment: statistical significance (P < 0.01) was reached after 41 un-tied pairs. CONCLUSIONS The tight and loose nuchal cord could not be distinguished by ultrasound. Color Doppler imaging can provide useful additional information to gray-scale imaging in the detection of nuchal cord displacement during labor.
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Affiliation(s)
- Y Qin
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
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Rogers MS, Wang CC. A comparison of three ultrasound estimates of intrapartum oligohydramnios for prediction of fetal hypoxia-reperfusion injury. Early Hum Dev 1999; 56:117-26. [PMID: 10636591 DOI: 10.1016/s0378-3782(99)00043-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A prospective observational study assessed the predictive value of three techniques for amniotic fluid volume assessment on umbilical cord arterial lipid peroxide levels and acid-base balance. Women with singleton, term, cephalic presentation, and an initially normal fetal heart rate tracing were recruited. All pregnancies had the largest vertical pocket (LVP), two diameter pocket (2phi), and amniotic fluid index (AFI) assessments before and after amniotomy and cord arterial acid-base and lipid peroxide determinations at delivery. In 171 cases with confirmed cord arterial samples, malondialdehyde (MDA), organic hydroperoxide (OHP), pH and base excess (BE) were examined in relationship to intrapartum LVP, 2phi and AFI before and after amniotomy. Improvements in correlation between the estimates of amniotic fluid volume and outcome measures were observed 30 min after amniotomy, particularly with lipid peroxide measurements. Examination of scatter-plots using Lowess regression suggested that the correlation was only valid in cases of oligohydramnios but that the cutoff values recommended in the literature for defining oligohydramnios were not appropriate in our population sample. We suggest that oligohydramnios should be defined as an AFI < 8 cm or LVP < 4 cm. We concur with the recommendation of < 15 cm2 for the 2phi measurement.
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Affiliation(s)
- M S Rogers
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT.
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Rogers MS, Mongelli JM, Tsang KH, Wang CC, Law KP. Lipid peroxidation in cord blood at birth: the effect of labour. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:739-44. [PMID: 9692414 DOI: 10.1111/j.1471-0528.1998.tb10204.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the effect of labour on free oxygen radical activity in the fetus, as reflected by lipid peroxide levels in umbilical cord arterial blood. DESIGN Prospective, observational study. SETTING Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong. METHODS Umbilical cord arterial and venous blood samples were collected from singleton term infants delivered by elective caesarean section. Base excess, PO2, pCO2 and pH were measured in both samples and compared to identify double venous samples. Cord arterial acid-base balance and concentrations of organic hydroperoxides and malondialdehyde were compared with those obtained from normal vaginal deliveries. RESULTS Cord arterial blood samples, obtained from cases of uncomplicated labour followed by spontaneous vaginal delivery, had significantly higher lipid peroxide concentrations than those delivered following elective caesarean section. This was most marked for malondialdehyde with a median value increased by 105%, whilst organic hydroperoxide was increased by only 27%. Of the acid-base parameters, base excess was increased by 78%, with only minimal changes in pH, pCO2 and PO2. These differences remained highly significant after including other pregnancy characteristics in multivariate analysis. CONCLUSION The findings indicate that high levels of free oxygen radical activity in the fetus are a function of the labour process, as are changes in acid-base balance.
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Affiliation(s)
- M S Rogers
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, NT
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Wang CC, Rogers MS. Lipid peroxidation in cord blood: a randomised sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:1145-51. [PMID: 9332992 DOI: 10.1111/j.1471-0528.1997.tb10938.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the efficacy of prophylactic intrapartum amnioinfusion in reducing cord arterial lipid peroxide levels in cases of intrapartum oligohydramnios. DESIGN Sequential randomised pairs trial. SETTING Delivery suite of a teaching hospital, the Chinese University of Hong Kong. POPULATION Women with singleton, term pregnancy, cephalic presentation, clear amniotic fluid and an amniotic fluid index < or = 5 cm, with a normal intrapartum fetal heart rate tracing within 30 minutes of amniotomy. METHODS Selected patients were randomised either for prophylactic saline amnioinfusion or as control cases. Cord arterial lipid peroxide concentrations and acid base balance were determined at delivery. MAIN OUTCOME MEASURES Operative intervention for fetal distress, cord arterial malondialdehyde and organic hydroperoxide levels, pH and base excess. RESULTS Amnioinfusion was associated with significant reductions in the incidence of operative delivery for fetal distress and in lipid peroxide levels, an increase in base excess, but no significant alteration in pH. CONCLUSIONS Oligohydramnios in labour is associated with high levels of lipid peroxidation, reflecting cellular damage by release of free radicals following hypoxia reperfusion. Prophylactic intrapartum saline amnioinfusion is an effective technique for the reduction of lipid peroxidation and of the incidence of operative intervention for fetal distress but has no significant effect on overall operative delivery rates.
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Affiliation(s)
- C C Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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Wang CC, Rogers MS. Lipid peroxidation in cord blood: the effect of amniotic fluid volume. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:1140-4. [PMID: 9332991 DOI: 10.1111/j.1471-0528.1997.tb10937.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the effect of amniotic fluid volume on umbilical cord arterial lipid peroxide levels in relation to intrapartum events. DESIGN Prospective observational study. SETTING Delivery suite of a teaching hospital, the Chinese University of Hong Kong. POPULATION Women with singleton, term, cephalic presentation, and an initially normal fetal heart rate tracing. METHODS All pregnancies had amniotic fluid index assessments before and after amniotomy and cord arterial lipid peroxide determination at delivery. Multiple regression analysis. MAIN OUTCOME MEASURES Cord arterial malondialdehyde and organic hydroperoxide levels. RESULTS In 247 cases following amniotomy levels were inversely correlated with intrapartum amniotic fluid index. Amniotic fluid index during labour was an independent determinant of cord arterial lipid peroxide concentration, along with duration of second stage, absence of epidural, presence of tight nuchal cord entanglement and evidence of fetal distress. CONCLUSIONS Oligohydramnios during labour is associated with high levels of lipid peroxidation in the fetus, reflecting an increase in hypoxic cellular damage by free radicals.
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Affiliation(s)
- C C Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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