Umbilical cord blood sampling--a tool for delivery quality control?

BACKGROUND: Regular cord blood analysis post partum is regarded by many as one of the most accurate and objective methods of auditing intrapartum care. Emergency cesarean sections and ventouse deliveries, due to the threat of asphyxia, are examples where post partum acid base data from the umbilical artery ought to be a must. The possibility of having cord blood analyses as a routine at all deliveries was investigated in this study. METHODS: During a two month period blood samples were drawn from both the umbilical artery and vein at all vaginal deliveries and cesarean sections between 8 am and 4 pm. Samples were analysed for a complete acid base status and lactate concentration. RESULTS: True paired artery-venous samples for acid base data and lactate concentrations were obtained from 48% of the women. Sampling was especially difficult after emergency cesarean section and vaginal twin deliveries. Lactate analyses gave the same information about the metabolic state of the newborn as did BEecf. CONCLUSIONS: Cord blood acid base data are a superior method of retrospective analyses of CTG-tracings and partographs within a quality control program relating to intra partum care. However, routines for cord blood sampling must be well established in both the delivery room and in the operating theater to obtain samples from the umbilical artery in cases of threatening intrapartum asphyxia. A graph for easy post partum documentation and interpretation of acid base data is introduced.

Fingerprinting of molecular components in individual human cerebrospinal fluid samples with a new micropurification system.

This paper reports a rapid and sensitive microtechnique for fingerprinting as little as 20 microliters of cerebrospinal fluid (CSF) from individual humans. Different molecular components were also isolated from the fluid. The SMART system, a new system optimized for high-recovery micropurification, was used for this purpose. The CSF sample, obtained by lumbar puncture, was applied directly into the system, and the patterns recorded for different individuals under various physiological conditions were compared. The results indicate that the procedure provides a powerful tool for the identification or recovery of CSF components and may also be of importance for diagnostic use.

Application of high performance liquid chromatography combined with diode-array detection for analysis of proteins and peptides in human cerebrospinal fluid.

Different strategies for HPLC separation, including molecular sieving, ion-exchange, and hydrophobic interaction as well as reversed phase chromatography, were used to study molecular components in human cerebrospinal fluid (CSF). The separations were followed by photodiode-array UV detection, which is a recently developed technique allowing a direct and rapid discrimination between peptides and proteins differing in their content of aromatic amino acids. By the various HPLC techniques in conjunction with diode-array detection it was possible to identify and characterize several protein and peptide components present in CSF. The procedure also allowed quantitative analysis of CSF proteins using minute amounts of the fluid.

Cerebrospinal fluid activity of dynorphin-converting enzyme at term pregnancy.

Cerebrospinal fluid activity of a dynorphin-converting enzyme transforming prodynorphin-derived peptides to [Leu]enkephalin-Arg6 was measured in 12 women at term pregnancy before cesarean section and in eight nonpregnant, nonpuerperal controls. In pregnant women, the dynorphin-converting enzyme activity was significantly lower (mean +/- SD 6.8 +/- 3.8 U/L) than in nonpregnant controls (11.7 +/- 2.6 U/L; P less than .01). Furthermore, prodynorphin-derived [Leu]enkephalin-Arg6-containing polypeptides were significantly increased in samples from pregnant women (P less than .05). This indicates that a reduced activity of opioid peptide-degrading enzymes might contribute to an increased resistance to pain at term pregnancy.

Cyclical mood changes as in the premenstrual tension syndrome during sequential estrogen-progestagen postmenopausal replacement therapy.

The etiology of the cyclical mood changes seen in the premenstrual syndrome is still unknown. A close relation to the luteal phase has been shown. One of the differences between the follicular and the luteal phase is the higher plasma progesterone concentration during the luteal phase. The present investigation has been conducted to study the effect of exogenously administered estrogen/gestagen sequential postmenopausal replacement therapy on mood and physical signs. Twenty-two women requiring postmenopausal estrogen treatment were recruited and divided into two groups. Eleven women were given estradiol treatment only (Oestrogel creme 3 mg percutaneously/day) for 21 days with a subsequent break of 7 days. The other 11 women were in addition given progestagen (Lynestrenol, Orgametril 5 mg/day) during the last 11 days of treatment. The women were asked to keep a daily record of their mood, using a visual analogue scale earlier tested in women with premenstrual syndrome. They also kept a record of physical signs and sexual feelings. The records were kept for between one and 6 months. The group with estrogen treatment only did not show any cyclical worsening in mood or physical signs during the treatment. The women who in the latter stage of the estrogen treatment cycle also received progestagen, showed significant cyclicity in both moods and physical signs, with a maximum symptom degree during the final days of gestagen treatment. The negative mood change started 1-3 days after the progestagen was added to the treatment. The results suggest that progestagens are involved in the provocation of cyclical symptom changes seen in the premenstrual syndrome.

A comparison of serum oestrogen levels after percutaneous and oral administration of oestradiol-17 beta.

Equivalent doses of oestradiol-17 beta were given orally and percutaneously to eight post-menopausal women and three men. The resultant serum levels of unconjugated immunoreactive oestrogens and total oestrone were followed during 48 hours after hormone administration. A single percutaneous dose of 4 mg oestradiol-17 beta resulted in increased serum levels of oestradiol-17 beta in all individuals. Compared to oral administration the increase in serum oestrogen levels was quite slow and they were maintained for 48 hours. In contrast to the rapid and very marked increase in serum total oestrone following oral administration of oestradiol-17 beta, only a moderate increase was obtained after percutaneous administration and there was a tendency to a biphasic pattern. Topical administration of oestradiol-17 beta might have physiological advantages as the steroid will reach the peripheral circulation without passing the entero-hepatic circulation.