The influence of maternal oxygen inhalation on human placental and umbilical venous blood flow

Jouppila, Pentti; Kirkinen, Pertti; Koivula, A.; Jouppila, R.

doi:10.1016/0028-2243(83)90094-1

Cited by 14 publications

(6 citation statements)

References 14 publications

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“…Maternal oxygen treatment has been shown in fetal lambs to be associated with fetal cerebral vasoconstriction6, 7, the cause of which is unclear. High inspired oxygen concentrations have been shown to cause significant hyperventilation and thus hypocapnia in adult humans20, while hypocapnia itself is associated with cerebral vasoconstriction10, 21–24. In preterm 8‐day‐old neonates, cerebral blood flow has been shown to be even more sensitive to low CO 2 than in adults, with hyperoxygenation associated with decreased cerebral blood flow25.…”

Section: Discussionmentioning

confidence: 99%

Effects of maternal hyperoxia with and without normocapnia in uteroplacental and fetal Doppler studies

Simchen

Tesler

Azami

et al. 2005

Ultrasound in Obstet & Gyne

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Section: Discussionmentioning

confidence: 99%

Effects of maternal hyperoxia with and without normocapnia in uteroplacental and fetal Doppler studies

Simchen

Tesler

Azami

et al. 2005

Ultrasound in Obstet & Gyne

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“…It can be postulated that maternal hyperoxia could cause hypoventilation and consequent CO 2 retention in mother and fetus and placental vasoconstriction. Giving labouring mothers oxygen at 5 l.min −1 has indeed been found to reduce intervillous blood flow significantly [71]. Nevertheless, maternal hyperoxia during labour has been found to increase PO 2 in the compromised fetus, though not in the normal.…”

Section: Maternal Inhaled Oxygen Concentrationmentioning

confidence: 99%

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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SummarySpinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid-base status provides a valid index of fetal welfare. Twenty-seven studies reporting neonatal acid-base data with different types of anaesthesia were used to compare umbilical artery or vein pH and base deficit, using random-effect meta-analysis. Cord pH was significantly lower with spinal than with both general (difference: )0.015; 95% CI )0.029 to )0.001; 13 studies, 1272 subjects) and epidural anaesthesia (difference )0.013; 95% CI )0.024 to )0.002; 11 studies, 828 subjects). Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434-1.784 mEq.l )1 ; seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222-1.598 mEq.l ; seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus. In labour, regional analgesia has a more favourable effect on the newborn than systemic analgesia [1][2][3], a fact that tends to be neglected by consumers and carers alike. By contrast, it is widely accepted that regional anaesthesia for Caesarean section is preferable to general anaesthesia. Spinal anaesthesia is commonly considered both more practical and safer than other techniques for the mother, and is therefore widely used [4]. It is often assumed, similarly, that spinal anaesthesia for Caesarean section must be better for the baby than general or epidural anaesthesia. There are several reasons for this assumption.• General anaesthesia was shown in the 1970s to depress the Apgar score, although this is reversible and rarely significant by 5 min [5,6].• Maternal hypotension, which is believed to be detrimental to fetal wellbeing, can be minimised by appropriate vasopressor control. Cardiac output, however, is more likely to be impaired by spinal than by epidural anaesthesia [7], is rarely measured and may not be so easily corrected.• The doses of drugs required to induce spinal anaesthesia are small and are therefore unlikely to produce systemic effects in the baby. With the brief duration of anaesthesia before delivery of the baby, however, pharmacological fetal depression is likely to be less important than that following prolonged maternal administration of depressant drugs, as may occur during labour. It must be borne in mind, moreover, that drugs may affect the baby in two ways: firstly via a direct effect, resulting from placental drug transfer, which is transient even when general anaesthesia is used for Caesarean section, and clearly unimportant with spinal anaesthesia; and secondly, through an indirect effect resulting from maternal physiological or biochemical changes, which Anaesthesia, 2005, 60 , pages 636-653 .........................................................................................................................................

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“…Tervilä et al [41,42], however, reported decreased uterine perfusion in healthy fetuses and those with various noncardiac diseases in response to AMH. Jouppila et al [43] similarly found a significant decrease in intervillous blood flow in healthy fetuses exposed to AMH. While this study is underpowered to prove the theory that CMH results in increased PLVR, reduced placental perfusion, and reduced fetal head growth, it highlights the potential negative effects of hyperoxygenation and the need for larger, randomized control trials to elucidate the risks and benefits of maternal hyperoxygenation.…”

Section: Discussionmentioning

confidence: 77%

Chronic Maternal Hyperoxygenation and Effect on Cerebral and Placental Vasoregulation and Neurodevelopment in Fetuses with Left Heart Hypoplasia

et al. 2018

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Introduction: In a pilot study of chronic maternal hyperoxygenation (CMH) in left heart hypoplasia (LHH), we sought to determine effect estimates of CMH on head size, vascular resistance indices, and neurodevelopment compared to controls. Material and Methods: Nine gravidae meeting the inclusion criteria (fetal LHH, ≥25.9 weeks’ gestation, and ≥10% increase in percent aortic flow after acute hyperoxygenation) were prospectively enrolled. Controls were 9 contemporary gravidae with fetal LHH without CMH. Brain growth and Doppler-derived estimates of fetal cerebrovascular and placental resistance were blindly evaluated and compared using longitudinal regression. Postnatal anthropomorphic and neurodevelopmental assessments were compared. Results: There was no difference in baseline fetal measures between groups. There was significantly slower biparietal diameter (BPD) growth in the CMH group (z-score change –0.03 ± 0.02 vs. +0.09 ± 0.05 units/week, p = 0.02). At 6 months postnatal age, the mean head circumference z-score in the CMH group was smaller than that of controls (–0.20 ± 0.58 vs. +0.85 ± 1.11, p = 0.048). There were no differences in neurodevelopmental testing at 6 and 12 months. Discussion: In this pilot study, relatively diminished fetal BPD growth and smaller infant head circumference z-scores at 6 months were noted with in utero CMH exposure.

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The influence of maternal oxygen inhalation on human placental and umbilical venous blood flow

Cited by 14 publications

References 14 publications

Effects of maternal hyperoxia with and without normocapnia in uteroplacental and fetal Doppler studies

Effects of maternal hyperoxia with and without normocapnia in uteroplacental and fetal Doppler studies

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Chronic Maternal Hyperoxygenation and Effect on Cerebral and Placental Vasoregulation and Neurodevelopment in Fetuses with Left Heart Hypoplasia

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