Peripheral chemoreflex control of fetal heart rate decelerations overwhelms the baroreflex during brief umbilical cord occlusions in fetal sheep
Autor: | Shoichi Magawa, Christopher A. Lear, Joanne O. Davidson, Jenny A. Westgate, Laura Bennet, Lindsea C. Booth, Tomoaki Ikeda, Yoshiki Maeda, Michi Kasai, Paul P. Drury, Etsuko Miyagi, Alistair J. Gunn |
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Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
Fetus medicine.medical_specialty Physiology business.industry Peripheral vasoconstriction Baroreflex Umbilical cord 03 medical and health sciences Fetal heart rate decelerations 030104 developmental biology 0302 clinical medicine medicine.anatomical_structure Internal medicine embryonic structures Heart rate medicine Cardiology business Phenylephrine 030217 neurology & neurosurgery circulatory and respiratory physiology medicine.drug Peripheral chemoreflex |
Zdroj: | The Journal of Physiology. 598:4523-4536 |
ISSN: | 1469-7793 0022-3751 |
Popis: | Key points The majority of intrapartum decelerations are widely believed to be mediated by the baroreflex secondary to brief umbilical cord occlusions (UCOs) but this remains unproven. We examined the responses to brief-UCOs in fetal sheep and compared these to a phenylephrine-stimulated baroreflex in a separate cohort. A further cohort was instrumented with near-infrared spectroscopy to measure cerebral oxygenation during UCO. The first 3-4 s of the brief-UCOs were consistent with a baroreflex, and associated with a minor fall in FHR. Thereafter, the remainder of the FHR decelerations were highly consistent with the peripheral chemoreflex. The baroreflex is not sufficient to produce deep, rapid decelerations characteristic of variable decelerations and it is therefore likely a minor contributor to intrapartum decelerations. Abstract Fetal heart rate (FHR) monitoring is widely used to assess fetal wellbeing during labour, yet the physiology underlying FHR patterns remains incompletely understood. The baroreflex is widely believed to mediate brief intrapartum decelerations, but evidence supporting this theory is lacking. We therefore investigated the physiological changes in near-term fetal sheep during brief repeated umbilical cord occlusions (brief-UCOs, n = 15). We compared this to separate cohorts that underwent a phenylephrine challenge to stimulate the baroreflex (n = 9) or were instrumented with near-infrared spectroscopy and underwent prolonged 15-min complete UCO (n = 9). The first 3-4 s of brief-UCOs were associated with hypertension (p = 0.000), a fall in FHR by 9.7-16.9 bpm (p = 0.002). The FHR/MAP relationship during this time was consistent with that observed during a phenylephrine-induced baroreflex. At 4-5 s, the FHR/MAP relationship began to deviate from the phenylephrine baroreflex curve as FHR fell independently of MAP until its nadir in association with intense peripheral vasoconstriction (p = 0.000). During prolonged-UCO, cerebral oxygenation remained steady until 4 s after the start of prolonged-UCO, and then began to fall (p = 0.000). FHR and cerebral oxygenation then fell in parallel until the FHR nadir. In conclusion, the baroreflex has a minor role in mediating the first 3-4 s of FHR decelerations during complete UCO, but thereafter the peripheral chemoreflex is the dominant mediator. Overall, the baroreflex is neither necessary nor sufficient to produce deep, rapid decelerations characteristic of variable decelerations; it is therefore likely to be a minor contributor to intrapartum decelerations. This article is protected by copyright. All rights reserved. |
Databáze: | OpenAIRE |
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