Abstract
In a prospective study, third trimester plasma levels of BE and ACTH were determined in 58 women who delivered vaginally. Peptide regulation was compared between subjects who used conduction anesthesia at delivery and subjects who did not. Third trimester levels of maternal BE and ACTH were significantly related; however, the relationship was significant only in subjects who did not receive conduction anesthesia ( n = 24) at delivery. The normal corelease pattern between BE and ACTH in subjects receiving conduction anesthesia ( n = 34) during birth was uncoupled. The use of conduction analgesia during vaginal delivery was significantly related to a disregulation index created to quantify the BE-ACTH release pattern. Uncoupled ACTH and BE patterns may result from modified control of pro-opiomelanocortin (POMC) expression during pregnancy or unique proteolytic processing of POMC, and may alter pain tolerance during delivery.
Highlights
The purpose of the present investigation was to determine whether third trimester opiate levels or disruption of coreleased proopiomelanocortin (POMC) products, BE and adrenocorticotrophic hormone (ACTH), predicted the use of conduction anesthesia during vaginal delivery
Use of conduction anesthesia was recorded if the subject received epidural anesthetic
Findings from this study suggest that disregulation or uncoupling of the relationship between BE and ACTH during the third trimester prospectively predicted maternal utilization of conduction anesthesia during vaginal delivery
Summary
Fifty-eight subjects (from an initial sample of 76) who delivered vaginally constituted the study sample. All subjects giving consent were English-speaking adults with a singleton intrauterine pregnancy. Subjects were not excluded based on obstetric risk. Subjects were approached consecutively for participation during the late second trimester of their pregnancy. Informed consent was obtained according to the procedures of the University of California
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