Fetal Plasma Renin Activity Research Articles

Function curve of the membranes that regulate amniotic fluid volume in sheep

Seven singleton 120-day fetal lambs were prepared with a shunt from the lung to the gastric end of the esophagus, a bladder catheter, and multiple amniotic fluid and vascular catheters. The urachus was ligated. Beginning 7 days later, amniotic fluid volumes were determined by drainage, followed by replacement with 1 liter of lactated Ringer (LR) solution. Urine flow into the amnion was measured continuously. In 14 of 27 experiments, amniotic fluid volumes were determined again 2 days after the inflow into the amnion had consisted of urine only and in 13 experiments after the inflow of urine had been supplemented by an intraamniotic infusion of LR solution. Intramembranous absorption was calculated from the inflows and the changes in volume between the beginning and end of each experiment. The relations between absorption rate and amniotic fluid volume, the "function curves," were highly individual. Urine production during the infusion of LR solution did not decrease, fetal plasma renin activity decreased (P < 0.001), and amniotic fluid volume increased by 140% [SE (27%), P < 0.005], but the increase in the amniochorionic absorption rate of 411% [SE (48%), P < 0.001] was greater (P < 0.005) than the increase in volume. Each of the seven fetuses was proven capable of an average intramembranous absorption rate that exceeded 4.5 liters of amniotic fluid per day. During the infusion of LR solution, the increase in the rate of absorption matched the rate of infusion (both in ml/h), with a regression coefficient of 0.75 (P < 0.001). Thus, even for large amniotic fluid volumes, volume is not limited by the absorptive capacity of the amniochorion, and, at least in these preparations, the position of the function curve and not the natural rate of inflow was the major determinant of resting amniotic fluid volume.

The ovine fetal endocrine reflex responses to haemorrhage are not mediated by cardiac nerves.

This study was designed to test the hypothesis that cardiac receptors tonically inhibit the secretion of renin, arginine vasopressin (AVP) and adrenocorticotropic hormone (ACTH) in late-gestation fetal sheep. Eight chronically catheterised fetal sheep between 122 and 134 days gestation were subjected to injection or infusion of saline or 4 % procaine into the pericardial space. Fetal blood pressure and heart rate were monitored and fetal blood samples were drawn to measure the response to these injections. Injection of procaine into the pericardial space effectively blocked cardiac nerves, as evidenced by a reduction in the variability of fetal heart rate and by the blockade of reflex reductions in fetal heart rate after intravenous injection of phenylephrine (an alpha-adrenergic agonist which raises blood pressure). Injection of saline had no discernable effects on any of the measured variables. A single injection of procaine, followed by a slow infusion, produced a transient blockade of cardiac nerves. Multiple injections of procaine produced a sustained blockade of cardiac nerves and a sustained rise in fetal plasma renin activity and ACTH. In none of the experiments did procaine significantly alter fetal plasma AVP concentrations. In 11 fetuses between 121 and 134 days gestation, we combined the cardiac nerve blockade with slow haemorrhage to test the cardiac nerves as mediators of the endocrine response to haemorrhage in utero. Cardiac nerve blockade exaggerated the fetal blood gas response to haemorrhage somewhat but did not significantly alter the magnitude of the ACTH, AVP, or plasma renin activity response to haemorrhage. We conclude that cardiac nerves in the late-gestation fetal sheep have minor influences on plasma renin activity and ACTH in normovolaemic fetuses, but that changes in cardiac nerve activity do not mediate the endocrine responsiveness to haemorrhage.

Intrauterine exposure to cocaine increased plasma ANP (atrial natriuretic peptide) but did not alter hypoxanthine concentrations in the sheep fetus

To assess the effects of cocaine, administered to the ewe, on the secretion of atrial natriuretic peptide (ANP), Plasma Renin Activity (PRA) and hypoxanthine in the fetus we studied 6 chronically cannulated sheep fetuses late in gestation. The ewe was given an intravenous injection of cocaine (2 mg/kg). Maternal and fetal arterial blood samples were withdrawn prior to the injection and at 2, 5, 10, 15, 45 and 60 min after the injection for the measurement of ANP, PRA and hypoxanthine. Fetal arterial blood pressure (MAP), plasma ANP and protein levels increased and pH and pO 2 decreased after cocaine was administered to the ewe. Fetal plasma hypoxanthine and PRA did not change. These results suggest that cocaine administration to the ewe is associated with fetal hypertension, hypoxemia and acidemia all of which may serve as stimuli for the secretion of ANP.

Reflex control of fetal arterial pressure and hormonal responses to slow hemorrhage

Late-gestation fetal sheep respond to slow hemorrhage with increases in plasma concentrations of adrenocorticotropic hormone (ACTH), hydrocortisone, arginine vasopressin (AVP), and plasma renin activity (PRA) that correlate to the acidemia and hypercapnia also produced by hemorrhage. This study was designed to investigate the role of peripheral chemoreceptors in the mediation of these responses. Chronically catheterized fetal sheep were left intact or were subjected to bilateral section of cervical vagosympathetic trunks and carotid sinus nerves. At least 5 days after surgical preparation (between 121 and 138 days of gestation) fetuses were bled at a rate of 11 ml/10 min for 2 h. Denervated fetuses were studied with or without simultaneous infusion of phenylephrine. Denervation exaggerated the decrease in mean arterial pressure and arterial pH and the increase in arterial PCO2 during hemorrhage. Infusion of phenylephrine in the denervated fetuses prevented the decrease in blood pressure and reduced the magnitudes of changes in blood gases. Fetal plasma ACTH, hydrocortisone, and PRA responses to the hemorrhage were exaggerated in the denervated fetuses (not infused with phenylephrine) compared with the intact fetuses. Phenylephrine infusion attenuated the ACTH response and inhibited the AVP response but did not alter the PRA response. We conclude that the sectioned fibers are important for the maintenance of blood pressure and blood gases during hemorrhage and that the PRA, AVP, and ACTH responses to slow hemorrhage are not mediated by peripheral chemoreceptors.

Fetal swallowing: response to systemic hypotension

The fetal swallowing and endocrine responses to systemic hypotension were studied in five chronically instrumented ovine fetuses (125 +/- 2 days). Fetuses were prepared with bipolar electrodes inserted in the thyrohyoid muscle, nuchal esophagus, and thoracic esophagus, a flow probe surrounding the thoracic esophagus, and arterial and venous catheters. In response to an intravenous infusion of sodium nitroprusside, fetal mean arterial blood pressure decreased from 50.8 +/- 3.6 to 41.7 +/- 3.8 mmHg. Fetal plasma renin activity (5.0 +/- 1.4-25.1 +/- 10.3 ng.ml-1.h-1) and arginine vasopressin (5.6 +/- 4.5-26.3 +/- 21.0 pg/ml) increased, while fetal swallowing electromyogram activity (7.3 +/- 1.1-1.9 +/- 0.3 swallows/10 min) and esophageal flow (5.5 +/- 3.1-1.2 +/- 0.9 ml/10 min) significantly decreased during the nitroprusside infusion. These results indicate a suppression of fetal swallowing in response to systemic hypotension despite stimulation of the renin-angiotensin system.

Short communications

Fetal plasma renin activity (PRA) was measured in 42 pregnancies. Compared to control fetuses, PRA was elevated in three of four hypoxemic fetuses, in two of five with hydrops and in two of five with uropathies. PRA did not change with transfusion in seven alloimmunized fetuses. This study demonstrates PRA in human fetuses and suggests that the renin-angiotensin system can respond to stimuli in fetal life.

Acidemia stimulates ACTH, vasopressin, and heart rate responses in fetal sheep

Adrenocorticotropic hormone (ACTH), arginine vasopressin (AVP), and renin responses to hemorrhage are highly correlated to the hemorrhage-induced decreases in arterial pH. The present study was designed to test the responses of these three systems to acute fetal acidemia, produced by intravenous infusion of H+. HCl was infused into chronically catheterized fetal sheep at rates of 0.02 (n = 5), 0.10 (n = 6), and 0.50 (n = 5) meq/min. Infusions at rates of 0.10 and 0.50 meq/min significantly decreased fetal arterial pH and increased arterial PCO2. Fetal heart rate and plasma concentrations of ACTH, cortisol, and AVP were significantly increased during infusion of HCl at 0.5 meq/min. Neither fetal plasma renin activity nor fetal arterial blood pressure was significantly altered by any of the infusions. The results of these experiments suggest that fetal ACTH, AVP, and heart rate are stimulated by decreases in arterial pH and/or increases in arterial PCO2. We speculate that these responses are chemoreceptor mediated, although we cannot distinguish the apparent relative roles of peripheral and central chemoreceptors on the basis of the present study.

Are fetal adrenocorticotropic hormone and renin secretion suppressed by maternal cortisol secretion?

Previous studies from this laboratory have demonstrated that intravenous infusions of hydrocortisone (cortisol) into fetal sheep at rates that produce plasma concentrations achieved during fetal stress inhibit fetal adrenocorticotropic hormone (ACTH) and renin secretion. The present study was designed to test for inhibition of fetal renin and ACTH after maternal adrenal secretion of cortisol. ACTH-(1-24) or saline infusion into 12 pregnant ewes (120-132 days gestation) at rates of 0, 1, 5, or 20 ng ACTH.kg-1.min-1 for 5 h produced dose-related increases in maternal plasma ACTH and cortisol concentrations and fetal plasma cortisol concentration. In the 20-ng.kg-1.min-1 group, increases in fetal plasma cortisol of 8.0 ng/ml (to 24.3 +/- 3.7 ng/ml) did not suppress basal fetal plasma renin activity. One hour after the end of the maternal vehicle or ACTH infusion, fetal ACTH secretion was stimulated by fetal intravenous infusion of sodium nitroprusside. In the 0-, 1-, and 5-ng.kg-1.min-1 groups, fetal ACTH responses to nitroprusside were suppressed in animals infused with ACTH. Together, these results indicate that the maternal adrenal secretion of cortisol inhibits stimulated secretion of ACTH but not renin in 120- to 132-day-gestation fetal sheep.

The effects of frusemide, saralasin and hypotension on fetal plasma renin activity and on fetal renal function.

1. In eleven chronically catheterized fetal sheep aged 124-142 days, hypotension caused by infusion of sodium nitroprusside (1.6-3.3 mg/h) and competitive antagonism of angiotensin II by saralasin (3.3 mg/h) both caused a fall in fetal urine flow (P less than 0.02 and P less than 0.05, respectively), and in sodium excretion (P less than 0.05 and P less than 0.01) because they both caused a fall in glomerular filtration rate (G.F.R., P less than 0.02 and P less than 0.01). Neither hypotension nor saralasin had any significant effect on fractional sodium reabsorption. Saralasin only caused a significant fall in systolic pressure (P = 0.05) while infusion of sodium nitroprusside caused a fall in both systolic and diastolic pressure (P less than 0.005 and P less than 0.02). 2. Frusemide (6 mg I.V) caused a marked natriuresis and diuresis (F = 24.9, P less than 0.005 and F = 30.5, P less than 0.005). This effect was maximal within 30 min. There was no change in fetal G.F.R. and there was a significant decrease in the fraction of the filtered sodium load that was reabsorbed (F = 10.44, P less than 0.0025). Fetal mean plasma renin activity (p.r.a.) rose progressively throughout (F = 9.3, P less than 0.005). When frusemide was given to fetal sheep which were hypotensive because they were infused with sodium nitroprusside, it still caused a diuresis (F = 5.73, P less than 0.025) and the fraction of the filtered sodium load that was reabsorbed decreased (F = 4.06, P less than 0.05) to a similar extent to that seen in animals given frusemide alone. On the other hand, frusemide was ineffective as a diuretic i.e. it had no effect on fractional sodium reabsorption, when given to fetal sheep which were infused with saralasin. 3. Injection of frusemide was associated with a significant rise in the diastolic pressures of hypotensive fetuses (P less than 0.05). Furthermore, when the infusion of saralasin was terminated 1.5 h after frusemide injection, blood pressure rose significantly (F = 11.19, P less than 0.0005 for systolic pressure and F = 7.15, P less than 0.005 for diastolic pressure) and p.r.a. fell (F = 4.78, P less than 0.025). 4. It is concluded that the fetal renin-angiotensin system can play a significant role in regulation of fetal blood pressure.(ABSTRACT TRUNCATED AT 400 WORDS)

Negative-feedback inhibition of fetal ACTH secretion by maternal cortisol.

Previous studies in this laboratory have shown that small increases in fetal cortisol (F) decreased basal fetal plasma renin activity (PRA) and completely inhibited the fetal adrenocorticotropin hormone (ACTH) response to hypotension. The present study was designed to quantitate suppression of fetal ACTH and renin secretion by maternal F. Fetal and maternal femoral arteries and veins were chronically catheterized (11 fetuses, 118-129 days gestation). Maternal intravenous infusion of 0, 0.5, 1.0, and 2.0 micrograms F X kg-1 X min-1 (n = 5-6) increased mean maternal and fetal cortisol and suppressed fetal ACTH responses to a subsequent period of hypotension in a dose-related manner. Increases in fetal plasma cortisol to 8.3 ng/ml completely suppressed the fetal ACTH response to hypotension. The results indicate that increases in maternal plasma cortisol concentration sufficient to produce modest increases in fetal plasma cortisol inhibit fetal ACTH secretion.

Fetal cardiovascular and endocrine responses to prolonged fetal hemorrhage

Twelve chronically catheterized fetal sheep averaging 131 +/- 1 (SE) days gestation (term = 145-150 days) were hemorrhaged an average of 30.8 +/- 1.8% of their initial blood volume over 2 h by removing blood at 10-min intervals. During the hemorrhage, fetal blood volume decreased by 14.3 +/- 1.4%, and arterial pressure (AP), venous pressure (VP), and heart rate (HR) did not change significantly, although fetal plasma renin activity (PRA), arginine vasopressin (AVP), and norepinephrine (NE) were elevated to 1.5-2.5 times their initial values (P less than 0.05). Circulating levels of PRA, AVP, and NE began to rise when 5-10, 10-15, and 20-30%, respectively, of the initial blood volume was removed. Three to five hours after the hemorrhage, blood volume had returned to normal, AP was reduced by an average of 6 mmHg, VP was unchanged, and HR was elevated by an average of 20 beat/min; PRA, AVP, and NE averaged two to three times control (P less than 0.05). Twenty-two hours after the hemorrhage, blood volume was 5.4 +/- 2.4% above control; AP and HR returned toward normal; VP was elevated by an average of 2 mmHg; PRA and NE levels remained elevated (P less than 0.05), but AVP was not different from control. Plasma concentrations of epinephrine, dopamine, and prolactin showed little change during or after the hemorrhage. Thus these studies indicate that the fetus rapidly returns its blood volume to normal after a substantial loss of blood. In addition, the fetal cardiovascular and endocrine responses to a prolonged fetal hemorrhage of moderate volume are substantially less than those that occur after rapid hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Sensitivity of cortisol-induced inhibition of ACTH and renin in fetal sheep.

Previous experiments demonstrated that increases in ovine fetal plasma cortisol concentration to maximal stress levels suppressed fetal plasma renin activity and completely inhibited fetal adrenocorticotropin (ACTH) responses to subsequent stress. This study was designed to quantitate the suppressive action of cortisol on both ACTH and renin. Fetal sheep between 117 and 131 days gestation were surgically prepared with chronically implanted catheters. At least 4 days after surgery, vehicle or cortisol (0.25, 0.5, 1, 2, or 3 micrograms/min) were infused for 5 h. One hour after the end of the vehicle or cortisol infusion, fetal ACTH and renin secretion were stimulated by intravenous infusion of sodium nitroprusside. Cortisol infusions suppressed basal plasma renin activity (caused by suppression of plasma renin concentration) to degrees that were related to the increases in fetal plasma cortisol concentration. After cortisol infusions, renin responses to hypotension were apparently suppressed to degrees not obviously related to the rate of cortisol infusion. Fetal plasma ACTH responses to hypotension were completely suppressed by increases in total and unbound fetal plasma cortisol concentration 1.6 and 1.7 ng/ml, respectively. These results demonstrate a high sensitivity of the fetal hypothalamopituitary unit and renin-angiotensin system to cortisol.

Absence of fast negative feedback control of ACTH and renin in fetal and adult sheep.

Fetal adrenocorticotropin (ACTH) and renin secretion are increased by a variety of stimuli and decreased by cortisol negative feedback inhibition. However, the time courses of these interactions are unknown. The present studies were designed to test for rapid feedback negative suppression of ACTH and renin secretion in fetal and adult sheep. In chronically catheterized fetal sheep, ACTH and renin secretion were stimulated by intravenous infusion of sodium nitroprusside, a vasodilator drug. Vehicle or cortisol, infused at rates of 1, 2, or 4 micrograms/min for 2 min before and during the infusion of nitroprusside did not significantly alter the fetal ACTH or renin responses to nitroprusside. In five nonpregnant ewes, chronically prepared with skin loops containing the carotid arteries, nitroprusside (20 micrograms X kg-1 X min-1) was infused beginning 2 min after infusion of vehicle or cortisol (3.5 or 7 micrograms X kg-1 X min-1). Cortisol infusion produced a rising plasma cortisol concentration similar to that after stress but did not alter the magnitude of the ACTH response to nitroprusside. The results indicate that cortisol-induced suppression of ACTH secretion does not occur rapidly in the fetal or adult sheep and that the cortisol-induced suppression of fetal plasma renin activity is a slow process.

Changes in fetal renal function in response to infusions of a hyperosmotic solution of mannitol to the ewe.

In six pregnant ewes a reduction in transplacental water transfer was produced by increasing maternal osmolality (by infusion of 180 g of mannitol in 500 ml of 0.15 M-sodium chloride) and the fetal renal responses to this reduction in water transfer were studied. These responses were compared with the renal responses of five other chronically catheterized fetal lambs whose mothers received I.V. infusions of 500 ml of 0.15 M-sodium chloride. Intravenous infusion of 500 ml of 0.15 M-sodium chloride to the ewe produced no changes in fetal plasma sodium, potassium or plasma renin activity and had no effect on fetal renal function. After I.V. infusion of mannitol to the ewe, fetal urinary flow rate fell from control levels of 0.69 +/- 0.12 ml/min to 0.32 +/- 0.04 ml/min (S.E. of mean, P less than 0.006). This fall in urinary flow rate was due to increased water reabsorption because there was no change in glomerular filtration rate and osmolar clearance. Fetal urinary sodium excretion increased from 16.2 +/- 2.0 mumol/min, to 34.2 +/- 6.9 mumol/min (S.E. of mean, P less than 0.04). This increase in fetal urinary sodium excretion was due to a fall in the fractional reabsorption of sodium which was related to this rise in fetal plasma sodium levels that occurred following infusion of mannitol to the ewe. The increases in fetal plasma sodium levels were also associated with reductions in fetal plasma renin activity.

Plasma renin activity during acute ventilatory hypoxia in the ewe and fetal lamb.

Plasma renin activity (PRA) was determined during ventilatory hypoxia (n = 6) or normoxia (n = 5) in chronically catheterized ewes and fetuses. Compared to identically studied controls, hypoxemic ewes (PaO2 = 34.2 +/- 3 Torr, p less than 0.01) developed significant tachycardia (103 vs. 125 +/- 6, p less than 0.05) without change in blood pressure. Hypoxemic (PaO2 = 9.1 +/- 0.7 Torr, p less than 0.01) fetuses developed hypertension (39.3 vs 44 +/- 2 mm Hg, p less than 0.05), tachycardia (182 +/- 2 vs. 202 +/- 5, p less than 0.05), and elevated hematocrit (34 +/- 1.5 vs. 38.5 +/- 1.8%, p less than 0.02) during hypoxemia. Fetal plasma renin levels increased from 0.26 +/- 0.05 to 7.6 +/- 2.8 ng/ml/h (p less than 0.06) and to 14.7 +/- 5.6 ng/ml/h (p less than 0.05) after 60 and 120 min of hypoxia, respectively. Fetal PRA returned to baseline after 60 min of recovery. Ewe PRA did not change in either group. From these data, we conclude that differences exist between fetal and adult plasma renin levels during hypoxia. The mechanism of this response remains to be clarified.

Role of Aldosterone on Renal Sodium and Potassium Excretion during Fetal Life and Newborn Period

The renal response to endogenous aldosterone production at different times during gestation and immediately after birth, as well as factors controlling aldosterone secretion during fetal life have been studied in 34 lamb fetuses (106-142 days of gestation, term 145 days) and in 6 newborn lambs (3-8 days postnatal age). It was demonstrated that the increase in fetal plasma aldosterone concentrations correlated with the increase in fetal plasma renin activity (PRA) (r = 0.67, p < 0.001). Moreover, it was fond that the slope of the regression line between plasma aldosterone and PRA during fetal life was significantly steeper (p < 0.05) than after birth. Significant correlation coefficients were found between the fetal urinary to plasma ratios (U/P) of sodium over potassium [(U/P)Na+/(U/P)K+] and either fetal plasma aldosterone (r = -0.53, p < 0.005) or fetal age (r = -0.52, p < 0.005). Moreover, in 7 out of 9 fetuses over 125 days, frank secretion of potassium by the fetal tubular cells was demonstrated; such a secretion was present in only 1 of the 15 fetuses between 101 and 125 days of gestation. Finally, it was demonstrated that the increase in mean arterial blood pressure during fetal life and after birth is not a major factor in the increase in fetal glomerular filtration rate during gestation or in the adaptation of glomerular filtration rate to extrauterine life.

Maternal fetal osmolar homeostasis: fetal posterior pituitary autonomy.

Summary: After the infusion of a bolus of 225 mEq NaCl (HS) to maternal ewes, we studied fetal plasma sodium, osmolality, total serum solids, plasma arginine vasopressin (AVP) and plasma renin activity (PRA) responses in 16 chronically catheterized, 112–139 days of gestation fetal lambs. To examine the degree to which this might have represented transplacental passage of AVP, we infused a large amount of synthetic AVP into the fetal circulation (protocol 3) and detected no change in maternal plasma AVP. The protocol was designed to allow multiple, frequent blood sampling not possible by infusing the synthetic AVP into the maternal circulation. In order to compare the fetal AVP response elicited by HS in the maternal ewe and that after direct HS into the newborn lamb and fetus, we calculated stimulus response ratio (SRR) as: Log (AVP)1 - Log (AVP)2, divided by Δosmolality. The SRR of lamb fetuses after maternal HS was significantly greater (0.16 ± 0.02) than that after direct fetal HS (0.04 ± 0.01). In comparison, the newborn lamb has a SRR of 0.02 ± 0.01, and the ewe has a SRR of 0.02 ± 0.01 after HS. These data suggest that after maternal HS infusion, both a volume and, to a lesser extent, an osmolar stimulus for AVP secretion occurs after an induced water flux from the fetal to maternal compartments. Maternal plasma sodium concentration rose promptly from a base line of 146 ± 2.2 (mean ± SEM) to 157 ± 2.8 mEq/liter by 1–20 min where it remained throughout the hour observation period. Fetal plasma sodium concentration rose more slowly from base line of 143 ± 1.8 to 149 ± 1.8 mEq/liter by 1 hr. When 85 mCi22Na was additionally infused with the HS, fetal 22Na constituted only 10% of maternal 22Na counts by the end of 1 hr. During the same period fetal PRA rose from a base line of 12.9 ± 3.8 to 32.0 ± 3.6 ng/ml/hr, while maternal renin remained unchanged. Maternal AVP rose modestly, 11 min after the HS, but promptly returned to base line. There was a rapid and sustained rise by fetal AVP from a base line of 0.7 μU/ml to a peak of 8.2 μU/ml by 22 min post HS. A fetal SRR, Log (AVP)1-Log (AVP)2/Δosmolality after maternal HS was greater than that after direct fetal HS or HS to the ewe or newborn lamb. In an additional experiment, using five chronically catheterized fetuses, 10 million μU AVP injected in the fetal circulation failed to produce an increase in maternal AVP. These results demonstrate that: 1) AVP does not cross the placenta; 2) the fetal sheep neurohypophysis is autonomous and responsive to both direct and indirect (maternal) osmolar stimulation; and 3) the relatively slow rate of maternal to fetal sodium transfer, the augmented SRR after maternal HS, and the elevated fetal PRA and AVP concentration suggest that there is a rapid fetal to maternal flow of water after maternal HS and a combined volume and osmolar stimulus to the fetus. Speculation: Infusions of hypertonic saline in pregnant ewes resulted in rapid increases of fetal plasma sodium due to transfer of water from fetus to mother. A marked rise in fetal renin activity and AVP was also observed. The increase in AVP exceeded that seen in the mother and that produced by infusing hypertonic saline in the fetus. Fetal secretion of AVP is stimulated by hyperosmolality and volume contraction. Elevated AVP may help the fetal kidney retain water and, thereby, minimize hypotonic urine formation and volume depletion.

The dynamics of vasopressin release and blood volume regulation during fetal hemorrhage in the lamb fetus.

Summary: Experiments were performed on 11 long-term fetal lamb preparations (103–138 days of gestation) to investigate the sensitivity and relative responsiveness of the fetal volume receptors in modulating fetal plasma arginine vasopressin (pAVP) secretion and plasma renin activity (PRA) secretion during fetal hypovolemia and after fetal blood volume replacement. During fetal hemorrhage there were significant decreases (P < 0.05) in fetal hematocrit (34.7 ± 2.58 to 27.0 ± 1.64%), plasma proteins (3.14 ± 0.15 to 2.78 ± 0.19 g/100 ml), mean arterial blood pressure (MABP) (58.1 ± 2.59 to 52.2 ± 2.60 mmHg) and fetal arterial pH (7.38 ± 0.01 to 7.35 ± 0.01). A significant increase in fetal pAVP concentration from 0.73 ± 0.21 to 34.9 ± 10.04 μU/ml (P < 0.01) and fetal PRA from 4.78 ± 2.22 to 40.4 ± 18.31 ng/ml/hr (P < 0.05) was demonstrated at the peak of fetal hemorrhage. Two hr after correction of the fetoplacental blood volume, these values were back to base line levels. No change in either maternal pAVP or PRA was seen during fetal hemorrhage. When individual values for log pAVP and log PRA were plotted as a function of percent of fetoplacental blood volume removed the correlation coefficients were 0.82 and 0.60, respectively. A multiple regression analysis showed a high correlation of log pAVP and log PRA with the volume of blood removed and a low partial correlation with the fetal MABP. This suggests the decrease in fetal MABP was not the primary factor explaining the increase in pAVP and PRA during fetoplacental blood volume depletion. The data indicate that the fetal volume receptors for control of arginine vasopressin secretion are fully functional in the last trimester of gestation and suggests that fetal pAVP and PRA are released as an exponential function of the percent of fetoplacental blood volume depletion. Finally, an isosmotic water shift from the fetal interstitial space to the fetal vascular space is described during fetal hemorrhage.Speculation: It is suggested that a change in the equilibrium between the forces regulating fluid movement through the fetal capillary membranes, in accordance with Starling's principle, activates isosmotic water fluxes from the fetal interstitial space to the fetal vascular compartment counteracting the effects of fetal blood volume depletion. Therefore, the role of arginine vasopressin (AVP) release during fetal hemorrhage, if any, will be to act as a pressor substance helping to maintain fetal blood pressure. No major effect of AVP on placental membranes was demonstrated in vivo.

The Actions of Vasoactive Drugs on Fetal and Maternal Plasma Renin Activity

The association between fetal arterial pressure and fetal plasma renin activity (PRA) was studied in 30 fetal lambs prepared acutely, but studied in utero. There was a negative correlation between resting fetal arterial pressure and resting fetal PRA (p less than 0.05). Fetal hypotension caused by intravenous infusion of sodium nitroprusside was associated with increases in fetal PRA. Fetal hypertension caused by intravenous infusion of phenylephrine to the fetus was associated with a decrease in fetal PRA. Maternal hypotension caused by infusion of sodium nitroprusside to the mother, and maternal hypertension caused by maternal infusion of phenylephrine caused an increase in fetal blood pressure and a fall in fetal PRA. It is concluded that the hypertensive response of the fetus to these changes in maternal blood pressure was not initiated by the fetal renin-angiotensin system. Isoprenaline caused a rise in fetal PRA. In 11 of 28 infusions this increase in fetal PRA occurred even though diastolic pressure was increased. It is concluded that there is a beta-adrenergic receptor in the fetal kidney which can release renin. The increase in fetal PRA with intravenous isoprenaline was blocked by propanolol. Infusions of adrenaline were not associated with increases in fetal PRA.

Maternal and fetal plasma renin activity during ritodrine infusion to the mother.

The effect of ritodrine to the mother on plasma renin activity (PRA) in the mother and fetus was examined in 10 mothers coming to elective cesarean section. 10 comparable mothers without ritodrine infusion served as controls. At the end of 2 h infusion of ritodrine, the mean maternal PRA was significantly (p less than 0.001) higher than in the control group. Also the mean PRA levels in the umbilical vein (p less than 0.001) and umbilical artery (p less than 0.01) were significantly higher after ridodrine infusion to the mother than the respective levels in the control group.