Abstract：
BACKGROUND: Stress hormones like catecholamine and cortisol are thought to reflect the magnitude of physical stress in adults and were studied in relationship to the cause of death and agony time. Intrauterine distress, intrapartum events, and modes of delivery can affect the fetal endocrine stress response, as reflected by biochemical analyses. The aim of the present study was to evaluate the role of catecholamines and cortisol as markers of ante-mortem fetal distress. The role of cortisol as a marker of circadian timing of delivery was also assessed.
METHODS: A 2-year prospective cohort-comparison inclusion of stillbirths and newborns took place with collection of antemortem data, labor parameters, neonatal outcome, post-mortem data and blood samples. Stillbirths were classified as acute or chronic on the basis of a multidisciplinary evaluation. Heart blood of stillbirths and cord blood of newborns were analyzed by high pressure liquid chromatography (HPLC) for adrenaline and noradrenaline and by immunoassay for cortisol determination.
RESULTS: Fifteen stillbirths and 46 newborns, as a comparison group, delivered by spontaneous vaginal birth, elective, and emergency cesarean sections were included. Stillbirths\' main cause of death was cord thrombosis. Levels of adrenaline and noradrenaline (median: 14,188 pg/ml and 230.5 pg/ml, respectively) were significantly higher (p < 0.001) in stillbirths than in newborns and were also higher in acute compared to chronic distress. Cortisol levels were significantly higher (p < 0.05) in spontaneous vaginal delivery (median: 18.2 μg/dl) compared to elective cesarean sections (median: 3.8 μg/dl). No difference in cortisol concentrations was detected between newborns delivered at morning and at afternoon/evening.
CONCLUSIONS: Our results suggest that the biochemical measurement of adrenaline and noradrenaline levels might reflect a marked physical stress response during the process of death in stillbirths. On the contrary, the elevation of cortisol levels could mirror the elevation in maternal cortisol level during vaginal delivery. For the post-mortem evaluation of stillbirths, the analysis of CA levels could provide additional data on the duration of distress, useful to integrate the forensic diagnosis.
METHODS: A 2-year prospective cohort-comparison inclusion of stillbirths and newborns took place with collection of antemortem data, labor parameters, neonatal outcome, post-mortem data and blood samples. Stillbirths were classified as acute or chronic on the basis of a multidisciplinary evaluation. Heart blood of stillbirths and cord blood of newborns were analyzed by high pressure liquid chromatography (HPLC) for adrenaline and noradrenaline and by immunoassay for cortisol determination.
RESULTS: Fifteen stillbirths and 46 newborns, as a comparison group, delivered by spontaneous vaginal birth, elective, and emergency cesarean sections were included. Stillbirths\' main cause of death was cord thrombosis. Levels of adrenaline and noradrenaline (median: 14,188 pg/ml and 230.5 pg/ml, respectively) were significantly higher (p < 0.001) in stillbirths than in newborns and were also higher in acute compared to chronic distress. Cortisol levels were significantly higher (p < 0.05) in spontaneous vaginal delivery (median: 18.2 μg/dl) compared to elective cesarean sections (median: 3.8 μg/dl). No difference in cortisol concentrations was detected between newborns delivered at morning and at afternoon/evening.
CONCLUSIONS: Our results suggest that the biochemical measurement of adrenaline and noradrenaline levels might reflect a marked physical stress response during the process of death in stillbirths. On the contrary, the elevation of cortisol levels could mirror the elevation in maternal cortisol level during vaginal delivery. For the post-mortem evaluation of stillbirths, the analysis of CA levels could provide additional data on the duration of distress, useful to integrate the forensic diagnosis.
摘要：
背景：诸如儿茶酚胺和皮质醇之类的应激激素被认为反映了成年人身体应激的程度，并研究了与死亡原因和痛苦时间的关系。宫内窘迫,产时事件，分娩方式会影响胎儿内分泌应激反应，正如生化分析所反映的那样。本研究的目的是评估儿茶酚胺和皮质醇作为死前胎儿窘迫标志物的作用。还评估了皮质醇作为分娩昼夜节律时间标志的作用。
方法：对死产和新生儿进行了为期2年的前瞻性队列比较，并收集了死前数据，人工参数，新生儿结局,验尸数据和血样.根据多学科评估，将死胎分为急性或慢性。通过高压液相色谱（HPLC）分析死胎的心脏血液和新生儿的脐带血中的肾上腺素和去甲肾上腺素，并通过免疫测定法测定皮质醇。
结果：15例死胎和46例新生儿，作为一个比较组，自然阴道分娩，选修,包括紧急剖宫产。死胎死亡的主要原因是脐带血栓形成。肾上腺素和去甲肾上腺素的水平（中位数：14,188pg/ml和230.5pg/ml，分别）在死胎中显着高于新生儿（p<0.001），在急性窘迫中也高于慢性窘迫。自发阴道分娩（中位数：18.2μg/dl）的皮质醇水平明显高于选择性剖宫产（中位数：3.8μg/dl）（p<0.05）。在早上和下午/晚上分娩的新生儿之间没有检测到皮质醇浓度的差异。
结论：我们的结果表明，肾上腺素和去甲肾上腺素水平的生化测量可能反映了死产死亡过程中明显的身体应激反应。相反,皮质醇水平的升高可以反映阴道分娩期间母体皮质醇水平的升高。对于死产的事后评估，对CA水平的分析可以提供关于遇险持续时间的额外数据，有助于整合法医诊断。
方法：对死产和新生儿进行了为期2年的前瞻性队列比较，并收集了死前数据，人工参数，新生儿结局,验尸数据和血样.根据多学科评估，将死胎分为急性或慢性。通过高压液相色谱（HPLC）分析死胎的心脏血液和新生儿的脐带血中的肾上腺素和去甲肾上腺素，并通过免疫测定法测定皮质醇。
结果：15例死胎和46例新生儿，作为一个比较组，自然阴道分娩，选修,包括紧急剖宫产。死胎死亡的主要原因是脐带血栓形成。肾上腺素和去甲肾上腺素的水平（中位数：14,188pg/ml和230.5pg/ml，分别）在死胎中显着高于新生儿（p<0.001），在急性窘迫中也高于慢性窘迫。自发阴道分娩（中位数：18.2μg/dl）的皮质醇水平明显高于选择性剖宫产（中位数：3.8μg/dl）（p<0.05）。在早上和下午/晚上分娩的新生儿之间没有检测到皮质醇浓度的差异。
结论：我们的结果表明，肾上腺素和去甲肾上腺素水平的生化测量可能反映了死产死亡过程中明显的身体应激反应。相反,皮质醇水平的升高可以反映阴道分娩期间母体皮质醇水平的升高。对于死产的事后评估，对CA水平的分析可以提供关于遇险持续时间的额外数据，有助于整合法医诊断。
