Cerebral and Peripheral Circulatory Responses to Intracranial Hypertension in Fetal Sheep

• Published in: Circulation research 1989-05, Vol.64 (5), p.991-1000
• Main Authors: Harris, Andrew P, Koehler, Raymond C, Gleason, Christine A, Jones, M Douglas, Traystman, Richard J
• Format: Article
• Language: English
• Subjects: Animals; Arginine Vasopressin - blood; Biological and medical sciences; Cerebrovascular Circulation; Delivery, Obstetric; Epinephrine - blood; Female; Fetus - physiology; Hemodynamics; Intracranial Pressure; Medical sciences; Nervous system involvement in other diseases. Miscellaneous; Neurology; Norepinephrine - blood; Placenta - blood supply; Pregnancy; Regional Blood Flow; Sheep
• ISSN: 0009-7330; 1524-4571
• DOI: 10.1161/01.RES.64.5.991

Fetal head compression during normal labor can increase intracranial pressure (ICP). We studied the cerebral and peripheral blood flow responses to ICP elevation in utero in chronically catheterized fetal sheep using the radiolabeled microsphere technique. ICP was elevated, stepwise, in increments of 6±1 mm Hg by infusion of artificial cerebrospinal fluid into a lateral ventricle. When ICP was raised to within 28 mm Hg of baseline mean arterial blood pressure (i.e., ICP above 22 mm Hg), arterial pressure began to increase. Above this ICP level, up to 41 mm Hg, mean cerebral perfusion pressure was maintained by equivalent increases in arterial pressure. Cerebral blood flow and O2 uptake at the highest ICP levels were not different from baseline values. Changes in peripheral organ blood flow were graded according to the level of ICP. At the highest level (ICP=41 nun Hg), renal, gastrointestinal, and skin blood flow decreased by 68percent;, 69percent;, and 65percent;, respectively. Myocardial and adrenal blood flow doubled, whereas heart rate and cardiac output were unchanged. Placenta! blood flow increased in proportion to arterial pressure. Arterial plasma epinephrine, norepinephrine and arginine vasopressin increased by nearly two orders of magnitude. Therefore, as ICP approaches baseline mean arterial pressure, fetal lambs are capable of sustaining cerebral perfusion by initiating profound visceral vasoconstriction without curtailing placental blood flow. Since cerebral O2 uptake was maintained, there is no evidence that stimulation of the peripheral response requires pronounced cerebral ischemia. This highly developed Gushing response may be important for ensuring cerebral viability when the fetal head is compressed during parturition.