Innervation of the umbilical vessels

Summary Umbilical vessels of guinea-pig fetuses were studied shortly before birth. In all umbilical cords investigated an innervation of the umbilical vessels is lacking. The intrafetal parts of the umbilical vessels on the other hand are richly innervated. A marked difference in the amount of nerve fibres and the pattern of innervation is found between artery and vein. The artery is supplied by a dense nerve plexus which spins around the media and which originates from nerve bundles within the outer adventitial layers. The comparatively scanty innervation of the vein exhibits a more coarsely meshed net pattern. The nerve bundles in the vein exhibit a close affinity to the vasa vasorum.Number and type of the close contacts between the muscle cells are different in the various sections of the umbilical vessels. Similar to the distribution of nerves they are almost absent in the vessels of the umbilical cord, numerously, however, in the intrafetal parts. Contrary to the innervation, the close contacts in the vein are developed more numerously and more broadly than in the corresponding artery.     

A mathematical model of umbilical venous pulsation

Pulsations in the fetal heart propagate through the precordial vein and the ductus venosus but are normally not transmitted into the umbilical vein. Pulsations in the umbilical vein do occur, however, in early pregnancy and in pathological conditions. Such transmission into the umbilical vein is poorly understood. In this paper we hypothesize that the mechanical properties and the dimensions of the vessels do influence the umbilical venous pulsations, in addition to the magnitude of the pressure and flow waves generated in the fetal atria. To support this hypothesis we established a mathematical model of the umbilical vein/ductus venosus bifurcation. The umbilical vein was modeled as a compliant reservoir and the umbilical vein pressure was assumed to be equal to the stagnation pressure at the ductus venosus inlet. We calculated the index of pulsation of the umbilical vein pressure ((max-min)/mean), the reflection and transmission factors at the ductus venosus inlet, numerically and with estimates. Typical dimensions in the physiological range for the human fetus were used, while stiffness parameters were taken from fetal sheep. We found that wave transmission and reflection in the umbilical vein ductus venosus bifurcation depend on the impedance ratio between the umbilical vein and the ductus venosus, as well as the ratio of the mean velocity and the pulse wave velocity in the ductus venosus. Accordingly, the pulsations initiated by the fetal heart are transmitted upstream and may arrive in the umbilical vein with amplitudes depending on the impedance ratio and the ratio between the mean velocity and the pulse wave velocity in the ductus venosus.     

The control of cardiovascular shunts in the fetal and perinatal period

The fetal circulation has two major vascular shunts, the ductus arteriosus and the ductus venosus. The ductus arteriosus connects the pulmonary artery with the descending portion of the aortic arch, hence shunting most of the right ventricular output away from the unexpanded lungs. The ductus venosus connects instead the portal sinus with the inferior vena cava and allows well-oxygenated umbilical vein blood to bypass the liver and reach the central circulation rapidly. Both blood vessels cease their function after birth and undergo permanent closure. It is now well established that prenatal patency of the ductus arteriosus is an active state sustained by a prostaglandin. A similar mechanism has been recently recognized in the fetal ductus venosus. Evidence is presented indicating that prostaglandin E2 and prostaglandin I2 are natural relaxants, respectively, for the ductus arteriosus and the ductus venosus. In addition, both vascular shunts share the dependence on an endogenous cytochrome P-450 mechanism to develop their contractile tone. This mechanism may be important in the normal process of shunt closure at birth. While broadening the knowledge of fetal cardiovascular homeostasis, advances in this field have important implications for the prevention and management of certain pathological conditions affecting the newborn.     

Venous responses to hypoxemia in the fetal lamb

The factors regulating umbilical venous return and its distribution between the ductus venosus and liver are poorly understood. This study was designed to determine where the major changes in resistance to umbilical venous return occur in response to fetal hypoxemia. In eight chronically-instrumented fetal lambs, during control and hypoxemic periods, we measured pressure in the descending aorta, extra-abdominal umbilical vein, portal sinus, and inferior vena cava; we also measured blood flow using radionuclide-labeled microspheres. During the control period, the umbilical arteries and placental vasculature accounted for 82% of total resistance to umbilical-placental blood flow, the umbilical veins for 11%, and the ductus venosus and liver for 7%. Hypoxemia increased resistance in the umbilical veins more than twofold, but did not affect resistance in the umbilical arteries or placenta. Although combined liver/ductus venosus resistance did not change, hepatic vascular resistance increased, and ductus venosus resistance decreased. We conclude that the major increase in resistance to umbilical venous return in response to hypoxemia resides in the umbilical veins. This increased resistance may improve maternal-fetal blood gas exchange by increasing the fetal surface area in the placenta.     

Velocity profiles in the human ductus venosus: a numerical fluid structure interaction study

The veins distributing oxygenated blood from the placenta to the fetal body have been given much attention in clinical Doppler velocimetry studies, in particular the ductus venosus. The ductus venosus is embedded in the left liver lobe and connects the intra-abdominal portion of the umbilical vein (IUV) directly to the inferior vena cava, such that oxygenated blood can bypass the liver and flow directly to the fetal heart. In the current work, we have developed a mathematical model to assist the clinical assessment of volumetric flow rate at the inlet of the ductus venosus. With a robust estimate of the velocity profile shape coefficient (VC), the volumetric flow rate may be estimated as the product of the time-averaged cross-sectional area, the time-averaged cross-sectional maximum velocity and the VC. The time average quantities may be obtained from Doppler ultrasound measurements, whereas the VC may be estimated from numerical simulations. The mathematical model employs a 3D fluid structure interaction model of the bifurcation formed by the IUV, the ductus venosus and the left portal vein. Furthermore, the amniotic portion of the umbilical vein, the right liver lobe and the inferior vena cava were incorporated as lumped model boundary conditions for the fluid structure interaction model. A hyperelastic material is used to model the structural response of the vessel walls, based on recently available experimental data for the human IUV and ductus venous. A parametric study was constructed to investigate the VC at the ductus venosus inlet, based on a reference case for a human fetus at 36 weeks of gestation. The VC was found to be \(0.687\,\pm \,0.023\) (Mean \(\pm \) SD of parametric case study), which confirms previous studies in the literature on the VC at the ductus venosus inlet. Additionally, CFD simulations with rigid walls were performed on a subsection of the parametric case study, and only minor changes in the predicted VCs were observed compared to the FSI cases. In conclusion, the presented mathematical model is a promising tool for the assessment of ductus venosus Doppler velocimetry.     

Prostacyclin producing activity of human umbilical blood vessels in adrenergic innervated and non-innervated portions

The present experiment was performed in order to clarify the significance of prostacyclin (PGI2) in the regulation of human umbilical blood flow. Distribution of adrenergic nerve fibers in umbilical cord was examined by means of a modification of the glyoxylic acid fluorescence histochemical technique. PGI2 producing activity in various portions of umbilical blood vessels was measured by platelet bioassay. Adrenergic nerve fibers were observed only in the region surrounding umbilical arteries at the fetal end of the cord. PGI2 producing activity of umbilical arteries was significantly lower in the innervated region than in the non-innervated region. There were no significant regional differences in umbilical vein which has no adrenergic innervation. The relationship between vascular PGI2 producing activity and adrenergic innervation, and the significance of PGI2 in the regulation of human umbilical blood flow are discussed.     

Simulation of pressure drop and energy dissipation for blood flow in a human fetal bifurcation.

The pressure drop from the umbilical vein to the heart plays a vital part in human fetal circulation. The bulk of the pressure drop is believed to take place at the inlet of the ductus venosus, a short narrow branch of the umbilical vein. In this study a generalized Bernoulli formulation was deduced to estimate this pressure drop. The model contains an energy dissipation term and flow-scaled velocities and pressures. The flow-scaled variables are related to their corresponding spatial mean velocities and pressures by certain shape factors. Further, based on physiological measurements, we established a simplified, rigid-walled, three-dimensional computational model of the umbilical vein and ductus venosus bifurcation for stationary flow conditions. Simulations were carried out for Reynolds numbers and umbilical vein curvature ratios in their respective physiological ranges. The shape factors in the Bernoulli formulation were then estimated for our computational models. They showed no significant Reynolds number or curvature ratio dependency. Further, the energy dissipation in our models was estimated to constitute 24 to 31 percent of the pressure drop, depending on the Reynolds number and the curvature ratio. The energy dissipation should therefore be taken into account in pressure drop estimates.     

On the presence of a ductus venosus in the fetal pig in late gestation

Evidence is presented to show that there is a functional bypass in the liver of the fetal piglet between the umbilical vein and the posterior vena cava. Injections of labelled microspheres (14 micrometer) into the umbilical vein in six fetuses in late gestation resulted in the appearance of radioactivity in the arterial blood and throughout the tissues of all piglets. About 60% of the umbilical venous blood bypassed the liver whereas in a fetal foal, injection in a similar manner, no evidence for a shunt was found. Radiographic studies confirmed the presence of a large vascular connection, equivalent to the ductus venosus, between the umbilical vein and posterior vena cava in the fetal piglet.     

Blood flow in ductus venosus in early uncomplicated pregnancy

The ductus venosus is the very important part of fetal venous circulation. It plays a central role in return of venous blood from the placenta. This unique shunt carries well-oxygenated blood from the umbilical vein through the inferior atrial inlet on its way across the foramen ovale. Using Doppler ultrasound, it is possible to assess the blood flow in fetal vessels including ductus venosus. It is observed, in animal and human studies, that the typical waveform for blood flow in ductus venosus in early pregnancy can be different depending on numerous conditions e.g. fetal karyotype. This study is performed to assess the physiologic parameters of blood flow in ductus venosus in uncomplicated early pregnancy. Material and Methods: 404 women were examined between 11+0 and 13+6 weeks (+ days) of gestation by ultrasound. Fetal crown-rump length (CRL) was measured to assess the gestational age. The assessment of risk of fetal abnormalities was based on nuchal translucency (NT) measurement. The ductus venosus blood flow with color and spectral Doppler was obtained in all patients. The following features were assessed: pulsatility index (PI), and direction of flow (positive/negative) during atrial contraction (wave A). All cases were followed up to 22 weeks of gestation when the control scan was performed. Results and conclusions: 30 cases were excluded from the uncomplicated group due to: high risk of fetal abnormalities, fetal loss, confirmed fetal abnormalities and utero-placental pathology. 374 women were considered as uncomplicated pregnancy. In both uncomplicated and complicated groups the mean values for pulsatility index (PI) were established. The mean PI value in uncomplicated pregnancies was: 0.91 (SD +/- 0.32). No significant differences between groups were noticed. In 370 cases of uncomplicated pregnancy the A wave direction was positive but in 1.1% of cases the reverse flow in atrial contraction was observed.     

Contribution of the umbilical and portal veins to the hepatic blood supply of guinea pig fetuses--an angiographic study.

The interlobular distribution of the umbilical and portal venous blood flow within the liver was examined in 35 guinea pig fetuses between 59 and 65 days of gestation. Contrast medium was injected into the umbilical or vitelline vein, and its passage through the liver was monitored by serial angiography. In four experiments, injections were made into both the umbilical and vitelline veins of the same fetus. To ease interpretation of the angiograms obtained in vivo, we also made a postmortem examination of livers in which the venous system had been filled with an aqueous suspension of barium sulphate in gelatin. These combined experiments demonstrated no passage of contrast medium from the placenta to the inferior vena cava, which is in accordance with independent evidence that the term guinea pig fetus lacks a functional ductus venosus. The area supplied by the umbilical and portal veins was clearly and consistently delineated. The umbilical vein supplied the left lobe and the left sublobe of the quadrate lobe. The portal vein supplied the right lobe, the smaller caudate lobe, and all or most of the right sublobe of the quadrate lobe. This pattern of distribution appears to be determined by flow and pressure gradients within the hepatic circulation.     

Localization of noradrenaline and serotonin in nerves in the pineal gland of rats and guinea-pigs studied by glyoxylic acid histofluorescence and electron microscopy

Summary The nerves in the pineal gland of the rat and guinea-pig contain both noradrenaline and serotonin and fluoresce intensely after histofluorescence procedures. Vesicle-filled terminals in the perivascular space of the pineal body contain numerous clear and dense-cored vesicles. A 5mg/kg dose of reserpine causes disappearance of histofluorescence from the pineal nerves and a virtual elimination of dense-cored vesicles from vesicle-filled terminals. A 1mg/kg dose of reserpine results in loss of fluorescence and virtual depletion of dense cores in nerves in the rat, but the guinea-pig pineal nerves continue to fluoresce lightly and the dense-cored vesicles are still present but reduced to about 1/3 in number. Subsequent treatment of lightly reserpinized guinea-pigs withp-chlorophenylalanine, a specific depletor of serotonin, results in dis ppearance of fluorescence in nerves in the pineal gland and virtual depletion of the remaining dense cores. A dose of 1mg/kg reserpine succeeds in depleting noradrenaline from most peripheral nervous structures of the guinea-pig. Hence, the remaining monoamine in guinea-pig pineal nerves after depletion of noradrenaline appears to be serotonin located in the remaining dense-cored vesicles. Since, in lightly reserpinized guinea-pig pineal nerves, a number of dense-cored vesicles containing serotonin are still present after depletion of noradrenaline, it is suggested that noradrenaline and serotonin are not in the same vesicles at the same time.     

The actions of vasoactive compounds in the foetus and the effect of perfusion through the placenta on their biological activity

In acute experiments on the in utero foetal lamb, angiotensin II was a more potent pressor agent that either noradrenaline or adrenaline, and the response to angiotensin II was not consistently modified by the combined administration of alpha and beta-adrenergic blocking agents. A significant reduction in the pressor response of the foetus to angiotensin II and noradrenaline occurred with infusion of these compounds to the foetus by the umbilical artery when compared with the response obtained with infusions of the same doses of these drugs by the umbilical vein. Moreover, the concentration of angiotensin II (pg. ml-1) present in the foetal circulation was less following umbilical arterial infusions compared with umbilical vein infusions of the same doses. A similar reduction in the pressor activity of adrenaline and the cardio-stimulant effect of isoprenaline occurred when these drugs were infused by the umbilical artery. It is concluded that the foetus, like the adult animal, is more sensitive to angiotensin II than to catecholamines and that the biological activities of noradrenaline, angiotensin II, adrenaline and isoprenaline are reduced by perfusion through the foetal placenta.     

An assessment of ductus venosus tapering and wave transmission from the fetal heart

Pressure and flow pulsations in the fetal heart propagate through the precordial vein and the ductus venosus (DV) but are normally not transmitted into the umbilical vein (UV). Pulsations in the umbilical vein do occur, however, in early pregnancy and in pathological conditions. Such transmission into the umbilical vein is not well understood. In particular, the effect of the impedance changes in the DV due to its tapered geometry is not known. This paper presents a mathematical model that we developed to study the transmission of pulsations, originating in the fetal heart, through the DV to the umbilical vein. In our model, the tapered geometry of the DV was found to be of minor importance and the only effective reflection site in the DV appears to be at the DV inlet. Differences between the DV inlet and outlet flow were also found to be minor for medium to large umbilical vein–DV diameter ratios. Finally, the results of a previously proposed lumped model were found to agree well with the present model of the DV–umbilical vein bifurcation.     

The distribution and clearances of hormones and metabolites in the circulation of the foetal sheep.

Plasma hormone and metabolite concentrations have been measured in the plasma of blood collected simultaneously from the femoral artery, umbilical vein and carotid artery of the exteriorized foetal sheep. The concentration of vasopressin and catecholamines was consistently lower and of glucose, lactate and corticosteroids consistently higher in the umbilical vein compared with the femoral artery. ACTH concentrations showed no consistent pattern and fluctuated widely at each site, but during synacthen infusion the concentration in the umbilical vein was consistently lower than in the femoral artery. For corticosteroids the concentration in the carotid artery was much lower than that in the umbilical vein; the converse was true for catecholamines. Concentrations in the carotid and femoral artery were similar for all compounds investigated. These results indicate that the placenta is a major site of vasopressin, catecholamine and ACTH clearance and of glucose, lactate and corticosteroid production. The foetal liver is probably a major site of corticosteroid and catecholamine clearance.     

Evidence for different pre-and post-junctional receptors for neuropeptide Y and related peptides

The effects of neuropeptide Y (NPY), peptide YY (PYY), desamido-NPY and five C-terminal fragments of NPY or PYY were tested on different smooth muscle preparations in vitro. The fragments were NPY 19-36, NPY 24-36, PYY 13-36, PYY 24-36 and PYY 27-36. NPY and PYY appear to exert three principally different effects at the level of the sympathetic neuroeffector junction. Firstly, they have a direct post-junctional effect, leading to constriction of certain blood vessels; this was studied on the guinea-pig iliac vein. Secondly, they potentiate the response to various vasoconstrictors; this was studied on the rabbit femoral artery and vein, using noradrenaline and histamine, respectively, as agonists. Thirdly, NPY and PYY act prejunctionally in that they suppress the release of noradrenaline from sympathetic nerve endings upon stimulation; this was studied in the rat vas deferens. NPY and PYY were approximately equipotent in constricting the guinea-pig iliac vein, while desamido-NPY and the fragments were without effect. Desamido-NPY and the fragments were ineffective also in potentiating the response to noradrenaline in the rabbit femoral artery, nor did they potentiate the response to histamine in the rabbit femoral vein. NPY and PYY potentiated the response to noradrenaline in the artery, as well as the response to histamine in the vein. The NPY- and PYY-induced suppression of noradrenaline release from the prostatic portion of the rat vas deferens was reproduced by PYY 13-36 but not by the shorter fragments nor by desamido-NPY. In conclusion, a C-terminal portion seems to be sufficient for exerting the prejunctional effect of NPY and PYY, while the whole sequence seems to be required for post-junctional (direct and modulatory) effects. An amidated C-terminal is crucial for maintaining the biological activity of NPY. Desamido-NPY and the fragments that were inactive as agonists also seemed inactive as antagonists.     

The blood supply to the abdominal organs of the fetal guinea-pig

Guinea-pigs near term of pregnancy were anaesthetized with diazepam and sodium pentobarbitone. A fetus was exposed and the vitelline artery catheterized to measure blood pressure and heart rate or to render a reference sample of blood for the determination of organ blood flow by the microsphere technique. The radioactive microspheres were injected through a catheter in the right atrium. Mean arterial blood pressure was 4.0 kPa and heart rate was 261 beats min-1. The liver, spleen, pancreas and gut receive most of their blood supply from the same trunk as the vitelline artery. The sample from this vessel was also used to calculate blood flow to the adrenal glands, kidneys, urogenital tract, and placenta, assuming even mixing of microspheres and blood in the abdominal aorta. Umbilical blood flow, corrected to a fetal weight of 100 g, averaged 7.5 ml min-1. The adrenal glands, which are known to increase their cortisol secretion near term, had a very high rate of perfusion. If the microspheres were injected in the umbilical vein, almost all were trapped in the liver, confirming the absence of a ductus venosus in the guinea-pig fetus. Most of these microspheres were found in the quadrate lobe of the liver. Hepatic arterial blood flow was also unequally distributed, with more than two-thirds going to the right lobe of the liver. Although the distribution of portal venous blood flow is not known, it is evident that different areas of the liver are presented with blood of greatly varying oxygen saturation.     

Organization of the sympathetic innervation in liver tissue from monkey and man

Summary The sympathetic innervation of the liver of monkey and man has been investigated in a combined fluorescence histochemical, chemical and electron microscopical study. By means of the Falck-Hillarp fluorescence method a dense network of monoamine-containing nerve fibers was visualized in liver tissue of monkey and man. The nerve fibers ran in close contact to both hepatocytes and blood vessels. Chemical quantitations showed high concentrations of noradrenaline in both human and monkey liver. Microspectrofluorometry of the intraneuronal monoamine resulted in spectra characteristic of a catecholamine. For the electron microscopical study the dopamine analogue, 5-hydroxydopamine, was used to label the catecholamine terminals in both human and monkey liver. The nerve profiles, identified as catecholamine-containing, were demonstrated in a perivascular location and in close contact to hepatocytes. No synaptic membrane specializations were present between nerve fibers and hepatocytes. The general ultramorphology and intralobular distribution pattern of nerves in the liver of monkey and man were similar. The present results prove the existence of a sympathetic innervation of hepatocytes and blood vessels in the liver of man and monkey.     

Partial depletion of neuropeptide Y from noradrenergic perivascular and cardiac axons by 6-hydroxydopamine and reserpine

The effects of 6-hydroxydopamine (6-OHDA) and reserpine on the storage of neuropeptide Y (NPY) in noradrenergic cardiovascular nerves were examined with both immunohistochemistry and radioimmunoassay (RIA). Immunohistochemical double-labelling techniques demonstrated that NPY was located only in noradrenergic axons in the guinea-pig carotid artery, mitral valve, thoracic inferior vena cava, thoracic aorta, superior mesenteric artery and small saphenous vein. Treatment with 6-OHDA in vivo eliminated noradrenergic, NPY-containing axon terminals from all tissues, but preterminal axons were still prominent in the superior mesenteric artery. The greatest depletion of NPY detected by RIA after 6-OHDA treatment was found in tissues with a predominance of terminal noradrenergic axons, such as the small saphenous vein, whereas NPY accumulating in preterminal axons masked the loss of NPY from terminal axons in the superior mesenteric artery. After treatment with doses of reserpine that led to a rapid depletion of noradrenaline (NA) from perivascular nerves, NPY was still detected histochemically at all times although levels sometimes appeared to be reduced. RIA demonstrated that the partial depletion of NPY after reserpine consisted of a rapid phase seen in the vena cava and saphenous vein after the highest doses, and a slower phase of NPY depletion from all tissues after all doses of reserpine. The greatest depletion of NPY from terminal axons by reserpine (in small saphenous vein) was 85-90%. These results demonstrate that some NPY can be stored in noradrenergic perivascular axons in the absence of noradrenaline, but that partial depletion of NPY from axon terminals results when NA stores are depleted by reserpine. The variation in extent of NPY depletion between tissues after drug treatments can be explained by variation in the ratio of preterminal to terminal axons.     

Effect of NO, phenylephrine, and hypoxemia on ductus venosus diameter in fetal sheep

To study the regulation of the ductus venosus (DV) inlet in vivo, we measured the effect of vasoactive substances and hypoxemia on its diameter in nine fetal sheep in utero at 0.9 gestation under ketamine-diazepam anesthesia. Catheters were inserted into an umbilical vein and a fetal common carotid artery, and a flowmeter was placed around the umbilical veins. Ultrasound measurements of the diameter of the fetal DV during normoxic baseline conditions [fetal arterial PO(2) (PaO(2)) 24 mmHg] were compared with measurements during infusion of sodium nitroprusside (SNP; 1.3, 2.6, and 6.5 microg. kg(-1). min(-1)) or the alpha(1)-adrenergic agonist phenylephrine (6.5 microg. kg(-1). min(-1)) into the umbilical vein or during hypoxemia (fetal Pa(O(2)) reduced to 10 mmHg). SNP increased the DV inlet diameter by 23%, but phenylephrine had no effect. Hypoxemia caused a 61% increase of the inlet diameter and a distension of the entire vessel. We conclude that the DV inlet is tonically constricted, because nitric oxide dilates it but an alpha(1)-adrenergic agonist does not potentiate constriction. Hypoxemia causes a marked distension of the entire DV.