Low baseline proBNP associated with increased risk of intraoperative hypotension during spinal anaesthesia for cesarean delivery

BACKGROUND AND OBJECTIVES: Brain natriuretic peptide (BNP) has a role in the regulation of body fluid volume and blood pressure (BP). BNP remains within a normal range during spinal anaesthesia (SA) in patients undergoing cesarean delivery. However, the effect of BNP on changes in BP during the perioperative period has not been evaluated. We aimed to investigate the effect of preoperative serum BNP on the risk of hypotension during cesarean delivery with SA. DESIGN AND SETTING: Patients were randomly selected among the patient group who were attending routine clinic visits for pregnancy monitoring. All had a healthy pregnancy and no other acute or chronic disease by their obstetrician. The study design was cross-sectional. PATIENTS AND METHODS: Patients who had uncomplicated pregnancy process and no known medical disease were selected consecutively during their last outpatient clinical examination. Baseline BP was recorded before SA. Simultaneously, blood samples were drawn for routine biochemistry and BNP. BP, SaO(2), and electro-cardiography were monitored during surgery. Intraoperative hypotension (IOH) was defined as >= 25% decrease in mean arterial pressure (MAP) at the 5th minute of SA. RESULTS: In 41 term pregnant women, 18 of the 41 patients (43.9%) fulfilled the criteria for IOH, while 23 (56.1%) showed a decrease 13.1 (11.3%) and were classified as normotensive. Baseline BNP was significantly lower in patients with IOH compared with normotensive patients 45.7 (26.9) vs. 70.2 (40.5); P=. 05. Baseline BNP had no significant correlation MAP at any time point. Age, body mass index, hemoglobin, baseline MAP and heart rate were not different between patients with and without IOH. CONCLUSION: Those findings suggest that higher baseline BNP levels might have a protective role in development of hypotension in healthy term pregnant women during SA for cesarean delivery

Role of corin in trophoblast invasion and uterine spiral artery remodelling in pregnancy

In pregnancy, trophoblast invasion and uterine spiral artery remodeling are important for lowering maternal vascular resistance and increasing uteroplacental blood flow. Impaired spiral artery remodeling has long been implicated in preeclampsia, a major complication of pregnancy, but the underlying mechanisms remain unclear(1, 2). Corin is a cardiac protease that activates atrial natriuretic peptide (ANP), a cardiac hormone important in regulating blood pressure(3). Unexpectedly, corin expression was detected in the pregnant uterus(4). Here we identify a novel function of corin and ANP in promoting trophoblast invasion and spiral artery remodeling. We show that pregnant corin- or ANP-deficient mice developed high blood pressure and proteinuria, characteristics of preeclampsia. In these mice, trophoblast invasion and uterine spiral artery remodeling were markedly impaired. Consistently, we find that ANP potently stimulated human trophoblasts in invading Matrigels. In patients with preeclampsia, uterine corin mRNA and protein levels were significantly lower than that in normal pregnancies. Moreover, we have identified corin gene mutations in preeclamptic patients, which decreased corin activity in processing pro-ANP. These results indicate that corin and ANP are essential for physiological changes at the maternal-fetal interface, suggesting that defects in corin and ANP function may contribute to preeclampsia