Response to hemorrhagic stress in the rhesus monkey fetus in utero: effects on the pituitary-adrenal axis.

In human pregnancy, fetoplacental hemorrhage is often associated with morbidity and potentially mortality. We investigated the effect of acute fetal hemorrhage on the fetal pituitary-adrenal axis in the subhuman primate (Macaca mulatta). We measured fetal and maternal plasma concentrations of ACTH, cortisol, and dehydroepiandrosterone sulfate (DHAS) by RIA in 10 rhesus monkeys. At 133-158 days of gestation (d) the fetuses were subjected to acute hemorrhage (0.5 mL/min for 10 min). Fetal plasma ACTH and cortisol concentrations were significantly increased above baseline in response to fetal hemorrhage. There was a more rapid, but significantly reduced, fetal plasma ACTH and cortisol response in the 133-143 d fetuses than in the 147-158 d fetuses. In 133-143 d fetuses, the maximal changes from baseline in plasma ACTH and cortisol concentrations were +6.5 +/- 2.6 pmol/L at +25 min and +4.55 +/- 1.19 nmol/L at +10 min, respectively. Fetal plasma ACTH and cortisol concentrations remained elevated throughout the 60-min period after hemorrhage (3.06 +/- 1.21 pmol/L and +2.42 +/- 1.05 nmol/L at +70 min). In 147-158 d fetuses, the maximal changes from baseline in plasma ACTH and cortisol concentrations were +13.7 +/- 4.23 pmol/L and +12.92 +/- 3.25 nmol/L at +70 min. In the 133-143 d fetuses, plasma DHAS concentrations did not change in response to hemorrhage, whereas in the 147-158 d fetuses, plasma DHAS concentrations were elevated above baseline during the hemorrhage (+624.2 +/- 269.5 nmol/L, at +9 min) and returned quickly to pre-hemorrhage values. These data suggest that the fetal pituitary-adrenal axis plays a role in the fetal response to intrauterine stress, but that only later in gestation is the fetal cortisol response to fetal hemorrhage mediated via ACTH secreted by the fetal pituitary.