Activin betaA in term placenta and its correlation with placental inflammation in parturients having epidural or systemic meperidine analgesia: a randomized study.
OBJECTIVE
To investigate the immunohistochemical localization of betaA subunit of activin A in human term placenta, as a marker for placental infection/inflammation and elevated temperature, in parturients laboring during two analgesic regimens.


METHODS
Prospective, randomized controlled study.


METHODS
Delivery room.


METHODS
56 healthy, ASA physical status I and II primiparous women in labor.


METHODS
Parturients were assigned to receive patient-controlled epidural analgesia (PCEA) with 0.2% ropivacaine or patient-controlled intravenous analgesia PCA with meperidine.


METHODS
Histologic and immunohistochemical placental evaluation for white blood cell infiltration and activin betaA staining were made. Maternal temperature elevation above 37.6 degrees C and leukocytosis above 15,000/microL were recorded.


RESULTS
Temperature was not significantly increased in parturients receiving PCEA over those who received (PCA) with meperidine (31% vs 11%, respectively; P = 0.1). There was also no association between temperature elevation during epidural analgesia and increased white blood cell count (>15,000/microL) or presence of polymorphonuclear and/or lymphocyte aggregation in the placenta. Immunohistochemical staining with antisera against the betaA subunit of activin was present mainly in the placental cytotrophoblast, syncytiotrophoblast, and vascular endothelium, and was not associated with an increase in maternal temperature. No significant difference was noted between the two analgesic techniques with regard to maternal temperature elevation. Intrapartum temperature elevation was not associated with histologic signs of placental inflammation or with expression of activin betaA in the placenta.


CONCLUSIONS
Other mechanisms may be involved in the etiology of temperature elevation during labor.
Evron
Shmuel
S
Obstetric Anesthesia Unit, The Edith Wolfson Medical Center, Holon 58100, Israel.
Parameswaran
Reshmi
R
Zipori
Dov
D
Ezri
Tiberiu
T
Sadan
Oscar
O
Koren
Rumelia
R
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid; D015415:Biomarkers / Q000032:analysis; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D028322:Inhibin-beta Subunits / Q000032:analysis*; D008614:Meperidine; D010920:Placenta / Q000737:chemistry* / Q000473:pathology; D011247:Pregnancy; D011446:Prospective Studies
D000701:Analgesics, Opioid; D015415:Biomarkers; C103008:inhibin beta A subunit; D028322:Inhibin-beta Subunits; D008614:Meperidine