title: Fetal surgery and maternal cortisol response to stress. The myelomeningocele sheep model.
abstract: BACKGROUND
  Prenatal surgery represents a multifactorial stressor event for mother and fetus. The stress response to fetal surgery was evaluated by measuring maternal plasma and amniotic fluid (AF) cortisol levels in the myelomeningocele (MMC) sheep model.
  
  
  METHODS
  Pregnant ewes (n = 8) underwent general anesthesia for MMC-induction (step 1: 75 d gestation), surgical defect repair (step 2: 110 d gestation), and delivery (step 3: 140 d gestation). Maternal blood samples were taken before surgery (surgical stage T1), after laparotomy and uterine exposure (surgical stage T2), at the end of the procedure (surgical stage T3). Fetal stress was evaluated by measuring cortisol levels in AF after hysterotomy at steps 1-3.
  
  
  RESULTS
  Maternal cortisol concentrations at T2 and T3 increased compared with T1 (p = 0.019 and p = 0.046). AF cortisol response increased from 1 to 3 surgical steps and during pregnancy. The AF cortisol level was lower than maternal serum levels (induction p < 0.001; repair p < 0.001; caesarean section p < 0.001).
  
  
  CONCLUSIONS
  Hysterotomy was the most stressful event in the ewes. Fetuses seemed to be partially protected from the high maternal cortisol levels. The fetal stress response to prenatal surgery increased with gestational age. Pain perception development, fetal maturation, and "pain memory" are probably associated with this increase.
authors.affiliation: a Department of Maternal and Children's Health, Pediatric Surgery Unit , Fondazione IRCCS Policlinico San Matteo and University of Pavia , Pavia , Italy .
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
authors.affiliation: b Neonatal Intensive Care Unit , University of Siena , Policlinico Le Scotte , Siena , Italy .
authors.forename: Carlo Valerio
authors.initials: CV
authors.lastname: Bellieni
authors.affiliation: c Intensive Care Unit , IRCCS Burlo Garofolo , Trieste , Italy .
authors.forename: Clara
authors.initials: C
authors.lastname: Dell'Oste
authors.affiliation: a Department of Maternal and Children's Health, Pediatric Surgery Unit , Fondazione IRCCS Policlinico San Matteo and University of Pavia , Pavia , Italy .
authors.forename: Elisa
authors.initials: E
authors.lastname: Zambaiti
authors.affiliation: a Department of Maternal and Children's Health, Pediatric Surgery Unit , Fondazione IRCCS Policlinico San Matteo and University of Pavia , Pavia , Italy .
authors.forename: Federico
authors.initials: F
authors.lastname: Costanzo
authors.affiliation: d Laboratory of Clinical Chemistry , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy .
authors.forename: Riccardo
authors.initials: R
authors.lastname: Albertini
authors.affiliation: e CRABCC s.r.l., Rivolta d'Adda , Cremona , Italy .
authors.forename: Marino
authors.initials: M
authors.lastname: Campagnol
authors.affiliation: f Biometry & Clinical Epidemiology, Scientific Direction , Fondazione IRCCS Policlinico San Matteo , Italy .
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: g Department of Internal Medicine , University of Pavia , Pavia , Italy , and.|h Department of Maternal and Children's Health, Pediatric Endocrinology and Diabetes Unit , Fondazione IRCCS Policlinico San Matteo Pavia , Pavia , Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
mesh_terms: D000653:Amniotic Fluid / Q000737:chemistry*; D000818:Animals; D002585:Cesarean Section; D005260:Female; D005333:Fetus / Q000601:surgery*; D006854:Hydrocortisone / Q000032:analysis*; D020883:Hysterotomy; D008591:Meningomyelocele / Q000601:surgery; D023421:Models, Animal; D011247:Pregnancy; D012756:Sheep; D013312:Stress, Physiological
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; fetal surgery; myelomeningocele; sheep model; stress