Oxygen consumption, acid-base status, and behavior during and after acute, severe hemorrhage in fetal lambs

Abstract

The metabolic and behavioral effects of 40-45% hemorrhage (at approximately 1%/min) were studied in nine fetal lambs in utero (130-135 days of gestation) until 2 days posthemorrhage. Umbilical blood flow (Qum) fell from 192 +/- 14 to 100 +/- 9 ml.min-1.kg-1 at the end of blood loss, and on the day of hemorrhage it was linearly related to blood volume. However, on the posthemorrhage days, Qum was restored even though blood volume was still reduced. Fetal O2 delivery (DO2) fell with the decrease in Qum and later due to anemia (decrease in hematocrit from 33.4 +/- 1.2 to 23.6 +/- 1.2%), from 946 +/- 81 to 494 +/- 47 mumol.min-1.kg-1, but the decrease was lessened because of a rise in umbilical venous PO2 (31.7 +/- 2.6 to 45.9 +/- 2.8 mmHg). Fetal O2 consumption was reduced during and for 2 h after hemorrhage (262 +/- 17 to 190 +/- 16 mumol.min-1.kg-1), and this was associated with modest lactic acidemia (1.25 +/- 0.11 to 2.91 +/- 0.43 mM). There was also a temporary reduction in fetal breathing activity, low voltage electrocortical state, and rapid eye movements, but this was not associated with hypoxemia. It is concluded that reductions in fetal DO2 achieved via fetal blood loss are better tolerated than during hypoxemia and that the associated depression in fetal biophysical activities involves mechanisms other than systemic hypoxia.