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PubMed1975

Can the oxytocin challenge test serve as the primary method for managing high-risk pregnancies?

The purpose of this investigation was to determine whether the oxytocin challenge test (OCT) could serve as the primary method for managing pregnancies characterized by possible placental insufficiency. One hundred and five patients underwent 225 oxytocin challenge tests; no perinatal deaths occurred. Eight tests were positive, 21 suspicious, and 196 negative. Because of data obtained in a preliminary study, all 8 fetuses with positive tests were delivered by cesarean section. Four of the 8 had repetitive suspicious tests prior to a positive test, suggesting that utero-placental function may deteriorate gradually. Urinary excretion of estriol did not decrease significantly in any patient, suggesting that the OCT is a more sensitive indicator of placental function than excretion of estriol. Except for patients with preeclampsia who were induced for maternal indications, all pregnancies with a negative OCT were allowed to terminate spontaneously. Five of the 97 fetuses with negative tests developed late-onset deceleration patterns during labor. This indicates that a negative OCT will not necessarily predict fetal tolerance to labor, contrary to assertions made by some other investigators. It is concluded that the OCT can serve as the primary method for assessing the fetal status in pregnancies characterized by placental insufficiency.

Chronic Disease↗
PubMed1975

Urinary excretion of steroids by Japanese women with breast cancer.

The urinary excretion of steroids was determined in premenopausal patients with advanced breast cancer in the non-menstrual phase and in control women in the follicular phase, ovulatory stage, and luteal phase. The estrone level in the urine of cancer patients was higher than that in the urine of control women at any phase. Excretion of 17 beta-estradiol in the follicular and luteal phases was similar in the urine of control women and cancer patients, but estradiol and estriol levels in the ovulatory stage of control women were higher than those of cancer patients. The estriol level in the urine of control women in the luteal phase was also higher than that of cancer patients. Total 17-ketosteroid was lower in the urine of cancer patients than in that of controls at any phase. Among the fractions of 17-ketosteroids, only dehydroepiandrosterone was excreted at a higher level by cancer patients than by control subjects.

17-Hydroxycorticosteroids↗
PubMed2002

Maternal serum triple analyte screening in pregnancy.

According to the American College of Obstetricians and Gynecologists, it has become standard in prenatal care to offer screening tests for neural tube defects and genetic abnormalities. There have been some changes in the recommended method of prenatal screening over the past few years, and research to improve detection rates with better combinations of maternal serum analytes is ongoing. The issues facing physicians are the sensitivity and specificity of multiple serum analyte combinations. The current maternal serum analytes in use in most areas are alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and unconjugated estriol. Measurement of AFP alone can detect the vast majority of neural tube defects and a small portion of trisomy 21-affected pregnancies in patients of all ages. Adding hCG and unconjugated estriol to this screen increases the rate of detection of trisomies 21 and 18. Counseling patients about the risks and benefits of such screening is important to provide a balanced discussion of screening issues.

Adult↗
PubMed2002

Correlation of ultrasound findings and biochemical markers in the second trimester of pregnancy in fetuses with trisomy 21.

OBJECTIVE: The aim of the present study was to assess possible correlations between ultrasound findings and maternal serum biochemical ('triple test') markers among fetuses with trisomy 21 in the second trimester of pregnancy. METHODS: The study was a retrospective cohort study of 72 pregnancies affected by trisomy 21 who had a second trimester ultrasound and biochemical screen performed at a single center between 1990 and 1999. The biochemical screen consisted of alpha-fetoprotein (AFP), total beta human chorionic gonadotrophin (hCG) and estriol (uE(3)). Marker levels were expressed in multiples of the median (MoM). The ultrasound findings assessed were major structural anomalies, short humerus length, short femur length, increased nuchal fold thickness (NF), hyperechoic bowel, echogenic intracardiac focus (EIF), ventriculomegaly, choroid plexus cysts and renal pyelectasis. RESULTS: Second trimester maternal serum biochemical markers and ultrasound findings appeared to be largely independent of each other. However, some significant correlations were observed. Estriol was significantly lower when a fetal cystic hygroma was detected on ultrasound compared to those with no cystic hygroma (0.40 vs. 0.70 MoM, p<0.05). The median hCG level was significantly lower in those pregnancies with a normal second trimester fetal ultrasound compared to those with positive ultrasound findings (2.07 vs. 2.87 MoM, p<0.05). Median hCG levels were also significantly higher in those cases with NF> or =5 mm as compared to those with NF<5 mm (2.99 vs. 2.49 MoM, p<0.05). This difference persisted after exclusion of the five cases with cystic hygromas (2.99 vs. 2.49 MoM, p<0.05). A significant positive correlation was observed between log(10) hCG and log(10) NF MoM (Spearman's rho=0.252, p<0.05). NF was significantly greater among fetuses with an identifiable cardiac defect compared with those without a detectable cardiac defect (median of 7.0 mm vs. 3.8 mm, p<0.01). This difference persisted when expressed as multiples of the median (2.8 vs. 1.3 MoM, p<0.01). CONCLUSION: Second trimester ultrasound and biochemical markers are largely independent in fetuses with trisomy 21, however significant correlations between the two were observed in the present series. These may be important in screening protocols that combine second trimester ultrasound and biochemical markers.

Chorionic Gonadotropin↗
PubMed2002

Concentrations of estrogens in patients with preeclampsia.

The role of estrogens in the pathophysiology of preeclampsia remains to be determined. The aim of our study was to compare serum concentrations of 17 beta-estradiol and estriol in women with preeclampsia to normotensive pregnant controls. Serum concentrations of estrogens were measured in women with mild (n = 24) and severe (n = 24) preeclampsia as well as is normotensive pregnant controls (n = 24). Patients were matched for gestational age. Pregnancies complicated by early onset severe preeclampsia are associated with increased rates of maternal and fetal morbidity. Subsequently, we created further subgroups before and after 34 weeks of gestation (34 + 0). Serum estrogen concentrations were determined by standard ELISA technique. Compared to normotensive controls, the differences between the overall median serum concentrations of 17 beta-estradiol in women with mild (3811 v. 3730 pg/ml, P = 0.9) and severe (3811 v. 3630 pg/ml, P = 0.1) preeclampsia were statistically not significant. The differences between the overall median serum concentrations of estroil in controls and in patients with mild (121 v. 76 ng/ml, P = 0.6) and severe (121 v. 79 ng/ml, P = 0.4) preeclampsia were similar. The differences between the median concentrations of 17 beta-estradiol in patient with early onset severe preeclampsia compared to patients with mild preeclampsia (3061 v. 3715 pg/ml, P = 0.004) and controls (3061 v. 3807 pg/ml, P = 0.006) were statistically significant. In addition, the differences between the median concentrations of estriol in women with early onset severe preeclampsia compared to controls were statistically significant (20 v. 92 ng/ml, P = 0.02). The differences between the median concentrations of estrogens in those with late onset severe preeclampsia compared to women with mild preeclampsia were not significant. We found significantly lower concentrations of estrogens in women with early onset severe preeclampsia.

Adult↗
PubMed1976

Oxytocin challenge test in high-risk pregnancy.

Seven hundred sixty-seven oxytocin challenge tests (OCT) were performed on 333 high-risk maternity patients. All of the patients had pregnancies complicated by diabetes mellitus, suspected postmaturity, preeclampsia, intrauterine growth retardation, hypertension and other disorders. In conjunction with OCT, 24-hour urinary estriol determinations were performed. Negative OCT's were reassuring for fetal well-being. There were 26 positive OCT's on 24 patients. A positive test was significant in identifying endangered fetuses existing in a markedly unfavorable environment. In our experience, we found the OCT more reliable and more predictable than urinary estriol determination. The oxytocin challenge test proved to be significant in the successful management of these 333 high-risk patients.

Adult↗
PubMed2005

[Sex hormones in female patients with systemic lupus erythematosus].

OBJECTIVE: To explore the levels of sex hormones in female patients with systemic lupus erythematosus (SLE) and its role in the genesis of SLE. METHODS: The serum levels of estradiol, estriol, testosterone, progesterone, and prolactin were determined by electro-chemiluminescence immunoassay in 98 female patients with SLE and compared with those of 38 healthy women. RESULTS: The serum levels of estradiol, estriol, progesterone, and prolactin were significantly higher than those in the healthy women (P <0.05). The serum levels of estradiol, progesterone, and prolactin in patients with SLE in 25 to 34 year old group were higher than the other age groups and the control group (P < 0.05), and the serum levels of estradiol and prolactin in patients with active phase of SLE were significantly higher than those in patients with stable phase of SLE (P <0.05). CONCLUSION: The levels of sex hormones have a close corretation with the genesis and development of SLE.

Adolescent↗
PubMed1978

Changes in cGMP and cAMP content in the estrogen-stimulated rat uterus: temporal relationship with other parameters of hormonal stimulation.

The effect of estradiol-17beta, estriol, diethylstilbestrol and nafoxidine on rat uterine cGMP content was studied in relation with their respective estrogenic potency. Confirming previous results from Kuehl et al. (5), we observed a rise in uterine cGMP and a simultaneous decrease in cAMP content in treated animals. The reverse effect was obtained in the vagina after stimulation with estradiol or estriol. In the uterus, all compounds tested induced two main waves of cGMP increase corresponding to the two main phases of the estrogenic response i.e. the early fluid imbibition and the later period of true growth. No direct relationship could be established between the late rise in cGMP and true growth responses. A causal link between the first accumulation of uterine cGMP and the wet weight response in the early phase of estrogenic action is suggested by the comparison of time-course effects of the different compounds used on those two parameters.

Animals↗
PubMedDate not supplied

[Detection of fetal growth retardation by instrumental and biochemical monitoring methods].

In 311 high-risk pregnancies between 28 and 42 weeks of gestation a fetal weight estimation by ultrasound, a Doppler sonography of the umbilical artery, an analysis of estriol and HPL-levels in maternal serum and a CTG nonstress-test were performed approximately at the same time. The aim of the study was to compare the value of these methods in the diagnosis of fetal growth retardation. By variation of cut-off levels between normal and pathological range, ROC curves were created which allowed an objective comparison of methods at any cut-off level from ranges of high sensitivity to ranges of high specificity. The course of these ROC curves determine the following rank of test validity: 1. ultrasound measurement, 2. Doppler sonography, 3. HPL assay, 4. CTG nonstress-test, 5. estriol assay.

Blood Flow Velocity↗
PubMedDate not supplied

[Attempt to diagnose a "small" placenta by HPL determination before the 18th week of pregnancy].

In a prospective study covering 175 gravidae it was investigated whether the risk of a "small" placenta could be detected by determining HPL or serum estriol once during the first 18 weeks of pregnancy. The results show that neither the HPL value nor the serum estriol value correlate with the weight of the placenta or the child. Therefore, the problem of early detection of a "small" placenta cannot be resolved with these hormone parameters.

Estriol↗
PubMed1979

Enzyme immunoassay of estrogen-like substances in plasma, with polyethylene glycol as precipitant.

We devised an enzyme immunoassay for plasma estrogen-like substances in pregnancy, using estriol covalently linked to horseradish peroxidase. Free and bound steroid were separated by use of polyethylene glycol reagent. The assay satisfies the normal criteria of specificity and precision. Results obtained by radioimmunoassay and enzyme immunoassay agreed well. Our assay is particularly applicable in smaller clinical laboratories to routine determination of plasma estriol in pregnancy.

Cross Reactions↗
PubMed1986

Inhibitory effect of female hormones on lipid peroxidation.

The female hormones estradiol, estrone, and estriol acted as antioxidants in the peroxidation of methyl linoleate by UV irradiation. All of them inhibited the peroxidation of microsomal lipids when they were added to the ADP-Fe3+ peroxidation system of rat liver microsomes. The efficiencies in the microsomal system were in the order of estradiol greater than estriol greater than estrone.

Animals↗
PubMed1985

[Usefulness of urethrocytologic studies in urinary incontinence].

Comparative cytological studies were conducted in urethra and vagina of 40 women with stress incontinence, another 40 with urge incontinence and 53 clinically intact women for morphological assessment of urinary incontinence. Evaluation was based on maturation index, maturation value, and dynamic estrogenicity index. During sexual maturity no significant difference regarding proliferability of urethral and vaginal epithelium was found existing between clinically intact women and patients with stress or urge incontinence. Differences of maturation values above 30 between urethral and vaginal cells were recordable only from post-menopause patients with urge incontinence, providing for certain possible conclusions as to the form of urinary incontinence. However, in post-menopause patients, oral and vaginal estriol therapy was followed by significant rise in intermedial and superficial cells in both organs. Improvement of stress and urge incontinence was recordable subjectively also from estriol therapy during sexual maturity, independent from urethral or vaginal cell patterns. Hence, urethral cytology is only conditionally suitable for differential diagnosis and optimization of therapy of urinary incontinence. Primarily it is suitable to coping for disturbances of micturition with an uncharacteristic urinary urge symptomatology or chronic urethritis.

Adult↗
PubMed1979

[Plasma hormonal pattern of the late diabetic pregnancy (author's transl)].

Plasma estradiol, estriol, progesterone, H.C.S. and cortisol were measured (RIA methods) every two days, in 20 diabetic pregnancies (classes B, C or D of White), between the 33th week and the delivery, and were compared with normal pregnancies. Estriol was always normal, and progesterone values were at the upper limit of the normal range; estradiol, H.C.S. and cortisol were normal or elevated, with mean values significantly higher than controls. E2 and/or progesterone dramatically decreased in 5 cases before birth, just as the urinary measurements. In this study, the insulin requirements were not correlated with these plasma hormone values. Besides pathogenic hypothesis )glycemic control of H.C.S. and cortisol--abnormalities of metabolic pathways of estrogens ?), this work informs the inferred hormonal deficiency in diabetic placenta. Also, it is unable to determine the practical usefulness of these plasma measurements in the management of diabetic pregnancy.

Adult↗
PubMed1978

Maternal serum estrogen and progesterone concentrations preceding normal labor.

Simultaneous measurement of serum concentrations of estrone (E1), estradiol (E2), estriol (E3), and progesterone were carried out in multiple serial blood samples obtained during the last 3-10 weeks of pregnancy, labor, and the immediate postpartum period in 5 normal women. Estrogen and progesterone levels showed a small, but statistically significant diurnal variation during pregnancy. They did not change during labor; however, with the exception of E1 levels, all declined following delivery. Individual patterns preceding labor, derived from calculated moving mean values, showed no consistent decline in progesterone levels nor a surge in E1 and E2 concentrations whereas estriol levels showed a steady rise starting 14-28 days prior to the onset of labor. Whether this E3 elevation reflects fetal maturation and/or plays a role in the triggering mechanism of labor is unknow. Failure to detect changes in E1, E2, and progesterone levels in the maternal peripheral circulation does not preclude the possibility that alterations of metabolism of these hormones in the fetal or uterine compartments might be involved in the initiation of human labor.

Adult↗
PubMed1980

[Ultrasonic and biochemical detection and prenatal treatments of intra-uterine fetal growth retardation (author's transl)].

Efficacy of three ultrasonographic and six biochemical methods for the detection of intrauterine growth retardation were assessed in prospective studies of 40 cases associated with short uterine fundal height less than -1.5 SD and/or small ultrasonographically determined total intrauterine volume (TIUV) less than -1 SD of normal populations. Prenatal treatments, consisting of bed rest, high protein diet, intravenous drip infusion of 10% maltose, 500 ml per day, for more than 12 days, etc., were administered on them. Fifteen cases (37.5%) delivered small-for-date infants, 9 of which complicated by toxemia of pregnancy. At the final determinations, small TIUV were found in all small-for-date cases (100%), short biparietal diameter 80.0%, and short longitudinal intracavital uterine length 53.3% of 15 small-for-date cases. In biochemical parameters, low maternal plasma estriol levels were found in 73.3%, low plasma human placental lactogen levels 66.7%, low urinary estriol excretion 53.3%, abnormal plasma alpha-fetoprotein levels 33.3%, and low plasma progesterone levels 20.0% of 15 small-for-date cases. Nineteen cases (47.5%) demonstrated remarkable increases in TIUV following prenatal treatments, and delivered appropriate-for-date infants. Despite of marked growth in biophysical parameters, abnormal biochemical values were mostly not improved by these treatments.

Estriol↗
PubMed1983

[The betamethasone test in the diagnosis of placental insufficiency].

A trial to evaluate a functional test of the fetoplacental unit by measuring the extent of suppression of maternal estriol serum levels by glucocorticoids is described. 21 women between the 30th and 40th week of gestation received 4 mg betamethason intravenous injection at 8.30 a.m. Blood samples were collected immediately before betamethason application and at 1.00 p.m., 4.00 p.m., 8 p.m. o'clock and at 8.30 a.m. on the next day. Estriol (E3), cortisol, dehydroepiandrosterone sulfate (DHEA-S) and human placental lactogen (HPL) were determined from serum samples by radioimmunologic methods. Patients were divided into 3 groups: severe placental insufficiency (group I, n = 6) described by growth retardation of the fetus of more than 2 weeks, normal gestations (group II, n = 8) and slight growth retardation (group III, n = 7). After temporary suppression in groups II and III, E3, DHEA-S and cortisol levels showed a significant increase the day after betamethason. In group I an increase of these parameters was observed 2 to 5 days after betamethason. These results show that a low intravenous dosage of betamethason and collection of blood samples for E3 assays in intervals of 12 hours can be used as a functional test of the fetoplacental unit.

Betamethasone↗
PubMed1984

[Prenatal diagnosis of IUGR by assessing the multiple hormone concentration in maternal peripheral blood].

The serum concentrations of multiple hormones in maternal peripheral vein during pregnancy were simultaneously measured to determine whether it is possible to discriminate IUGR from normal pregnancy. Blood samples were obtained when the patients were at 30 to 35 weeks of gestation and IUGR was confirmed after delivery. The mean concentrations of progesterone and estriol were significantly lower in maternal vein with IUGR than those in normal pregnancy. On the other hand, the mean concentrations of 16 alpha-hydroxypregnenolone and DHA were significantly higher in the patients with IUGR than those in the patients with normal fetus. However, it seemed impossible to discriminate IUGR from normal completely, since the steroid values in IUGR overlapped in normal range. An attempt was made to apply the data to the computation in multivariate analysis. The computer used for this analysis was an HITAC-M-180 and the package was BMD. Using the principal component analysis, normal and IUGR groups were roughly separated. However, no definite border line could be drawn between normal and IUGR. The discriminant analysis was then applied to separate two groups. Using the estriol value as a variable, 58% reliability was achieved in separate two groups. 93% reliability was achieved when the values of 6 steroids were used. And finally, when the clinical data represented by the length of the uterine fundus and the girth were added to the steroidal values, 100% possibility was obtained in separate two groups.

17-alpha-Hydroxypregnenolone↗

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