Plasma Estriol Research Articles

Effect of Ampicillin Administration of Plasma Levels of Oestradiol‐17β, Oestriol and Placental Lactogen

Summary: Ampicillin was given to 21 noninfected patients in the last trimester of pregnancy. There was no significant alteration in plasma unconjugated oestradiol‐17β and placental lactogen levels during treatment. Total plasma oestriol, on the other hand, showed a significant reduction of 30% to 40% during and after treatment.

EFFECT OF ACTH AND DEXAMETHASONE ON THE DIURNAL RHYTHM OF UNCONJUGATED OESTRIOL IN PREGNANCY

ABSTRACT The present study is concerned with the role of maternal cortisol in regulating diurnal rhythm of unconjugated oestriol in 9 pregnant women. Blood was drawn at 30 min intervals between 5 p. m. and 3 a. m. In 5 patients endogenous ACTH-secretion was simultaneously suppressed by 12 mg dexamethasone over 48 h. Between 8 p. m. and 2 a. m., 0.25 mg ACTH1-24 (Synacthen®) was infused into the subjects. Free oestriol was measured by radioimmunoassay, and the total plasma cortisol by the protein binding method. Patients without dexamethasone demonstrated high oestriol levels (21.5 ± 9 ng/ml) and episodic secretion between 5 p. m. and 8 p. m. At the same time cortisol concentrations were relatively low (274.1 ± 66 ng/ml). Ninety min after starting ACTH-infusion, plasma oestriol decreased in negative correlation to rising cortisol (r = −0.916, P < 0.001). Between 11 p. m. and 2 a. m. oestriol levels were significantly below the control values (12.9 ± 3 ng/ml, P < 0.001) and were associated with high cortisol levels (887 ± 312 ng/ml). Episodic oestriol production did not occur during the period of elevated cortisol levels. Under dexamethasone both oestriol (2.1 ± 1.2 ng/ml) and cortisol values (36.5 ± 24 ng/ml) were markedly suppressed. Only cortisol production could be stimulated during ACTH-infusion (374 ± 80 ng/ml), whereas oestriol concentration remained in the range of the controls (1.91 ± 0.5 ng/ml). These results suggest that diurnal rhythm of unconjugated oestriol is predominantly regulated by feed-back action of maternal cortisol on the foetal hypothalamus.

Estriol in pregnancy: V. Unconjugated and total plasma estriol in the management of pregnant diabetic patients

Sixty-two consecutive diabetic women hospitalized from one to eight weeks prior to delivery were included in this study. Some 1,100 simultaneous unconjugated plasma estriol, total plasma estriol, 24 hour urinary estriol, and creatinine assays were performed on an almost daily schedule. Clinical management was based upon a weekly oxytocin challenge test and daily 24 hour urinary estriol and creatinine determinations. Twenty patients had spontaneous onset of labor and 32 were delivered electively at 38 weeks while three were delivered for maternal and seven for fetal indications. Gestational age at delivery averaged 38 weeks and ranged from 35 to 42 weeks. A total of 840 day-to-day variations of unconjugated plasma estriol, total plasma estriol, and the urinary estriol/creatinine ratio were computed as the per cent rise or fall from the highest mean of three consecutive preceding values. Observed were 369, 419, and 428 decreases in unconjugated plasma estriol, total plasma estriol, and urinary estriol/creatinine, respectively, averaging 12.8 ± 9.6 (S.D.), 13.4 ± 10.1, and 14.4 ± 10.6 per cent. One stillbirth occurred, which was preceded by a 42 per cent decrease in unconjugated plasma estriol but unheralded by either a drop in total plasma estriol or the urinary estriol/creatinine ratio. There were fewer falls of more than 40 per cent unassociated with perinatal morbidity and death with unconjugated plasma estriol (No. = 3) than with total plasma estriol (No. = 8) and urinary estriol/creatinine (No. = 8). These data suggest that unconjugated plasma estriol is the most predictive test among presently available estriol assays for managing the pregnant diabetic patient.

Total urine oestriol by a modification of a commercial plasma oestriol kit.

An adaptation of a radioimmunoassay for plasma oestriol for assaying urine oestriol is presented. The method has been shown to be precise, reliable, and directly comparable with the manual spectrophotometric technique for urine oestriol.

Plasma unconjugated estriol values in high-risk pregnancy

The usefulness of plasma estriol concentrations in the management of high-risk pregnancy is controversial. In this study, serial plasma unconjugated estriol (E3) concentrations determined by radioimmunoassay were evaluated in 321 patients with high-risk pregnancy for correlation with fetal and neonatal performance. A plasma E3 concentration of 4 ng. per milliliter or less in late pregnancy correlated significantly with low one- and five-minute Apgar scores and selected neonatal problems in pregnancies complicated by chronic hypertension and intrauterine growth retardation, with a similar trend for pregnancies complicated by moderate and severe pre-eclampsia. Most perinatal deaths in the study were associated with acute problems which began during labor and delivery, or fetal death occurred before early intervention was practical. Therefore, the perinatal mortality rate is not likely to be influenced by the use of E3 values, and the perinatal mortality rate is not a realistic measure of the usefulness of plasma E3 values in management of high-risk pregnancy. Low plasma E3 values were not always ominous, and for this reason it is suggested that clinical indications and the results of other tests for fetal-placental function be considered along with plasma E3 values in the selection of patients for early delivery to reduce the possibility of inappropriate intervention.

Plasma levels of pregnancy-specific beta 1-glycoprotein in complicated pregnancies.

Maternal plasma levels of the trophoblast product, pregnancy-specific beta 1-glycoprotein (PS beta G), have been measured both in normal pregnancies and in pregnancies complicated by pre-eclampsia and/or fetal growth retardation. PS beta G levels correlate significantly with placental and fetal weight and fall below the normal range in about 60 per cent of all patients with fetal growth retardation. PS beta G measurements appear to give a considerably better indication of fetal size than measurements of either human placental lactogen (HPL) or plasma oestriol.

PLASMA LEVELS OF HUMAN CHORIONIC SOMATOMAMMOTROPHIN, PROGESTERONE, UNCONJUGATED OESTRADIOL AND OESTRIOL, AND α-FOETOPROTEIN IN PATIENTS WITH HYDATIDIFORM MOLES

Human chorionic somatomammotrophin (HCS), progesterone, and unconjugated oestradiol and oestriol were measured in the plasma of 13 patients with intact hydatidiform moles from week 9 to 19 of pregnancy and in 89 normal women from week 5 to 20 of pregnancy. Plasma alpha-foetoprotein (AFP) was also measured in 9 out of 13 patients and in 23 of the normal women from week 13 to 20 of pregnancy. All the compounds were measured by radioimmunoassay. The plasma HCS concentration in 35 samples from 13 patients with hydatidiform moles ranged from 10 to 910 ng/ml; this was lower than that in normal pregnancy of corresponding duration in eight patients; within the normal range in four patients and high in one patient. The plasma progesterone concentration ranged from 17-5 to 79-2 ng/ml; it was higher than that in normal pregnancy in eight patients and within the normal range in five patients. The plasma unconjugated oestradiol concentration ranged from 1-82 to 8-10 ng/ml; it was higher than normal in six patients and within the normal range in seven patients. The plasma unconjugated oestriol concentration ranged from 0-168 to 1-37 ng/ml, the levels at 15-19 weeks of gestation being significantly lower than those in normal pregnancy at this time (P less than 0-005). Plasma AFP was not detectable in the nine patients (less than 10 ng/ml) whereas it ranged from 10 to 80 ng/ml in 18 out of 23 women in week 13-20 of normal pregnancy. The present results suggest that both plasma oestriol and AFP could be helpful in the diagnosis of hydatidiform mole at about 12-14 weeks though diagnosis could not be made with absolute certainty.

Variations in Plasma Steroid and Prostaglandin Concentrations During Human Pregnancy

Radioimmunoassay of sex steroids and prostaglandins was performed on plasma obtained from 10 uncomplicated primigravid subjects at a stated time of the day at varying stages of gestation. Prostaglandin E2 (PGE2), prostaglandin F2alpha (PGF2alpha), oestrone and oestriol concentrations reached a peak a few weeks before term and then declined. Progesterine, 17-hydroxyprogesterone and oestradiol increased during pregnancy particularly after 32 weeks. In two normal patients repeated blood samples were taken throughout the day at weekly intervals in late pregnancy for sex steroid assays to evaluate the variation of concentrations with the time of sampling and the significance of changes in mean concentrations of different steroids with approaching parturition. Marked variability was found in the levels of different steroids during the day. Plasma oestriol values were lowest at 8.00 a.m. in one patient sampled frequently. A marked decrease in oestriol, oestrone, oestradiol and 17-hydroxyprogesterone was found in one patient prior to the onset of spontaneous labour. In another subject there was no decrease in concentrations of oestrogens or progestogens prior to induction of labour at term.

Relation of plasma oestriol to changes in blood pressure in pregnant patients with hypertension.

Serial plasma oestriol levels were determined by radioimmunoassay in 24 patients with severe hypertension in pregnancy. No significant correlation could be found between plasma oestriol and percentage change in diastolic blood pressure. It seems unlikely that hypotensive therapy significantly improves fetoplacental function.

Human chorionic somatomammotropin in normal pregnancy in an Asian population.

Serial Human Chorionic Somatomammotropin (HCS) levels were measured during the last 10 weeks of pregnancy in 57 patients (375 samples). There was a gradual rise from 5.6 microgram/ml at the 30th week to microgram/ml at the 40th week, with a plateau during the last 4 weeks of pregnancy. No correlation could be found of HCS levels with parity, maternal age, maternal height, maternal weight, foetal weight and foetal sex. A weak but significant relationship was found between HCS and plasma oestriol (r = 2.4, p less than 0.001).

Plasma oestriol in normal pregnancy in an Asian population.

Serial plasma oestriol levels were measured by a radioimmunoassay in 49 normal pregnancies, Plasma oestriol rose from 43 ng/ml (149-1 nmol/l) at 22 weeks to 357 ng/ml (1237-91 nmol/l) at 40 weeks. The rise was gradual between 22 and 32 weeks and steep between 32 and 40 weeks. No significant relationship could be found between plasma oestriol and parity, maternal age, maternal height, maternal weight or fetal sex. However, a significant but low correlation was found between birth weight and plasma oestriol prior to labour and also oestriol increments from 30 weeks to delivery. The average day to day coefficient of variation of plasma oestriol in 11 patients was found to be 16-2 per cent.

Plasma concentrations of cortisol, progesterone and unconjugated oestradiol and oestriol in women with live anencephalic foetuses before, during and after labour.

Department of Obstetrics and Gynecology, Kumamoto University Medical School, Kumamoto, Japan (Received 24 October 1975) Miyakawa, Ikeda & Maeyama (1974) reported that in two women with anencephalic foetuses, the maternal plasma concentration of adrenocorticotrophin (ACTH) at term was similar to that of normal pregnancy, that ACTH was not detectable (<10pg/ml) in mixed cord blood, and that ACTH does not cross the placental barrier. The present study was undertaken to determine the levels of cortisol, progesterone and unconjugated oestradiol and oestriol in maternal plasma before, during and after labour, and in cord plasma of anencephalic newborn infants. Blood samples were obtained from the antecubital vein of mothers and from the umbilical cord of live newborn infants immediately after birth. Unconjugated plasma cortisol was determined using a kit for assay of plasma cortisol by competitive protein-binding from CEA-IRE-SORIN, La Societa Ricerche Impianti Nucleari, Italy. Plasma progesterone, and unconjugated oestradiol and oestriol were

A rapid specific radioimmunoassay for unconjugated estriol in plasma

A rapid, non-chromatographic radioimmunoassay for unconjugated estriol in pregnancy plasma has been developed which utilizes a commonly available antiestrogen antisera. Estradiol-17β and estrone demonstrate 135% relative cross-reactivity with our antiserum, as compared with 100% for estriol. Specificity is achieved by purification of estriol with solvent partitioning using benzene: petroleum ether (1:1). The results obtained using this method are similar to a radioimmunoassay utilizing a highly specific, but commercially unavailable, antiestriol antiserum. The method is precise, with coefficients of variation ranging from 3.0 to 8.2%.

Plasma oestriol and human placental lactogen measurements in patients with high risk pregnancies.

Maternal plasma oestriol and human placental lactogen (HPL) were measured serially in 383 at-risk pregnancies. Eight-five infants were growth retarded and 122 developed fetal distress or neonatal asphyxia. Of the infants whose mothers had either abnormal plasma oestriol or HPL levels, 58 per cent were growth retarded, while 65 and 73 per cent in each group respectively developed fetal distress. The incidence of fetal complications when both plasma oestriol and HPL were abnormal was consistently greater than 66 per cent.

Nonchromatographic radioimmunoassay of unconjugated estriol in plasma, with polyethylene glycol as precipitant.

We describe a rapid, reliable radioimmunoassay for unconjugated estriol in plasma. Polyethylene glycol (Carbowax 6000) is used to separate antibody-bound and free steroid. The assay is sensitive (25 pg for standards), precise, and accurate. At high and low concentrations of estriol, intra-assay coefficients of variation were 7.1% and 7.6%, respectively, and inter-assay coefficients of variation were 7.2% and 10.0 %, respectively. Free [3H] estriol is not precipitated by polyethylene glycol. This radioimmunoassay of estriol, with a highly specific antiserum and with polyethylene glycol as the antibody precipitant, is a reliable one-day assay that is practical both for the clinical laboratory and the obstetrician.

Estriol in pregnancy: IV. Normal concentrations, diurnal and/or episodic variations, and day-to-day changes of unconjugated and total estriol in late pregnancy plasma

Normal values of unconjugated, total, and immunoreactive (measured without extraction) plasma estriol (E3) have been determined from radioimmunoassay data obtained in 217 uncomplicated third-trimester pregnancies. Small but significant diurnal variations in unconjugated and total plasma E3 have been observed in a study comprising 12 women who were hospitalized during late pregnancy for diabetes, toxemia, or placenta previa. The late morning decreases in unconjugated and the afternoon/evening decreases in total plasma E3 concentrations, averaging some 10 to 15 per cent, were overshadowed by considerable episodic fluctuations and may thus be clinically irrelevant. Day-to-day changes of unconjugated and total plasma E3 concentrations in late pregnancy were similar and smaller than changes in urinary E3 measurements. The urinary E3/creatinine ratio, however, reducing inadequacies of 24 hour urine collections, varied less than unconjugated or total plasma E3. The data suggest that a decrease in unconjugated or total plasma E3 must exceed 40 to 45 per cent of the mean of the three preceding determinations if it is to be considered a signal of fetal distress.

Effect of ampicillin administration on estradiol, estriol, and cortisol levels in maternal plasma and on estriol levels in urine

Ampicillin treatment in the last trimester of pregnancy had no significant effect on the levels of estradiol, estriol, or cortisol in maternal plasma. Urinary estriol excretion was, however, notably decreased during or following ampicillin treatment in six out of 10 patients. These results suggest that the plasma estrogen assays have greater validity than the urinary estriol assay in assessing fetoplacental endocrine function during a period of ampicillin treatment of the mother.

Free and sulfoconjugated dehydroepiandrosterone, cyclic adenosine-3′,5′-monophosphate, and free estriol in maternal and cord blood

When free DHEA, its sulfatide, and sulfate were assayed in maternal plasma as well as in umbilical cord arterial and venous plasma, rather high concentrations were found in either fraction from cord arterial plasma, reflecting the fetal contribution not only of free DHEA and DHEA sulfate, but also of the lipophile steroid sulfatide. Since high DHEA levels were associated with elevated c-AMP concentrations, a certain interrelationship of both parameters is indicated. In the course of delivery, a rapid decrease of free estriol in maternal plasma was observed. Higher concentration of free estriol in umbilical venous plasma pointed at its placental biosynthesis from fetal precursors.

Plasma and Urinary Oestriol During Late Uncomplicated Pregnancy

Plasma levels of unconjugated oestriol and urinary excretion of conjugated oestriol were measured in ten healthy women with uncomplicated late pregnancy and with normal renal function. Considerably larger differences within or between days were noted for the plasma levels than for the urinary excretion of oestriol. Significant correlation between plasma levels and urinary excretion was found in only three out of ten patients. Due to the large variations within and between days, the estimation of unconjugated oestriol in plasma might be unsuitable as a substitute for the estimation of urinary conjugated oestriol in the supervision of complicated pregnancies.

66. Effects of surfactant stimulating agents on plasma estriol and progesterone in third trimester pregnancy

66. Effects of surfactant stimulating agents on plasma estriol and progesterone in third trimester pregnancy