Comparison Between Plasma and Urinary Oestrogen Measurements in Predicting Fetal Risk

Estrogen screening in evaluation of fetal outcome and infant's development

In an unselected obstetric population of 869 women serial determinations of estriol in serum and urine were performed from the 28th week of pregnancy until delivery. Clinical management was based on ultrasound and nonstress/contraction stress tests only. Data on the development of the infants were available after 1 year in 759 cases (89%) and after 2 years in 661 cases (78%). Serum free estriol (E3) screening during weeks 28-34 of pregnancy revealed a significantly increased risk for reduced Apgar scores, growth retardation and postnatal complications in pregnancies with decreased levels (p less than 0.001). The development of the children was disturbed by a higher incidence of childhood diseases, retardation in speech and bowel and bladder control. The urinary estrogen determinations (UE) during this period of pregnancy showed only a vague connection with birth weight and Apgar scores (p less than 0.05) and no connection to the infant's development. Serial determinations of E3 after the 35th week of pregnancy increased the significance for all parameters tested. If the estrogen concentration was determined in the last 2 weeks before delivery, 50% of the SGA and 60% of the endangered cases could be diagnosed. After reduced E3 serial levels neurological sequelae, reduced body weight, retarded speech and late development of bowel and bladder control were significantly more frequent at age two than after normal E3 levels. The differences obtained by serial UE determinations were less evident. Considering cost-benefit-calculations, an E3 screening of every pregnant woman cannot recommended. In pregnancies at risk serial E3 determinations allow better prognostication of fetal well-being. In the case of reduced E3 values maximum post partum care should be made available for all newborns. Special support should be given to the early infant's development after reduced E3 values have been observed.

Comparison of maternal serum and urinary oestrogen determinations as indicators of fetal well-being

Serum oestrogen concentration and urinary oestrogen excretion were measured in 134 women in the last trimester of pregnancy. An automated fluorimetric method was used for urinary oestrogens and a radioimmunoassay which measures both free and conjugated oestrogens, with the exception of sulphates, was employed for serum. Pregnancies were classified into a 'normal' or 'abnormal' group according to the clinical state of the baby at birth. The range of values for both serum and urinary oestrogens was wide at each stage of gestation and the mean values in the two groups were not significantly different. It was concluded that for a valid indication of fetal well-being serial determinations were essential, and that serum and urinary oestrogens were of comparable predictive value. Expressing the urinary results in terms of creatinine excretion did not improve their predictive value.

Plasma oestriol and placental proteins: a cross-sectional study at 38 weeks gestation

Blood was collected from 53 normal women in the 38th week of pregnancy. The plasma concentration of unconjugated oestriol, total oestriol and oestriol sulphate was measured and also human placental lactogen and pregnancy specific beta1 glycoprotein. The normal spread of the two proteins was found to be slightly smaller than that of the oestrogens. The concentrations of unconjugated and of total oestriol were related; otherwise these substances varied independently of one another. The concentration of these substances was not related to other obstetric parameters.