Placental lactogen as a reliable index of fetal outcome in threatened abortion during early pregnancy

Some endocrinological events associated with early pregnancy failure

Serial measurements of serum progesterone, oestradiol, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) have been determined in 33 women experiencing early pregnancy failure and compared with the values of the same hormones in 72 healthy women having uncomplicated pregnancies. Steroid production by the corpus luteum seemed similar in both groups up to 6 weeks gestation but thereafter placental steroidogenesis was not evident in those women in whom spontaneous pregnancy losses occurred. Placental production of the two protein hormones, hCG and hPL, did take place, and whereas the circulating levels were not as high as in normal pregnancies, levels did usually increase before clinical evidence of miscarriage occurred. hCG was not a sensitive discriminator of subsequent failure. In these women there were no significant hormone differences between those with evidence of a fetus and those without.

Endocrinologic events in early pregnancy failure

Fourteen women experiencing early pregnancy failure have been studied during the time of conception and at frequent intervals until spontaneous abortion occurred. Serial measurements of serum estradiol, progesterone, 17 alpha-hydroxyprogesterone, prolactin, human placental lactogen (hPL), and human chorionic gonadotropin (hCG) were determined; regular sonar scanning allowed the time of fetal death to be determined to within 7 days in six patients and a diagnosis of blighted ovum to be made in the remainder. In all patients serum progesterone and estradiol concentrations were within the normal range up to 7 weeks but appeared to decrease from about 8 weeks' gestation whether or not a living fetus was present. The placenta continued to produce hCG and hPL but, despite the continuing presence of hCG, the levels of 17 alpha-hydroxyprogesterone declined to concentrations below those associated with normal pregnancy. These data suggest that the placenta may require a particular stimulus to take over production of progesterone and estradiol.

Some new aspects of the endocrinological response to pregnancy

Serial measurements of serum progesterone, oestradiol, prolactin, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) have been determined in 32 healthy women at regular intervals throughout pregnancy. The data confirm previous reports that levels of these hormones vary widely between individuals at each stage of gestation, but further analyses have shown two other features: first there is a clear tendency for individuals to retain their rank in the spectrum of hormone values throughout pregnancy; second when the concentrations of the individual hormones (except hCG) are transformed to logarithmic values, the trends within individuals approximate well to straight lines during the second and third trimester of pregnancy. These findings provide a relatively simple method for describing the rates of change in the concentrations of these hormones and for examining possible relations between them. They also suggest that the quality of the maternal endocrine milieu may be determined at an early stage of gestation.