Assessment of ovulation synchronization protocols in goats and use of pregnancy specific protein B (PSPB) enzyme linked immunsorbent assay (ELISA) to determine kid number at birth

The efficacy of several protocols for ovulation synchronization and timed artificial insemination (TAI) in goats was examined. In addition, the relationship between levels of pregnancy specific protein B (PSPB) during gestation assessed with a commercially available ELISA and the number of offspring at birth was determined. In Experiment 1, 70 does were randomized into four treatments: (1) breed by estrus [BBE], (2) 6-d treatment with a new [C6N], (3) once-used [C61], or (4) twice-used Controled Internal Drug Release (CIDR) device [C62)]. BBE does received two 15 mg doses of prostaglandin-F2α (PGF) at a 10-d interval and were bred 12 h after estrus onset. CIDR groups received a CIDR for 6 d with 15 mg PGF given at CIDR removal. TAI was performed 48 h after CIDR removal and does were given 50 μg GnRH. All does were inseminated with a single dose of frozen semen using a non-surgical, transcervical technique. Pregnancy rates for the BBE, C6N, C61 and C62 treatment groups were 39% ± 12%, 64% ± 12%, 77% ± 12% and 57% ± 12%, respectively, and did not differ. Reuse of CIDRs, even with reuse extending for a total of 21 d, was as effective as new CIDRs for synchronization of ovulation. In Experiment 2, 68 does were randomized into four treatments: (1) BBE, (2) C6N, (3) NC.Synch [NCS], (4) modified NCS [NCSM]. The BBE and C6N groups were as described for Experiment 1. The NCS and NCSM groups received 15 mg PGF on Day 1, 50 μg GnRH on Day 8 and 15 mg PGF on Day 15 (NCS) or Day 15.5 (NCSM). Does were bred by TAI at 72 h (NCS) or 60 h (NCSM) after the second PGF injection. All does in the NCS and NCSM groups received 50 μg GnRH at TAI. Pregnancy rates were 53% ± 12%, 30% ± 11%, 50% ± 11% and 41% ± 12% for does in the BBE, C6N, NCS and NCSM group, respectively, and did not differ. In Experiment 3, 62 does pregnant to TAI were bled at Days 48 and 85 post-insemination for PSPB. Data on kid numbers and birth weights were subsequently recorded. At Day 48 of gestation, PSPB levels for does birthing singletons were lower than for does birthing twins or triplets (25.0 ± 0.1^a, 28.8 ± 0.1^b and 30.7 ± 0^b ng/mL, respectively, ^abP<0.05). At Day 85 of gestation, PSPB levels were progressively greater for does birthing singletons versus twins versus triplets (27.0 ± 0.1^a, 28.5 ± 0.1^b and 31.6 ± 0^c ng/mL, ^abcP<0.05). In conclusion, PSPB concentrations detected using a commercially available ELISA at Day 48 or 85 of gestation could distinguish does carrying single versus multiple fetuses.

[Vaccination against influenza A (H1N1) in pregnancy]

AIM

Evaluation of alterations of immune response regulation and possible risk of antenatal development of fetus in postvaccination period in pregnant women immunized against influenza A (H1N1).

MATERIALS AND METHODS

Women were vaccinated with MonoGrippol plus vaccine in the II trimester of physiological pregnancy. At certain intervals ofthe vaccination period (before the vaccination, 7 and 30 days after the vaccination) major biochemical markers in blood sera (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, creatinine, urea) and levels of key cytokines in spontaneous and stimulated test (IL-1alpha, IL-1RA, IL-2, IL-4, IL-10, IFNgamma, TNFalpha) were evaluated. Vaccination safety for the fetus and trophoblast development was evaluated by using human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and trophoblasitc beta-1-glycoprotein (TBG) levels.

RESULTS

During vaccination in 13% of cases mild local reactions were noted, in 26.1%--general systemic reactions in the form of weakness, dizziness and headaches. Levels of major biochemical markers at days 7 and 30 after the vaccination did not have any significant difference from the initial values (p > 0.05). Cytokine levels in spontaneous and stimulated tests also did not change significantly. Markers of the course of pregnancy and fetus development (HCG, AFP and TBG) in the two groups observed had comparable values.

CONCLUSION

Vaccination of pregnant women against influenza A (H1N1) by Russian subunit formulation (MonoGrippol plus) showed reactogenicity comparable to control group by the level of influence on general metabolic and immunologic homeostasis and on the course of pregnancy, which is an evidence of its safety.

Maternal serum levels of placental proteins afterin vitro fertilisation and their implications for prenatal screening

OBJECTIVES

To determine whether the serum levels of pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta(1)-glycoprotein (SP1), placental lactogen (hPL) and human chorionic gonadotrophin (hCG) are different in pregnancies obtained after in vitro fertilisation (IVF) and embryo transfer (ET) in comparison to spontaneous pregnancies. Assessment of the need to establish normal medians for biochemical trisomy screening in IVF pregnancies.

METHODS

The population comprised 96 IVF-ET pregnancies, of which 79 came from fresh gonadotrophin-stimulated cycles and 17 from embryo transfers without gonadotrophin stimulation (natural cycle IVF, frozen embryo transfers), and 156 spontaneous pregnancies. A single blood sample was obtained between 7 + 0 and 16 + 3 weeks. PAPP-A, SP1, hPL and hCG were quantified and the levels compared between gonadotrophin-stimulated IVF, steroid-only- or non-stimulated IVF, and controls with respect to gestational age using non-parametric statistical analysis.

RESULTS

PAPP-A and hPL levels were reduced after stimulated IVF in early gestation (before 10 pregnancy weeks); SP1 followed the same trend without reaching statistical significance. hCG tended to be increased after IVF treatment including non-gonadotrophin-stimulation cycles, and also beyond 10 pregnancy weeks.

CONCLUSION

Reduced PAPP-A with increased hCG yields an increased risk in screening for foetal trisomy 21. We confirm recently published observations but do not recommend the establishment of normal medians for IVF pregnancies since the extent of the deviations is varying according to the different stimulation protocols and dosages of gonadotrophins used.

First-trimester maternal serum PAPP-A, SP1 and M-CSF levels in normal and trisomic twin pregnancies

OBJECTIVE

To study PAPP-A and SP1 for biochemical trisomy screening in twin pregnancies and to investigate the role of maternal and placental compartments in marker production by comparing the levels of the decidual cytokine M-CSF with the PAPP-A and SP1 from the placenta.

METHODS

Thirteen twin pregnancies with at least one chromosomally abnormal fetus were compared with 68 normal twin pregnancies. Sera were obtained between 11 + 3 and 13 + 6 weeks of gestation, and PAPP-A, SP1 and M-CSF levels were determined by immunoassay. These concentrations were also compared with gestation-matched groups of 18 singleton normal pregnancies and 18 singleton Down syndrome pregnancies.

RESULTS

PAPP-A and SP1, but not M-CSF, levels were higher in normal twin pregnancy than in normal singleton pregnancy. SP1 levels, but not PAPP-A, correlated to M-CSF. PAPP-A, but not SP1, levels were reduced in abnormal twin pregnancies, with an increasing effect according to the number of affected fetuses, and were more pronounced in pregnancies with trisomy 18 or 13 than in trisomy 21 fetuses. M-CSF was inconsistent, with a trend towards increased levels in trisomy 21.

CONCLUSION

PAPP-A remains the best biochemical screening marker for fetal trisomies 21, 18 or 13, in singleton as well as in twin pregnancy. In contrast to SP1, its site of production is not likely to be restricted to the placenta. The role of the (maternally produced) M-CSF remains to be further investigated.

Trophoblastic beta1-glycoprotein and hemostasis system in pregnant women with antiphospholipid syndrome

Clinical and laboratory studies were carried out in 38 pregnant women with antiphospholipid syndrome. Increased functional activity of platelets and decreased protein-producing function of the placenta were observed starting from the early terms of gestation. These disorders were followed by the development of hypercoagulation in the plasma component of hemostasis, appearance of intravascular blood clotting markers, and inhibition of AT III and protein C. This led to the progress of disorders in the microcirculatory bed, fetoplacental insufficiency, decrease in trophoblastic beta1-glycoprotein level, chronic hypoxia, and fetal death. Infection accelerated this process. Measurements of trophoblastic beta1-glycoprotein every 2 weeks help to diagnose fetoplacental disorders, predict the course of pregnancy, and evaluate the efficiency of drug therapy.

SP1 in pregnancies with Down syndrome in the first trimester of pregnancy. International Prenatal Screening Research Group

We conducted a study to determine the value of serum pregnancy-specific beta-1-glycoprotein (Schwangerschafts protein 1, SP1) as an antenatal screening test for Down syndrome in the first trimester. Serum samples collected from women at 8 to 14 weeks of pregnancy, immediately prior to having a chorionic villus sampling procedure on account of advanced maternal age, were retrieved from 96 women with Down syndrome pregnancies (cases) and from 480 women with unaffected pregnancies (controls). Cases and controls were ascertained at 21 obstetric centres in nine countries. Each case was matched with five controls for maternal age (same five-year age groups), duration of storage of the serum sample (same calendar year) and gestational age (usually the same week of pregnancy). The levels of SP1 were lower in pregnancies associated with Down syndrome: the median level was 0.86 multiples of the median level in the controls (95 per cent confidence interval 0.76 to 0.97). This difference, though statistically significant, was not large enough for SP1 to be a useful marker in screening, at least from 10 weeks onwards where most of our data lie.

Maternal serum pregnancy-associated plasma protein A (PAPP-A) but not pregnancy-specific beta1-glycoprotein (SP1) is a useful second-trimester marker for fetal trisomy 18

The usefulness of early second-trimester serum determinations of pregnancy-associated plasma protein A (PAPP-A) and pregnancy-specific beta1-glycoprotein (SP1) in suspected cases of fetal trisomy 18 was examined in a retrospective, cross-sectional study. Maternal serum PAPP-A and SP1 in 20 cases of fetal trisomy 18 between 15 and 20 weeks of pregnancy, and in 40 controls matched for gestational age and storage time were determined and compared with hCG and free oestriol (uE3). In trisomy 18, the reduction in serum concentration was found to be more pronounced for PAPP-A than for hCG and free oestriol. While none of the 40 control sera had a MoM below 0.2 for either PAPP-A, hCG or uE3, in the trisomy 18 group (20 cases) 17 (85 per cent) of the PAPP-A but only 5 (25 per cent) of the hCG and 4 (20 per cent) of the uE3 results were below the 0.2 MoM threshold. SP1 did not distinguish between controls and trisomy 18. This chromosomal abnormality is too rare a condition to justify maternal serum PAPP-A determination in the second trimester as a routine procedure, but such a test can play a useful role whenever the risk of trisomy 18 is found to be only marginally increased after hCG and uE3 measurements.

The contribution of maternal serum markers in the early prenatal diagnosis of molar pregnancies

The aim of this study was to evaluate the usefulness of maternal serum markers in the early prenatal diagnosis of molar pregnancies. The ultrasound features, cytogenetic and histopathological findings of 10 cases of molar pregnancy diagnosed at 11-13 weeks of gestation were compared retrospectively with the maternal serum concentrations of human chorionic gonadotrophin (HCG), alpha fetoprotein (AFP), pregnancy-associated plasma protein A (PAPP-A) and pregnancy-specific beta1-glycoprotein (SP1). Free beta-HCG and intact HCG concentrations were very high [> or = 2.5 multiples of the median (MoM)] in all cases. AFP concentrations were extremely low in all cases of singleton complete moles (< or = 0.5 MoM) and were high in one case of twin complete mole, in one case of triploid partial mole and two cases of euploid partial mole (> or = 2.5 MoM). Serum PAPP-A and SP1 were high in complete moles. The combined use of ultrasound features, maternal serum proteins and fetal cytogenetic findings should enable the early differential diagnosis in utero and perinatal management of those molar pregnancies presenting with an anatomically normal fetus.

Revealing some oncofetal antigens in peripheral blood mononuclear cells of donors and patients with B-chronic lymphocytic leukemia

Eidelman et al. showed that the expression of functional carcinoembryonic antigen (CEA) on the surface of cells can block terminal differentiation and maintain their proliferative capabilities. This led us to analyze the expression of CEA, trophoblast-specific beta-1-glycoprotein (TSG) and embryonic prealbumin-1 (EPA) in peripheral blood mononuclear cells (PBMs) isolated from healthy donors and patients with B-chronic lymphocytic leukemia (B-CLL). We demonstrated that the PBMs of patients with B-CLL differed from PBMs of healthy donors by having greater numbers of CEA-, EPA- and TSG-positive cells.

[Serum leptin in women during the third trimester of pregnancy]

Leptin is a small protein produced mainly by adipocytes. Recently, its relationship to obesity has been studied extensively. It was proved that obese individuals have either relative or absolute leptin deficiency. Several years ago, leptin was found to be produced also by the placenta. This stimulated us to study relationship between leptinemia and placental hormones in 85 women in the second gravidity trimester. Within the prenatal screening, these pregnant women were subjected to analysis of AFP, hCG, SP-1 glycoprotein and leptin and the results obtained were processed statistically. The control group consisted of 20 nonpregnant women with tetany. Women in the second gravidity trimester were found to have a significantly higher leptinemia than nongravid women (even with respect to body weight). This may be due to a larger amount of adipose tissue during gravidity and also leptin-resistance. Moreover, we recorded a negative correlation between leptinemia related to body weight and concentration of SP-1 glycoprotein. This finding supports the presumption that mother's leptinemia correlated negatively in the second gravidity trimester with quality and quantity of the placental syncytiotrophoblast. Our findings can be explained as follows: the biological effect of leptin is metabolically unfavourable for the growth of the foetus and the placenta. An increased leptinemia with advancing gravidity can be caused by a larger fatty mass and an increased activity of adipocytes when leptin presence increases in system circulation but the organism begins to be leptin-resistant and an "unfavourable" metabolic effect fort the gravid woman and the foetus is not distinct. These findings thus support the hypothesis postulating the nonsignificance of leptin production in human placenta and on the contrary the necessity of leptin-resistance for foetus development from the metabolic point of view. Thus, a decreased leptinemia immediately before and after the delivery could be caused by the still unclear regulators of leptin sensitivity. This is again a metabolically highly favourable state (reduced appetite, decreased body weight, increased energy output and others).

Schwangerschafts protein 1 (SP1) adds little to the age-related detection of fetal Down syndrome in the first trimester of pregnancy

Schwangerschafts Protein 1 (SP1), being a placental protein appearing in the maternal circulation early in pregnancy, has been investigated as a potential marker for Down syndrome in the first trimester. Our study compared SP1 levels in 15 pregnancies with a Down syndrome fetus and 97 matched controls. Although the median MoM in Down syndrome pregnancies (0.49) was lower than in controls, its use as a marker added very little to the detection rate above the maternal age alone.

Serum pregnancy-specific beta1-glycoprotein before embryo transfer is related to endometrial thickness and to outcome prognosis in women undergoing in-vitro fertilization treatment

We have previously observed the repeated presence of low but detectable amounts of the trophoblast marker pregnancy-specific beta1-glycoprotein (SP1) in the serum of some women undergoing in-vitro fertilization (IVF) treatment around the time of oocyte retrieval. The occurrence of these signals seemed to be restricted to a defined group of patients which also showed a lower pregnancy success rate in a preliminary study. To test our hypothesis we have analysed 173 consecutive cycles leading to an embryo transfer. Fifty-four cycles (31%) had a serum SP1 level of at least 0.1 ng/ml between days embryo transfer -5 and embryo transfer (group A). Five pregnancies were obtained in this group (pregnancy rate = 9.3%), while in group B, defined by the absence of detectable SP1 before embryo transfer (119 cycles), 36 ongoing pregnancies were achieved (30.3%). Ten of the 41 pregnancies were achieved in 33 first-time non-pregnant patients undergoing further attempts during the study period. Again the pregnancy rate was higher in the first-time group B women (9/23 versus 1/10 for group A). Patients tended to remain in their groups A or B, the latter being associated with a better immediate as well as subsequent chance for pregnancy. Group A cycles had a significantly lower endometrial thickness two days before oocyte retrieval than group B (P = 0.0011). We postulate that the presence of an unknown, maternal and progesterone- or follicle stimulating hormone-independent factor in some patients could stimulate tonic ectopic SP1 synthesis and at the same time negatively influence endometrial development.

[Screening for transitional cell carcinoma of the bladder with trophoblastic differentiation in Upper Galilee]

Urinary bladder carcinoma with trophoblastic differentiation (TD) is a variant of urothelial (transitional cell) carcinoma (TCC) which secretes placental proteins, predominantly beta-human chorionic gonadotropin (HCG). An aggressive clinical course and a poor prognosis are characteristic of this tumor. We evaluated the frequency and clinical and pathological appearance of TCC-TD in the Upper Galilee and Golan Heights between 1988 and 1995 inclusive. Beta HCG, human placental lactogen (HPL), pregnancy specific beta-1 glycoprotein (SP-1) and placental alkaline phosphatase were determined immunohistochemically in paraffin-embedded TCC of urinary bladder. Tumor grade, stage and patient survival were also determined. There was beta-HCG immunostaining in 13 of 62 cases (20.9%). TD was correlated with higher grades of TCC and with advanced stages of disease. No cases of TCC-TD were found in grade 1, stage 0. Co-expression of beta-HCG and HPL was displayed in 2 cases, beta-HCG and SP-1 in 9, and beta-HCG, HPL and SP-1 in 2. Disease-free survival and overall survival were shorter in TCC-TD.

Biochemical screening of congenital developmental abnormalities using determination of fetoplacental antigens

In a prospective study of screening of maternal serum levels of alpha-1-fetoprotein (MS AFP) and trofoblast-specific beta-1-glycoprotein (MS SP1) were examined in samples from pregnant women between the 16th and 18th week of pregnancy. We detected 8 fetuses with chromosomal aberation, 8 fetuses with neural tube defects and 10 fetuses with inborn cardial defects. Our study confirms higher MS SP1 levels in women with fetuses with chromosomal aberation, while MS AFP's tendency is to decrease. When combining MS SP1 + MS AFP + age of mother (over 35), 75% of fetuses with chromosomal aberation were detected. In women with neural tube defect 75% fetuses were detected by MS AFP + MS SP1 combination.

Schwangerschaftsprotein 1 (SP1) as a maternal serum marker for Down syndrome in the first and second trimesters

The potential of the maternal serum concentration of schwangerschaftsprotein 1 (MSSP1) as a marker for Down syndrome (DS) pregnancies was evaluated in the fifth to the 20th gestational week using 156 DS pregnancies and 546 unaffected control pregnancies. In DS pregnancies, the median of the multiple of the median (MOM) of MSSP1 was 0.27 [95 per cent confidence interval (CI) 0.11-0.59] in weeks 5-9 (n = 25) and 1.28 (CI 1.11-1.49) in weeks 14-20 (n = 117), significantly different from controls (P < 10(-6). In weeks 10-12, the median MSSP1 MOM was 0.89 (CI 0.20-2.09) (n = 14), not different from controls (P = 0.42). Using MSSP1 alone as a marker for DS gave--in empirical receiver-operator-characteristics (ROC) analysis--a detection rate of about 44 percent for a false-positive rate of about 5 per cent in weeks 5-9 (using MSSP1 MOM < or = cut-off), whereas a sensitivity of about 20 percent was found for a false-positive rate of 5 percent in weeks 14-20 (using MSSP1 MOM > or = cut-off). In parameterized ROC analysis, the detection rates were 38 and 18 percent for a false-positive rate of 5 per cent in weeks 5-9 and 14-20, respectively.

Maternal serum concentrations of human placental lactogen, estradiol and pregnancy specific beta 1-glycoprotein and fetal growth retardation

BACKGROUND

To determine if maternal serum levels of human placental lactogen (hPL), estradiol, and pregnancy-specific beta 1-glycoprotein (SP1) measured at approximately 18 weeks' gestation were associated with fetal growth retardation (FGR) in infants delivered at or after 37 weeks.

METHODS

Serum samples were obtained at a mean of 18 weeks' gestational age from 200 multiparous women with risk factors for FGR. Maternal serum concentrations of hPL, estradiol and SP1 were correlated with FGR.

RESULTS

A total of 59 (29.5%) of the 200 infants were diagnosed postnatally with FGR. There were no significant differences in the prevalence of FGR among the lowest quartiles of estradiol, hPL or SP1. However, pregnancies in the highest quartile of estradiol levels at 18 weeks' (> 580 pg/ml) were associated with a significantly lower risk of FGR than those in the lower three quartiles, 8 out of 50 (16%) vs 51 of 150 (34%) (p = < 0.05). The prevalence of FGR associated with the highest quartile of hPL (> 1.73 micrograms/ml) was 12.2% compared to 35% in the lower three quartiles (p = 0.025) and the prevalence of FGR associated with the highest quartile of SP1 (> 43 ng/ml) was 14% compared to 34.7% in the lower three quartiles (p = 0.018). Only one out of 21 infants (4.5%) whose mothers had each value in the highest quartile of hPL, estradiol, and SP1 was diagnosed with FGR compared to 58 out of 178 (32.6%) of the remaining infants (p = 0.007).

CONCLUSIONS

In pregnancies of women at high risk for FGR, higher levels of estradiol, hPL, and SP1 at 18 weeks are associated with a decreased prevalence of FGR. This finding indicates that high levels of these hormones are related to a lower risk of FGR, but that low levels do not predict FGR.

Estrogen regulation of placental P-450 cholesterol side-chain cleavage enzyme messenger ribonucleic acid levels and activity during baboon pregnancy

The present study was conducted to determine whether estrogen regulates the P-450 cholesterol side-chain cleavage (P-450scc) enzyme component of the progesterone biosynthetic pathway in the placenta during the second half of baboon pregnancy. Placental estrogen formation was suppressed by removing the fetus, i.e. fetectomy, and thus fetal adrenal C19-steroid estrogen precursors, on day 100 of baboon gestation (term = 184 days). P-450scc activity and messenger ribonucleic acid (mRNA) levels were then determined in placentas obtained on day 160 after fetectomy alone and after fetectomy and s.c. administration of the estrogen precursor and rostenedione or estradiol benzoate. Placentas were maintained in situ after fetectomy, and placental villi were comprised of syncytiotrophoblasts that seemed morphologically normal, based on their histology and immunocytochemical expression of pregnancy-specific-beta 1-glycoprotein. In untreated baboons, peripheral serum estradiol increased with advancing gestation, and mean (+/-SE) concentrations were 1.22 +/- 0.05 ng/ml on days 101-160 of gestation. After fetectomy serum estradiol concentrations decreased to 24% (P < 0.01) of normal. Androstenedione or estradiol administration after fetectomy increased serum estradiol levels to values that were 57% (P < 0.01) of, or 90% (P < 0.001) greater than intact controls, respectively,. Placental P-450scc specific activity, determined on a mitochondrial-enriched fraction of villous tissue, was 281.1 +/- 15.0 pmol pregnenolone plus progesterone formed per mg mitochondrial protein in untreated control baboons. Fetectomy resulted in a 52% decrease (P < 0.001) in placental P-450scc activity. Administration of androstenedione or estradiol after fetectomy increased P-450scc activity to values that were not significantly different from control. P-450scc mRNA levels were quantified by competitive RT-PCR. P-450scc mRNA levels in placental villous tissue of fetectomized baboons was 38% lower (P < 0.01) than that in the intact controls (110.9 +/- 5.9 attomoles/microgram RNA). The administration of androstenedione after fetectomy restored P-450scc mRNA to a level that was not different from the untreated controls. The results of this study show that there was close association between the levels of estrogen and the specific activity of and the mRNA levels for placental P-450scc in the second half of baboon pregnancy. Therefore, we propose that the P-450scc enzyme that catalyzes the conversion of substrate cholesterol to pregnenolone is regulated, for the most part, by estrogen in the primate placenta.

[Effects of parents' exposure to genotoxic agents on the degree of maturity of the newborn]

The maturity of full-term newborns was studied by immunological, biochemical, and ecogenetic methods. The study yielded basic immunochemical and ecogenetic evidence. It shows that chronic intrauterine hypoxia and unfavourable ecogenetic factors apparently influence concurrently and result in severe fetal immaturity.

[Anti-phosphatidylserine antibodies in women with reproductive disorders]

Antiphosphatidylserine antibodies (APSA) belong to the heterogeneous population of antiphospholipid antibodies (APA) which are oriented above all against negatively charged phospholipids. The presence of APA in women is closely associated with repeated miscarriages and other complications during pregnancy. The most frequently detected specific antibodies in these patients are autoantibodies against cardiolipin and phosphatidylserine (PS). In a group of 84 pregnant women where within the framework of biochemical prenatal screening of inborn developmental defects serum levels of alpha-1-fetoprotein, choriogonadotropin and trophoblast specific beta-1-glycoprotein were examined as well as in 22 women treated for primary sterility and 22 blood donors the authors assessed, using the ELISA method, antiphosphatidylserine and cardiolipin antibodies (ACA). They found an increased prevalence of APSA in all examined groups as compared with the control group of blood donors. In pregnant women the prevalence of APSA and ACA did not differ and at least one type of antibodies was detected in 20.1%. In pregnant women with positive APSA in the case-records spontaneous abortions were recorded, or imminent abortions during the present gestation or treatment on account of sterility, and in some instances also changes of foetoplacental antigen serum levels were found. It is therefore likely that the presence of APA in women may be one of the factors participating in reproductive disorders and that assessment of APSA together with APA may extend the spectrum of immunological examinations, in particular in sterile and infertile women.

The role of pregnancy-specific beta-1 glycoprotein (SP1) in assessing the human blastocyst quality in vitro

The advent of new culture techniques resulting in more than 60% of embryos developing in vitro to the blastocyst stage suggests that blastocyst transfer in humans with its potential to increase in-vitro fertilization success rates could be a feasible option. Blastocyst quality markers, however, are required to ensure that an increase in numbers is not achieved at the expense of lowering quality. We have previously reported a morphology based method for grading blastocysts. The current study sought to determine whether the secretion of pregnancy-specific beta-1-glycoprotein (SP1) (a trophoblast product known to be associated with fetal well-being) by blastocysts of differing quality was reflected in the morphological grading. SP1 concentrations were measured in the culture medium of grade 1 (n = 19), grade 2 (n = 4) and grade 3 (n = 4) blastocysts as well as vacuolated morulae (n = 6) daily from day 1 to day 14. Cumulative SP1 concentrations secreted by blastocysts were significantly higher than those secreted by vacuolated morulae. However, SP1 levels could not distinguish between blastocysts of differing morphological grades. The inconsistent pattern of secretion suggests that at this early stage of development, SP1 secretion is probably not sufficiently defined to allow any differences in levels to be reflected by the morphological grading.

Preference of invasive cytotrophoblast for maternal vessels in early implantation in the macaque

The interaction of cytotrophoblast with maternal endometrium, especially endometrial blood vessels, was examined in macaque gestational stages between 2 and 8 days after the onset of implantation. Serial sectioning of these early implantation sites allowed immunostaining of consecutive sections with a number of different antibodies, facilitating cell identification. In the earliest implantation site, immunostaining showed that antibody to cytokeratin stained cytotrophoblast, syncytial trophoblast, epithelial plaque and endometrial gland cells. However, only those cytotrophoblast cells near the maternal-fetal border and within vessels showed surface staining for neural cell adhesion molecules and only syncytial trophoblast showed SP1 reactivity. Even at this early stage cytotrophoblast filled the lumen of superficial arterioles, whereas dilated venules contained only a few cytotrophoblast cells. In later stages endovascular cytotrophoblast not only plugged many spiral arterioles but also migrated into the walls of these arterioles, and progressed into deeper coils. Displacement of endothelial cells and disruption of vessel walls were illustrated with antibody to factor VIII, TGF alpha, and desmin. Clusters of cytotrophoblast cells at the fetal-maternal interface tended to bypass clusters of epithelial plaque cells and larger clusters of maternal fibroblasts, but readily entered all vascular spaces. Consequently the vascular system constituted a major pathway of invasion, although the arterioles were the only component substantially invaded beyond the trophoblastic-shell/endometrial border.

The expression of trophoblastic cell markers by lung carcinomas

The authors studied the expression of trophoblastic cell markers in lung carcinomas cells by immunoperoxidase staining using antibodies against three trophoblastic glycoproteins (human chorionic gonadotropin [hCG]; human placental lactogen [hPL]; pregnancy-specific beta 1-glycoprotein [SP-1]). One hundred five tissue sections from 44 lung carcinomas of various histological types were examined for positive staining with three antibodies. Hematoxylin-eosin-stained sections from the same tissue blocks were examined for the presence of tumor giant cells. The aim was to study the relationship between tumor giant cells and the trophoblastic glycoprotein expression in lung carcinomas. Small cell carcinoma (SCC) did not show any positive reaction with all three markers. Squamous cell carcinoma (SQCC) showed positive staining with hCG in 21% of cases, hPL in 28%, and SP-1 in 64%. Adenocarcinoma showed positive staining with hCG in 60% of cases, hPL in 10%, and SP-1 in 80%. Large cell carcinoma (LCC) showed positive staining with hCG in 93% of cases, hPL in 56%, and SP-1 in 93%. The positive reaction did not appear to be restricted to nor associated with the tumor giant cells. It was concluded that these trophoblastic cell markers are expressed in various types of lung carcinomas and that they are not associated with certain histological types or with tumor giant cells.

Maternal serum Schwangerschafts protein-1 (SP1) and fetal chromosomal abnormalities at 10-13 weeks' gestation

Maternal serum SP1 concentration was measured at 10-13 weeks' gestation in samples from 87 pregnancies with fetal chromosomal abnormalities (trisomy 21 n = 45; trisomy 18 n = 19; trisomy 13 n = 8; Turner syndrome n = 7; 47,XXX or 47,XXY n = 4; triploidy n = 4), and in samples from 348 matched controls. In the control group, SP1 increased significantly with fetal crown-rump length (r = 0.20, P < 0.0001) and there was no significant association with fetal nuchal translucency thickness (r = 0.03). Similarly, in the group with fetal chromosomal abnormalities, SP1 increased significantly with crown-rump length (r = 0.31, P < 0.01) and there was no significant association with nuchal translucency thickness (r = -0.08). In the groups with fetal trisomy 18 and trisomy 13, the median SP1 (0.76 MoM and 0.57 MoM, respectively) was significantly lower than in the controls (z = 2.64 and z = 3.27, respectively); in 21% and 25% of the cases, values were below the 5th centile. In the group with trisomy 21 and other chromosomal abnormalities the median SP1 (0.96 MoM and 0.93 MoM, respectively) was not significantly different from controls (z = 1.17 and z = 0.67, respectively). Measurement of SP1 concentration at 10-13 weeks' gestation is not likely to be useful in the prediction of fetal chromosomal abnormalities.

Endometrial and placental protein markers and ovarian steroids in serum during in-vitro fertilization cycles

The objective of this study was to find the earliest time at which it was possible to detect clinical pregnancy in an in-vitro fertilization (IVF) treatment cycle supported with human chorionic gonadotrophin (HCG), and also retrospectively to diagnose abnormal ovarian- or endometrium-related situations in failure cycles. Serum samples were taken in 41 IVF cycles at frequent intervals from the beginning of ovarian stimulation until menstrual bleeding occurred or a pregnancy was established. Concentrations of oestradiol, progesterone, placental protein 14 (PP14), pregnancy-specific beta 1-glycoprotein (SP1), and pregnancy-associated plasma protein A (PAPP-A) were determined in the serum samples using commercially available (steroid) or purpose-developed (protein) immunoassays. The cycles were retrospectively distributed into four outcome groups: (i) fertilization failure (FF, n = 8); (ii) implantation failure (IF, n = 10); (iii) 'interaction' (embryo-endometrium) cycle (IC, n = 14), and (iv) clinical pregnancy (CP, n = 9). The embryo-endometrium interaction was detected by a rise in SP1 in 23 cycles (70% of embryo transfers) at a time when endogenous HCG was still masked by external support. Early ('false') positive SP1 concentrations were observed in two out of eight and five out of 14 cases in groups FF and IC respectively, but never amongst the ongoing pregnancies (CP). PAPP-A did not distinguish pregnancy from the other outcomes. The PP14/progesterone ratio was lower, later in the cycle, in CP than in the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of a mathematical model to establish normal serum parameters characterizing the function of the fetoplacental complex]

Based on the author, data on the content of alpha-fetoprotein, trophoblastic beta-1-glycoprotein, and nonconjugated estriol in the blood serum of 278 somatically healthy women in various periods of normal gestation, the author proposes an approach to the definition of normal range of values. Using mathematical simulation methods, the values of normal concentrations of the fetoplacental complex products were calculated for every week of gestation, this permitting a different representation of laboratory findings and a dynamic follow-up of the course of gestation.

[Anticardiolipin antibodies and oncofetal antigens in pregnant women]

The presence of antiphospholipid antibodies (APA) in the blood stream is associated with some reproductive disorders in women. In the serum of 84 pregnant women, using the Elisa method, anticardiolipin antibodies (ACA) were examined. The first group of 53 women was formed by women with pathological levels of at least one of the oncofoetal antigens (alpha-1-fetoprotein-AFP, human chorionic gonadotropin-HCG and trophoblast-specific beta-1-glycoprotein- SP1). The second group of 31 pregnant women comprised women hospitalized on account of a risk pregnancy. In the first group women with reduced HCG were most frequently represented, where in 8.8% positive ACA were recorded. Of 11 patients with elevated HCG only in one the presence of ACA was detected. In nine pregnant women with reduced HCG and SP1 or AFP ACA positivity was found in 44.4%. In the second group ACA were detected in the serum of six pregnant women who had also pathological SP1 or HCG levels. From the results ensues that ACA could interfere with transduction signalizing processes in the cell and thus influence the synthesis of some proteins.

Screening for Down syndrome in the first trimester

Second-trimester maternal serum screening for Down syndrome is now well established, and permits detection of up to 70% of cases. The disadvantage of this sort of screening is that the timing of maternal blood sampling is relatively late (after 15 weeks). There is an accumulating body of evidence to suggest that in the first trimester concentrations of a number of pregnancy-associated proteins and hormones differ in chromosomally normal and abnormal pregnancies. A first-trimester maternal serum screening test for Down syndrome may therefore be possible. In addition, new methods of screening have recently been described based on ultrasound findings at 11 to 13 weeks of gestation. This review article presents a discussion of published data on the feasibility of first-trimester screening for Down syndrome.

Pregnancy-associated plasma protein A (PAPP-A): measurement by highly sensitive and specific enzyme immunoassay, importance of first-trimester serum determinations, and stability studies

It has recently been established that maternal serum pregnancy-associated plasma protein A (PAPP-A) was reduced in pregnancies with fetal Down syndrome in the first but not in the second trimester of gestation. In comparison with two other placental proteins, human chorionic gonadotrophin and pregnancy-specific beta 1-glycoprotein, an explanation for this can be formulated based on the large molecular weight of PAPP-A. With the increasing clinical demand for fetal abnormalities to be diagnosed in the first rather than in the second trimester of pregnancy, maternal serum PAPP-A is a strong potential candidate for being used in routine trisomy screening. We have developed a sensitive enzyme immunoassay (ELISA) intended at smaller laboratories due to its long shelf life. Here we show that repeated freezing and thawing, or the addition of iodoacetate (5 mM) did not affect the results, at both high or low concentration of PAPP-A. It is also possible to introduce the serum into the test as a dry sample on blotting paper, easily posted in an envelope. A decrease of 21% was observed after such dry storage for three weeks at room temperature, which can be compensated for by the inclusion of a dried control serum, mailed with the sample(s).

First trimester maternal serum pregnancy-associated plasma protein A and pregnancy-specific beta 1-glycoprotein in fetal trisomies

OBJECTIVE

To examine the potential value of maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) and pregnancy-specific beta 1-glycoprotein (SP1) in the detection of fetal trisomy.

DESIGN

Cross-sectional study.

SETTING

The Harris Birthright Research Centre For Fetal Medicine, King's College Hospital Medical School, London, UK and Division of Maternal-Fetal Medicine, Jefferson Medical College, Philadelphia, USA.

SUBJECTS AND METHODS

Maternal serum PAPP-A and SP1 concentrations were measured at 10 to 13 weeks gestation in samples from 42 pregnancies with fetal trisomy (trisomy 21, n = 29; trisomy 18, n = 9; trisomy 13, n = 4) and in samples from 210 matched controls.

RESULTS

In controls, both maternal serum PAPP-A and SP1 increased significantly with gestation and in trisomic fetuses levels of both hormones were reduced. However, discriminant analysis demonstrated that SP1 did not contribute significantly in the distinction between trisomic and control pregnancies. Although levels of PAPP-A were reduced throughout the gestational range examined (10 to 13 weeks), especially in cases with fetal trisomy 21, the deviation was more pronounced at 10 to 11 weeks than at 12 to 13 weeks gestation. In 45% of pregnancies with fetal trisomy 21 and 70% of pregnancies with trisomies 18 or 13 maternal serum PAPP-A levels at 10 to 11 weeks gestation were below the 5th centile of the normal range.

CONCLUSION

Maternal serum PAPP-A concentration in the first trimester of pregnancy may prove to be useful in the prediction of risk for fetal trisomies.

[Expression of human chorionic gonadotropin, human placental lactogen and pregnancy-specific 1-glycoprotein in malignant trophoblastic neoplasms]

The expression of placental hormones in 91 malignant trophoblastic neoplasms was studied immunohistochemically using a panel of antibodies against hCG, human placental lactogen (hPL) and pregnancy-specific 1-glycoprotein (SP). The results indicated that the expression of hCG in invasive moles was weaker than that in choriocarcinoma, but the expression of hPL and SP1 was stronger than those in choriocarcinoma. The expression of hPL and SP1 in the metastatic tumors of invasive moles was weaker than the expression at in the primary tumors, but the secretory capacity of hCG in metastatic choriocarcinomas was stronger than that in the primary neoplasms. In this study, the qualities of expression of the placental hormones in invasive moles and choriocarcinomas corresponded to the degree of tumor malignancy, the biological behaviour and the grading of trophoblastic cell differentiation. We believe that the detection of hCG, hPL and SP1, in malignant trophoblastic neoplasms was of value for establishing tumor diagnosis and typing and for judgement on prognosis.

Low levels of amniotic fluid pregnancy specific beta-1-glycoprotein in Down's syndrome

Amniotic fluid levels of beta-1-glycoprotein (SP1) were measured in 46 cases of Down's syndrome and compared with levels in 106 pregnancies of normal karyotype from 10 to 23 weeks of gestation. In normal pregnancies, levels rose from 87.5 iu/l at 10 weeks to a peak of 610.0 iu/l at 19 weeks of gestation. In cases of Down's syndrome, levels were reduced prior to 19 weeks of gestation (median multiple of the median, MoM = 0.75, P = 0.02). This effect was most marked prior to 16 weeks of gestation when the median multiple of the median (MoM) was 0.51 (P = 0.006). These data demonstrate that amniotic fluid levels of SP1 are low in Down's syndrome before 19 weeks of gestation.

Risk of fetal Down's syndrome based on maternal age and varying combinations of maternal serum markers

Serum samples from 320 women with chromosomally normal fetuses and from 50 women with fetuses affected by Down's syndrome were assayed retrospectively for human chorionic gonadotropin (hCG), pregnancy-specific beta 1 glycoprotein (SP1), alpha fetoprotein (AFP), and unconjugated estriol (uE3) between 14 and 21 weeks of gestation. Nonparametric discriminant analysis was applied to calculate Down syndrome risks on the basis of various combinations of serum parameters. At a risk threshold that falsely identifies 5% of controls as being affected, 46 to 48% of Down syndrome pregnancies were detected by combinations of hCG/AFP, hCG/AFP/uE3, and hCG/AFP/uE3/SP1 respectively. HCG, AFP, and uE3 were assayed in 652 serum samples from women who underwent amniocentesis because of maternal age (> or equal to 35 years in this prospective study). 49% of women with euploid fetal karyotype, 8 of 10 pregnancies with Down's syndrome, and 3 pregnancies with sex chromosomal anomalies were identified as being at an increased risk (> 1:380).

Prenatal biochemical diagnostics of inborn developmental defects

Screening of pathological pregnancies with the use of biochemical markers determined in maternal serum is now widely accepted as a useful procedure. In our experience, the main contribution is a finding of abnormal values of one or more of the markers, which will advise gynecologist upon a possibility of a risk pregnancy.

Neoplastic and non-neoplastic intermediate trophoblasts: an immunohistochemical and ultrastructural study

Five cases of non-molar trophoblastic disease including one placental site trophoblastic tumor (PSTT), two exaggerated placental sites and two choriocarcinomas were compared with each other and with normal chorionic villi and placental site. This involved light microscopic, immunohistochemical and ultrastructural studies. Comparison of PSTT with choriocarcinoma suggested that the former represented a neoplastic transformation of placental site intermediate trophoblast. The PSTT showed a characteristic immunohistochemical distribution of human placental lactogen and human chorionic gonadotropin, resembling that of the placental site intermediate trophoblast. Placental site trophoblastic tumor cells were also characterized ultrastructurally by prominent perinuclear filaments, abundant rough endoplasmic reticulum, or both. Infiltrating intermediate trophoblasts in exaggerated placental sites were similar to PSTT cells rather than normal placental site intermediate trophoblasts. However cells with vacuolated cytoplasm or spindle-shaped intermediate trophoblastic cells were observed more frequently in the PSTT than the exaggerated placental sites. The intermediate trophoblastic cells in the choriocarcinomas showed a morphologically transitional form from cytotrophoblastic cell to syncytiotrophoblastic cell, but did not share unique ultrastructural similarities with placental site intermediate trophoblasts.

Failure of sheep-goat hybrid conceptuses to develop to term in sheep-goat chimaeras

Six hybrid pregnancies were established: three in sheep-goat chimaeras, one in a sheep-(sheep-goat)hybrid chimaera and two in does. Pregnancies were monitored weekly by ultrasonography and peripheral concentrations of pregnancy specific protein B (PSPB) were measured. Placental development as detected by ultrasonography appeared to be slower in hybrid-in-goat pregnancies than in hybrid-in-chimaera pregnancies, although this difference was not reflected in PSPB concentrations. Time of fetal death could not be predicted from PSPB concentrations. Chimaeras appeared to carry hybrid pregnancies longer than ewes and does usually carry hybrid pregnancies, but none was carried to term.

Serum SP1, HPL levels and urinary estrogen/creatinine ratio in the detection of low birth weight

Serum pregnancy specific beta 1 glycoprotein (SP1), human placental lactogen (HPL) and urinary estrogen/creatinine (E/C) ratio levels were determined to study their clinical significance in predicting low birth weight (LBW) in women with normal pregnancy and patients with LBW. The results showed that the sensitivity of urinary E/C ratio was better than that of serum SP1 and HPL, and was increased gradually with the reduction of fetal weight. The specificity in predicting LBW decreased gradually with the increase of serum SP1 and HPL levels and urinary E/C ratio. When serum SP1 level was less than 50 mg/L, HPL less than 2.0 mg/L, and E/C ratio less than 10, their specificity could increase over 90%. It is suggested that multi-indexes measurement would improve the accuracy for predicting LBW. We conclude that SP1, HPL and E/C ratio measurement could be an useful index for predicting LBW.

Immunophenotyping of mitotic cells from long-term cultures of chorionic villi

Chromosomal mosaicism in chorionic villus samples (CVS) may arise from different sources, such as clonal diversity within the chorionic tissue or contamination with maternal cells. To determine the origin of karyotyped cells, we compared the immunocytochemical features of mitotic cells in CVS long-term cultures with histological sections of their tissue of origin, i.e. chorionic villi. Immunolabelling of intermediate filaments specific for epithelial cells (cytokeratin) and mesenchymal cells (vimentin) established that mitoses yielded from CVS long-term cultures indeed stem from independently growing clones derived from both the epithelial and mesenchymal parts of the chorionic villi. Thus, mosaicism in CVS cultures may reflect true genetic heterogeneity within the biopsy. However, epithelial chorionic cells undergo in vitro metaplasia leading to co-expression of cytokeratins and vimentin. Fetal-specific immune markers (beta-HCG and SP1-glycoprotein) are not reliably expressed in CVS cell culture.

Intermediate cells during cytotrophoblast differentiation in vitro

Differentiation of the human placental trophoblast cell involves a multistep process, with the generation of several distinct types of intermediate cytotrophoblast cells. Using a short term in vitro cell culture system and centrifugal elutriation, we studied the isolation and morphological and biochemical differentiation of these separated intermediate cell populations. Freshly isolated cell fractions, incubated for 24 h, are heterogeneous in their differentiation stages as determined by the secretion of the proteins chorionic gonadotropin alpha and beta, human placental lactogen, and pregnancy specific beta 1-glycoprotein. Maintenance in cell culture allows for the further differentiation of these intermediate cells and for syncytium formation. With the use of sequential trypsinizations, our data also suggest the parallel differentiation of cytotrophoblast cells into two distinct subsets: one which, through differentiation, gets committed to syncytium formation, and the other, which remains mononuclear despite high degrees of biochemical differentiation. These latter cells retain the capacity for syncytium formation when reintroduced into appropriate culture conditions. These findings refine the use of the term "intermediate cell" by previous investigators. We suggest that our in vitro system defines normal intermediate stages of trophoblast differentiation, and also serves as a model to simulate adverse conditions of syncytial degeneration or injury.

[SP1 serum levels in pregnancy with Rh isoimmunization]

The authors examined in 37 pregnant women hospitalized on account of Rh incompatibility during the second and third trimester 71 serum specimens for levels of trophoblast specific beta 1-glycoprotein (SP1), using the method of simple radial immunodiffusion. In the group of 16 women with Rh incompatibility whose pregnancy terminated by delivery of a normal neonate, in 22% the SP1 levels were higher than 1.5 x the median value for the given gestation week (MoM). In 17 pregnancies where the foetus suffered from haemolytic disease the SP1 levels were higher than 1.5 MoM in 45% of the examined foetuses. Markedly elevated SP1 levels of 2.3 and 2.4 MoM were recorded in two pregnancies with hydrops of the foetus.

Pregnancy specific beta 1-glycoprotein in human intestine

Pregnancy-specific beta 1-glycoprotein (PSG) transcripts have been identified in a number of placental and non-placental tissues. Using a placental PSG cDNA probe to screen a normal human intestinal cDNA library we have isolated 22 hybridizing clones. These clones could be divided into four groups. Nucleotide sequence analysis showed that one group of clones correspond to functional and another group correspond to non-functional PSG cDNAs. The other two groups are homologous to the nonspecific cross-reacting antigen (NCA) and biliary glycoprotein (BGP), both of which are members of the carcinoembryonic antigen (CEA) family. Thus, PSG, NCA and BGP are co-expressed in normal human intestine. RNA and immunoblot analysis, along with polymerase chain reaction amplification further confirm the expression of PSG in human intestinal tissue.

Pregnancy-associated plasma protein B (PAPP-B): isolation from human late pregnancy serum and biochemical characterization

The pregnancy associated plasma protein B (PAPP-B) was first described by Lin et al. as a glycoprotein with a molecular weight of about 1,000 kD and a serum half life of less than 24 hours after delivery. We isolated PAPP-B from late pregnancy serum using liquid chromatography including HPLC. PAPP-B was found to be a glycoprotein with a molecular weight of 1,300 kD and to be an octadecamer of identical subunits (74 kD each). Cleavage of the carbohydrates with trifluoromethanesulfonic acid reduced the molecular mass to 65 kD (by SDS PAGE, 12.2%). Isoelectrofocusing and titration curves fixed the isoelectric point at 5.3. Spectroscopy measurements between 230 and 360 nm yielded a trp/tyr ratio of 1.1. Amino acid analysis showed that each subunit contained five methionines; this was confirmed by a CNBr cleavage experiment.

Ultrastructural localization of pregnancy-specific beta 1-glycoprotein (SP1) and cathepsin B in villi of early placenta of the macaque

Pregnancy-specific beta 1-glycoprotein (SP1) is found in maternal serum very early in gestation in both human and non-human primates. As judged by light microscopic immunocytochemistry, the major source of SP1 is the syncytial trophoblast, but little is known of the subcellular localization of SP1 indicative of the cellular pathway involved in secretion of the hormone. To study subcellular distribution of SP1, we used electron microscopic immunocytochemistry carried out on macaque placental villi from early (3-4 weeks) gestation. Both light and electron microscopic results confirmed localization confined to syncytial trophoblast in the villi. Within syncytial trophoblast labeling was predominantly over small granules in the apical cytoplasm. The Golgi complex also showed labeling, and light labeling was associated with the endoplasmic reticulum. For comparison, we also localized cathepsin B, a lysosomal protease. By way of contrast this enzyme was localized primarily in large cytoplasmic granules. The results are consistent with a secretory pathway including synthesis in the ER, processing by the Golgi complex, and exocytotic release into maternal blood in the intervillous space.

Pregnancy-specific beta 1-glycoprotein (SP1) and its relation to fetal birth weight at term pregnancy

The relation between serum levels of pregnancy-specific beta 1-glycoprotein (SP1) and actual fetal and placental weights was studied in 100 full-term pregnant women. This was compared with fetal weight determination by ultrasound. SP1 levels significantly correlated with fetal and placental weights. Its determination was found to be comparable to ultrasonography in placental fetal weight assessment, especially at the extremes of fetal weight (macrosomia and small for gestational age) where special obstetric management is warranted.