[Diagnosis and monitoring of endangered early pregnancies with determination of oestrone, oestradiol 17beta, oestriol, progesterone and HPL in plasma and the pregnancy test in graduated dilutions of urine (author's transl)]

Abstract

Unconjugated oestrone (Oe1), oestradiol-17beta (Oe2), oestriol (Oe3), progesterone (P) and HPL in plasma were determined by radioimmunoassay and the immunological pregnancy-test in urine was carried out in 70 patients with normal pregnancy or imminent abortion from 4th-20th week of gestation. Oe2 and HPL showed the most pronounced rises, Oe3 increased especially after the first trimester. In cases with abortion symptoms and poor prognosis Oe2 and HPL gave the most reliable results concerning the endocrin function of early normal pregnancy. Oe1- and P-values in normal pregnancy did not differ so clearly from concentrations observed during normal menstrual cycles and were thus of less value. The pregnancy-test was positive (greater than 1000 IU/1) even in most cases of dead pregnancy and therefore not reliable. With increasing production of oestrogen precursors in the fetal adrenal cortex after the first trimester determination of Oe3 becomes more important. In cases with abortion symptoms in early pregnancy and subsequent normal development, plasma Oe2- and Oe3- values represented best criteria for a prognosis. -- For the diagnosis and control of the endangered early pregnancy we recommend, as a consequence of this study, determination of Oe2 up to the 13th week of pregnancy and thereafter Oe3 in maternal plasma.

PIP: For 70 patients with normal or threatened pregnancies in the 4th-20th weeks, radioummunoassay tests for free estrone (E1), estradiol-17beta (E2), estriol (E3), progesterone (P), and HPL in plasma were carried out and the immunological human chorionic gonadotropin pregnancy test in urine was performed. E2 increases specifically at the beginning of the second trimester. In cases of threatened abortion symptoms with unfavorable prognosis, E2 and HPL were found to be the most reliable indicators of intact pregnancies. E1 and P values were not as valuable, since even in normal pregnancies they do not deviate significantly from maximal menstrual values. The urine pregnancy test did not prove to be reliable; in cases of proved fetal death it often remained positive for several days (greater than 1000 IU/1). With increasing production of estrogen precursors int he fetal adrenal cortex after the first trimester, determination of E3 becomes more significant for diagnosis. In cases with abortion symptoms in early pregnancy and subsequent normal development, plasma E2 and E3 values represented the best criteria for prognosis. In conclusion, determination of E2 to the 12th week of pregnancy, and thereafter radioummunoassay determination of E3 in maternal plasma is recommended for diagnosing and supervising imminent abortion in early pregnancy. Serial examinations would seem to be more informative than individual values.