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Unconjugated Estradiol, Estriol and Total Estriol in Maternal Peripheral

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Unconjugated Estradiol, Estriol and Total Estriol in Maternal Peripheral Endocrinol. Japon. 1983, 30 (2), 155-162 Unconjugated Estradiol, Estriol and Total Estriol in Maternal Peripheral Vein, Cord Vein, and Cord Artery Serum at Delivery in Pregnancies with Intrauterine Growth Retardation. CHIKAYUKI, TAYAMA, SHUNZO ICHIMARU, MASAHARU ITO, MICHIO NAKAYANA, MASAO MAEYAMA AND ISAO MIYAKAWA Department of Obstetrics and Gynecology, Kumamoto University Medical School, Kumamoto 860 and *Department of Obstetricts and Gynecology, Miyazaki Medical College, Miyazaki Abstract The levels of unconjugated estradiol(E2), estriol (E3) and total (conjugated plus unconjugated) E3 in maternal vein serum during labor, cord vein serum, and cord artery serum were measured in normal singleton and twin pregnanceis with appropriate for dates babies (AFD) and with light for dates babies (LFD). The mean level of total E3 in the maternal vein serum in singleton pregnancy was significantlylower in the LFD group than in the AFD group, but no differenceswere seen in the mean levels of unconjugated E2 or E3 between the groups. The concentration of uncon- jugated E2 in the maternal vein serum was significantlyhigher in the twin group with a large placenta than in the singleton group with a small placenta, while the concentration of total E3 in the case of twin pregnancy with LFD was lower than that in singleton pregnancy with AFD but not significantly. No difference in the concentration of total E3 was observed between the cord vein serum and cord artery serum. The present data suggest that the total E3 level in maternal vein serum may be used in evaluating fetal states such as intrauterinegrowth retardation. In pregnancy complicated by intrauterine conjugated E2 and E3 into the maternal and growth retardationwith or without symptoms fetal circulation and to determine the total of maternal disease,such as toxemia of pre- (conjugated plus unconjugated) E3 in the gnancy or hypertension,not only the urinary maternal and fetal blood. As far aware, no E3 excretion (Aubry et al.,1970; Bell et al., comparative study on pregnancy with in- 1967; Greene et al.,1969) but also the levels trauterine growth retardation between sin- of serum unconjugated E3 (Gorwill and gletons and twins has yet been reported. Sarda, 1977) or total E3 (Klopper et al., 1975) are lower than normal. These obser- Materials and Methods vations indicatethat maternal E3 levels may be used to monitor such high-riskpregnan- Clinicalsubjects. cies,although the issue stillremains con- The patients under study comprised 11 singleton troversial. and 3 twin pregnancies who at clinicalexamination The purpose of the present study was to were thought probably to have fetuses with intra- uterinegrowth retardation. This was confirmed post investigatethe placental secretion of un- partum, when at delivery the neonates were on the weight/gestationalage curve of Gruenwald (Gruen- Received November 4, 1982. wald, 1966) at or lower than the tenth percentile, Endocrinol. Japon. 156 TAYAMA et al. April 1983 i.e. light for dates babies (LFD). Labor occurred fuged. The serum was stored at -20℃ until assay. at or after 37 weeks of gestation. All the patients revealed neither toxemias of pregnancy nor any Radioimmunoassay of serum estrogens. other definable medical complication. As a control Serum unconjugated E2 was determined in dupli- group, 11 normal singleton and 8 twin pregnancies cate using an Estradiol RIA kit (tracer: 3H) obtained without definable medical complications were selected. from Commissariat a l'Energie Atomique, Gif-sur- Each patient delivered appropriate for dates babies Yvette, France. Serum unconjugated E3 and total (AFD) at or after 37 weeks of gestation. E3 were determined in duplicate using an Oestriol Maternal peripheral vein blood samples were (unconjugated) RIA kit and an Oestriol RIA kit obtained during labor. Cord artery and vein samples obtained from the Radiochemical Centre, Amersham, were collected from an isolated segment of the cord Buckinghamshire, England (Miyakawa et al., 1978; immediately after fetal delivery. The blood was Ichimaru et al., 1980). allowed to clot at room temperature, and then centri- Table 1. Clinical data for patients with AFD and LFD in 22 cases of singleton pregnancy. *: n .s.; **: P<0.005. Fig. 1. Concentrations of unconjugated estradiol in the maternal peripheral vein, cord vein, and cord artery serum at delivery in normal pregnancies with AFD and LFD. MV: Maternal vein, CV: cord vein, CA: cord artery. Open columns: AFD, hatched columns: LFD. Figures in parentheses indicate the numbers of cases. Vertical lines with bars indicate mean ±SEM. Vol.30, No.2 SERUM ESTROGEN IN PREGNANCY WITH IUGR 157 Table 2. Clinical data for patients with AFD and LFD in 11 cases of twin pregnancy. †: Apgar score at 3min., ††: Total weight, *: n.s., **: P<0.005. AFD and LFD at birth were 63.9±7.2 and 57.6±6.0nmol/l(mean±SEM), respectively. Result The values for the cord artery serum were 25.3±4.2 and 24.2±4.7nmol/l(mean±SEM), Clinical data for the patients are given respectively, and were significantly lower in Tables 1 and 2. I. Singleton pregnancy. than those in the cord vein (P<0.005 and P<0.005, respectively). However, no sig- Unconjugated E2 concentrations in maternal nificant differences were seen in the cord peripheral vein serum during labor and in vein and artery among the groups. cord vein and artery serum of the infant at birth (Fig. 1). Unconjugated E3 concentrations in maternal The 11 women with AFD had serum un- peripheral vein serum during labor and in conjugated E2 concentrations ranging from cord vein and artery serum of the infant at 33.4 to 114.2nmol/l (mean±standard error birth (Fig. 2). of the mean (SEM)=74.9±6.6nmol/l). The The serum unconjugated E3 concentra- serum unconjugated E2 concentrations in 9 tions in the 11 women with AFD during women with LFD ranged from 30.5 to 98.0 labor ranged from 35.0 to 100.6nmol/l nmol/l (mean±SEM=72.7±7.6nmol/l). (mean±SEM=51.7±7.2nmol/l), and the There was no significant difference between values in the 11 women with LFD ranged the two groups. The unconjugated E2 con- from 1.25 to 104.0nmol/l (mean±SEM= centrations in the cord vein serum of the 47.4±7.5nmol/l). There was no significant Endocrinol. Japon. 158 TAYAMA et al. April 1983 Fig. 3. Concentrations of total (conjugated plus Fig. 2. Concentrations of unconjugated estriol in unconjugated) estriol in the maternal peripheral the maternal peripheral vein, cord vein, and cord vein, cordvein, and cord artery serum at delivery artery serum at delivery in normal pregnancies in normal pregnancies with AFD and LFD. with AFD and LFD. MV: Maternal vein, CV: cord vein, CA: cord MV: Maternal vein, CV: cord vein, CA: cord artery. Open columns: AFD, hatched columns: artery. Open columns: AFD, Hatched columns: LFD. Figures in parentheses indicate the num- LFD. Figures in parentheses indicate the numbers bers of cases. Vertical lines with bars indicate of cases. Vertical lines with bars indicate mean mean±SEM. *: P<0.005. ±SEM. difference between the groups. The un- the values in the cord artery were 7574.2± conjugated E3 concentrations in the cord 718.6nmol/l and 6300.6±602.8nmol/l (mean vein serum of the AFD and LFD at birth ±SEM), respectively. No significant differ- were 651.5±72.4nmol/l and 571.8±67.7 ences were in the cord vein and artery nmol/l (mean±SEM), respectively. The val- among the groups. It is interesting also that ues in the cord artery serum were 327.0± no significant difference in total E3 values 34.8nmol/l and 290.6±37.3nmol/l (mean± was found between the cord vein and artery SEM), respectively, and significantly lower serum. I1. Twin pregnancy. than those in the cord vein (P<0.005 and P<0.005, respectively). However, no sig- nificant differences were seen in the cord and artery among the groups. Total (conjugated plus unconjugated) E3 con- centrations in maternal peripheral vien serum during labor and in cord vein and artery serum of the infant at birth (Fig. 3). The 11 women with AFD had serum total E3 concentrations ranging from 527.0 to 1338.4nmol/l (mean±SEM=813.1±67.0 nmol/l). The serum E3 concentrations in the 11 waman with LFD ranged from 216.7 to 669.2nmol/l (mean±SEM=406.0±41.3 Fig. 4. Concentrations of unconjugated estradiol in the maternal peripheral vein, cord vein, and cord nmol/l), and were significatly lower those artery serum at delivery in normal twin preg- found in the maternal serum with AFD (P< nancies with AFD and LFD. 0.005). The total E3 concentrations in the MV: Maternal vein, CV: cord vein, CA: cord cord vein serum of the AFD and LFD at artery. Open columns: AFD, hatched columns: LFD. Figures in parentheses indicate the numbers birth were 7245.1±642.1nmol/l and 6158.5± of cases. Vertical lines with bars indicate mean 535.1nmol/l (mean±SEM), respectively, and ±SEM. 159 Vol.30, No.2 SERUM ESTROGEN IN PREGNANCY WITH IUGR Unconjugated E2 concentrations in maternal peripheral vien serum during labor and in cord vein and artery serum of the infants at birth (Fig. 4). The weights of the placentae in the twin pregnancies with LFD (896.7±27.2g) were significatly larger than those in the singleton pregnancies with AFD (609.1±15.3g) (P <0.005). The unconjugated E2 concen- trations in 6 women with twin AFD and in the 3 women with LFD were 114.2±4.7 nmol/l and 117.5±7.4nmol/l (mean±SEM), Fig. 5. Concentrations of unconjugated estriol in the maternal peripheral vein, cord vein, and cord respectively, and were significatly higher artery serum at delivery in normal twin preg- than those found in singleton pregnancy nanceis with AFD and LFD.
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