Urinary estriol as an index of placental function

Greene, John W.; Touchstone, Joseph C.

doi:10.1016/s0002-9378(16)35333-9

Cited by 169 publications

(23 citation statements)

References 14 publications

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“…There is an obvious need to reevaluate these parameters and to determine a proper harmonic mean thickness for both the intervillous and capillary blood plasma (8hp) and the villous membrane (i:hp). In addition, there are structural alterations in placental composition, in such conditions as maternal diabetes, toxemia and fetal dysmaturity [9,10], diseases known to be associated with altered placental transfer [64,65] and hormone secretion [4,6], which are grossly underestimated unless the extent of syncytial and capillary damage is quantitated by ultrastructural examination [66][67][68].…”

Section: Discussionmentioning

confidence: 99%

“…There is a need for quantitative data on the structural composition of the human placenta in order to establish correlates with the composition of fetal organs in nonsurvivors of pathological pregnancies [I], with the geneticenvironmental and pathological factors which determine both organ and placental composition [2,3] and with the results of serial placental hormone and enzyme assays in maternal serum, thought to represent different aspects of placental function in vivo [4][5][6].…”

Section: A G a / D R Is C O Il / M U N R Omentioning

confidence: 99%

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Quantitative Studies of Human Placenta I.

Laga¹,

Driscoll²,

Munro³

1973

Neonatology

105

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Eighteen term placentas from a middle-class North American urban population were examined by stereologic techniques and an image quantizer. The trimmed placental weight averaged 469 g, of which 339 g was Ê»functional parenchyma’ and 130 g Ê»nonparenchymal tissue’ (decidual and chorionic plates and large vessels and pathological components such as infarcts). Microscopically, the parenchyma was divided into villi and intervillous space. The volume of intervillous space was, at 110 cm³, significantly larger than that of the villous capillaries, which measured 30 cm³. The mass of the chorionic villi averaged 214 g and comprised 168 g of peripheral and 46 g of stem villi. Most of the 60 g of trophoblast and of the 31.5 g of fibroblasts, and a significant fraction of the 91 g of collagenous stroma were present in the peripheral villi. The longest diameter of the peripheral villi averaged 74 µm and their cross-sectional area 1,100 µm². The surface area of the peripheral villi was 16 m² and that of the corresponding xillous capillaries 12 m². A model for estimating placental oxygen diffusion capacity (Dpo₂) was constructed on the basis of these stereologic measurements. The resistance to oxygen diffusion from maternal to fetal red cells in the placenta was attributed to five serial compartments i.e. (1) the oxygen-hemoglobin interactions in the maternal red cells in the intervillous space; (2) the maternal blood plasma in the intervillous space; (3) the villous membrane comprising syncytiotrophoblast, basement membrane, connective tissue and fetal capillary wall; (4) the fetal blood plasma, in the villous capillaries and (5) the oxygen-hemoglobin interactions in the fetal red cells present in the villous capillaries. The diffusion capacity of the placental membrane (D_M), comprising (2–4), was 3.256 and that of the total placenta 3.086 ml oxygen min^––¹ · mm Hg^––1. The corresponding specific diffusion capacities per 100 g of placenta were 0.694 for the placental membrane (D_M/w) and 0.658 ml. min^––1 · mm Hg^––1 for the whole placenta (D_P/_w). The resistance of the villous membrane was consequently the limiting factor in oxygen diffusion, both when considering the 110-ml maternal and 30-ml fetal blood volumes as the effective exchangers or when considering a single capillary transit for oxygen with 10 ml in each of the maternal and fetal compartments.

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Section: Discussionmentioning

confidence: 99%

Section: A G a / D R Is C O Il / M U N R Omentioning

confidence: 99%

Quantitative Studies of Human Placenta I.

Laga¹,

Driscoll²,

Munro³

1973

Neonatology

105

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“…The daily estrogen excretion during the last half of pregnancy (the m ajor fraction being estriol) is a good index of the well-being of the feto-placental unit [2,6,18,34]. A sharp increase in the daily excretion of estrogens throughout pregnancy occurs [2,11,19] especially from the 18th week until term.…”

mentioning

confidence: 99%

Effects of Labor on Plasma Dehydroepiandrosterone Sulfate and Cortisol

Lefèbvre¹,

Chapdelaine²,

Bolté³

1970

Gynecol Obstet Invest

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Maternal and cord plasma dehydroepiandrosterone sulfate (DHAS) and cortisol were measured before cesarean section, during syntocinon induced labor, and at delivery after spontaneous or induced labor. The mean maternal plasma DHAS was significantly lower in cesarean sections than in spontaneous labor, and raised significantly by induction of labor. The cord plasma DHAS was not significantly different in cesarean, spontaneous or induced labor. In cesarean section, the cord plasma DHAS was higher than maternal DHAS, but they were not different during spontaneous or induced labor. Maternal plasma cortisol increases significantly during spontaneous or induced labor. During prelabor, the increase in maternal DHAS without a change in plasma cortisol suggest, at least, a change in the metabolism of maternal DHAS. During labor, the increase in plasma concentrations of both compounds indicates a change in the metabolism of cortisol and DHAS.

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“…Perinatal mortality rises up to 45% äs growth retardation is increased [10,26,63,69]. Depending on the duration of pregnancy some define a danger zone of 5-12 mg estriol/ 24 hrs [l, 26,32,38,48,63,88] or a value less than 25% of the mean [47]. All agree that repeated tests must be made, since single values are of little value.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound and biochemical findings in intrauterine growth retardation

Kunz¹,

Keller²

1976

Journal of Perinatal Medicine

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The early recognition of fetal maldevelopment due to chronic placental insufficiency is of decisive importance if perinatal mortality and morbidity are to be further reduced. This can be achieved by direct and indirect methods, i.e. cephalometry and thoracometry using ultrasound on the one hand, and biochemical tests of the function of the fetoplacental unit, on the other. Estriol, pregnandiol and HPL levels and some placental enzymes are here of special interest. In this investigation an attempt was made to asses the diagnostic value of the various parameters and to suggest when they should be used. Jürg KUNZ, born 1942, Zürich, Studied medicine at University of Zürich, 1962-69 Curriculum vitae l Material and methodA total of 83 patients presently, or with a case history of risk hospitalised because of suspect placental insufficiency, was investigated. Twin pregnancies and those with doubtful duration were excluded. In the third trimester of pregnancy the following determinations were made: An average of 4 determinations of the biparietal head diameter using the B-scan method (Vidoson), 10 determinations of estriol and 3 of pregnandiol in urine [13,50] and 6 HPL determinations in the semm [49], 7 determinations of heat stable alkaline phosphatase (HSAP) [9], all per individual case. Biparietal head diameter values were transferred to a Standard curve that was in agreement with the one reported by HOLLÄNDER [42]. Growth retardation was assumed if the last two values showed the same trend with the date being certain and were below two Standard deviations or showed decreased progress. Biochemical parameters were considered to be pathological if they were below 95% of the normal values, with two values being outside this normal ränge or with 3 or more values being continuously below the 95% normal ränge. Maturity was assessed after birth from neurological and somatic signs of maturity according to D u BÖ-WITZ [25]. Infants were diagnosed äs small for date if their birth weight was below the lOth percentile on the LUBCHENKO curve [62]. ResultsFifteen of the 83 newborn were small for dates. Five had a gestational age of less than 37 weeks, 4 in the 35/36 week and one in the 30.5 week. A further 11 prematures was in the group of 68 normotrophic children. However, only 3 out of the 15 small for date infants were below the lower limit of the norm. The remaining 81 (98%) were within nonnal limits, 71 % below the curve for mean values. In twelve SGA infants the head diameter was normal prenatally and increased normally. Fig. 2 shows a very good correlation between weight percentile and the percentage deviation from the normal mean of estriol excretion. In all SGA cases values were found to be decreased. Ten were outside the 95% normal limits and 5 were still at least 40% below those limits. In infants with body weights between the lOth and 50 th percentile estriol values were below, the normal mean in 44%.Weight percentiles and HPL concentration in maternal serum ( Fig. 3) also correlated well. In 8 out of 15 SGA inf...

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Urinary estriol as an index of placental function

Cited by 169 publications

References 14 publications

Quantitative Studies of Human Placenta I.

Quantitative Studies of Human Placenta I.

Effects of Labor on Plasma Dehydroepiandrosterone Sulfate and Cortisol

Ultrasound and biochemical findings in intrauterine growth retardation

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