Plasma estriol levels in normal and abnormal pregnancies: An index of fetal welfare

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      Serial plasma estriol determinations were conducted in the third trimester of human pregnancy on 22 normal, 25 diabetic, and 16 toxemic patients. In addition, 10 cases of suspected fetal death were evaluated. In normal pregnancy the levels rise in a generally regular fashion as pregnancy proceeds, increasing about fivefold in the last trimester. However, the individual curves vary considerably. The average plasma estriol level at term is about 27 μg per 100 ml. with a range between 10 and 55. The plasma estriol levels of the diabetic patients (Classes A, B, and C) in good control, were not statistically different from those of the normal patients. The toxemic patients could be classified into three groups according to their estriol levels. Those with severe symptoms and small fetuses had correspondingly low levels. The patients under good control had normal values while three patients with renal involvement superimposed on toxemia had surprisingly high levels. The values for patients with dead fetuses were extremely low. Although a larger number of cases involving fetal jeopardy must be studied before the contribution of plasma estriol determinations toward the improvement of fetal salvage rates can be assessed, the potential advantages of plasma assays over urine assays in this regard are discussed.
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