Hormonal changes in pathological pregnancy

Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study

The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regression analyses were conducted to determine the frequency of dry eye disease, its clinical subtypes and associated factors. The prevalence of dry eye disease among the cohort of pregnant women was 82/201 (40.8% 95% confidence interval 34.3%-47.3%). Among the 82 pregnant women with dry eye disease, the frequencies of the clinical subtypes of dry eye were: evaporative dry eye [15/82(18.3%; 95% CI, 12.2%–25.2%)], aqueous deficient dry eye [10/82(12.2.%; 95% CI, 7.3%–18.3)], mixed dry eye [6/82(7.3%; 95% CI, 3.7%–11.0%)], and unclassified dry eye [51/82(62.2%; 95% CI, 52.4%–72.0%)]. Binary logistic regression analysis showed that the following factors were not significantly associated with dry eye: age, BMI, lipid profile, prolactin level, testosterone level, ocular protection index and blink rate. Only gestational age was significantly associated with dry eye disease in pregnancy. In conclusion, the current study showed that dry eye disease occurs frequently in pregnant women ranging from the first to the third trimester and it is associated with increasing gestational age. The evaporative dry eye was more common compared to the aqueous deficient dry eye, but most dry eye could not be classified.

Abnormal steroid excretion in gestational trophoblastic disease complicated by ovarian theca-lutein cysts

Serum and urine steroids were examined in two subjects with trophoblastic disease accompanied by large ovarian theca-lutein cysts and compared with those from 10 patients with trophoblastic disease but without palpable cysts. In the patients without cysts normal values were obtained for serum oestradiol, progesterone, 17 alpha-hydroxyprogesterone and androstenedione, and for urinary total oestrogens, pregnanediol, pregnanetriol, and 17-oxosteroids. Nineteen urinary steroid metabolites, quantified by capillary gas-liquid chromatography, were either within reference limits or marginally raised. In several cases relatively minor increases in serum testosterone and cortisol and urinary free cortisol were observed. In contrast, the subjects with cysts showed pronounced excesses of androgen metabolites, 17 alpha-hydroxypregnenolone, pregnanediol, and pregnanetriol, and both exhibited a similar pattern of unusual additional metabolites. The profiles superficially resembled those seen in 21-hydroxylase deficiency adrenogenital syndrome, but there were important discrepancies reflecting known differences in ovarian and adrenal steroid metabolism. Chemotherapy led to decline of human chorionic gonadotrophin concentrations, regression of the cysts, and return to normal of the steroid profile. Excess steroids in the patients with cysts may have originated in the ovary rather than in the trophoblastic tissue.

15alpha-Hydroxyoestriol and other polar oestrogens in pregnancy monitoring

Although oestriol measurements are well established for the assessment of 'at risk' pregnancies, there are a number of other oestrogens, excreted during pregnancy, which contain additional hydroxyl groups and might be more sensitive indicators of the condition of mother or fetus. Some of these result from the action of hydroxylases possibly present only in the fetus and others from maternal hydroxylations. We review the evidence for the biosynthesis of these polar oestrogens, summarise methods of measurement, and compare values obtained in normal and pathological pregnancies. There is as yet insufficient evidence to enable their potential value to be confirmed.

The estimation of fetal weight by computer-assisted analysis

The need for a quick and easy method for estimating fetal weight in utero has been clearly established. Estimates by abdominal palpation and fetal hormone production have proved to be of limited value. Eight-five patients, ranging from 17 to 41 weeks' gestation, were ultrasonically scanned within 48 hours of delivery. Statistical analysis and multiple multivariant linear regressions were performed employing the BMD statistical packages. Our results show that birth weight is a logarithmic function of fetal body parameters and that the abdominal circumference has the single best correlation with the log10 birth weight. Our best linear regression with the use of two fetal dimensions (abdominal circumference and biparietal diameter) had a standard deviation of 106 grams per kilogram fetal weight. Since this derived formula is very cumbersome to manipulate, tables have been prepared with computer assistance to read the estimated fetal weight directly. Prospective estimates in 32 cases of both normal and pathologic gestations have proved to be within our expected accuracy.

Plasma concentrations of unconjugated estrone, estradiol-17beta and estriol, and HCS throughout pregnancy in diabetics and gestational diabetics

Plasma unconjugated estrone (E1), estradiol-17beta (E2) and estriol (E3), and HCS were measured in the same plasma samples collected throughout pregnancy in 19 gestational diabetics (GD) and 21 diabetics (D). When compared to the results obtained in 22 normal subjects, plasma levels of E1 and E2 were significantly elevated in D in the second half of gestation. The results were intermediate although closer to the normals, in GD. E3 values were not different from the normals in both D and GD. HCS values were lower than normal in early pregnancy in both D and GD. In late pregnancy HCS levels were not different from normal in either D or GD, although some individual values were much above the upper limit in some diabetic patients. The hormonal ratios in D and GD parallel those in normals, although E3/E2 and HCS/E2 were lower in D. These results are discussed with respect to the different behaviour of E2 and E3, taking into account the difference in their respective biosynthetic pathways. Besides a possible quantitative modification of the placental function in D, the results could tentatively be explained by a qualitative change in the fetal estrogen precursors to placental aromatization, in favour of the 16 non-hydroxylated compound. However, maternal modifications in precursor production or in estrogen metabolism can be an alternative hypothesis. Finally, the present work does not support the hypothetical estrogen deficiency in diabetic pregnancy. Estrogen treatment appears to have no objective justification.

Rapid determination of urine estriol by an on-column derivatization procedure

Estriol in pregnancy urine is determined by acid hydrolysis of steroid conjugates, followed by ether and aqueous sodium hydroxide extraction and gas chromatography. Derivatives are formed within the injection port of the gas chromatograph using tetramethylammonium hydroxide. Several samples may be processed simultaneously. Hydrolysis and extraction of a specimen are done in a single culture tube; for larger numbers of specimens, a Paton-Brown extractor may be used. With a two-column gas chromatograph, results on two specimens are available within one hour; twelve analyses may be completed within two hours.