Measurement of serum estrogen and estrogen metabolites in pre- and postmenopausal women with osteoarthritis using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry

Although 17β-estradiol (E2) deficiency has been linked to the development of osteoarthritis (OA) in middle-aged women, there are few studies relating other estrogens and estrogen metabolites (EMs) to this condition. We developed a high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC-ESI-MS/MS) method to measure the levels of six EMs (i.e., estrone, E2, estriol, 2-hydroxyestrone, 2-hydroxyestradiol, and 16a-hydroxyestrone) in healthy pre- and postmenopausal women and women with OA. This method had a precision ranging from 1.1 to 3.1% and a detection limit ranging from 10 to 15 pg. Compared to healthy women, serum-free E2 was lower in the luteal and postmenopausal phases in women with OA, and total serum E2 was lower in postmenopausal women with OA. Moreover, compared to healthy women, total serum 2-hydroxyestradiol was higher in postmenopausal women with OA and total serum 2-hydroxyestrone was lower in both the luteal and follicular phases in women with OA. In conclusion, our HPLC-ESI-MS/MS method allowed the measurement of multiple biochemical targets in a single assay, and, given its increased cost-effectiveness, simplicity, and speed relative to previous methods, this method is suitable for clinical studies.

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

Performance Characteristics of the UniCel DxI 800 Immunoassay for the Maternal Serum Quadruple Test, Including Median Values for Each Week of Gestation, in Korean Women / 대한진단검사의학회지

BACKGROUND: Maternal serum prenatal quadruple screening includes testing for alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and dimeric inhibin A (DIA). We evaluated quadruple screening using an automated platform and looked for any ethnic differences in the median values of each marker. METHODS: We measured the concentrations of each quadruple test analyte using the UniCel DxI 800 system (Beckman Coulter, USA) in 788 Korean mid-trimester maternal serum samples and calculated their median values using Benetech software (Benetech, Canada). We also compared the results with those obtained using the Immulite 2000 assay (Siemens Healthcare Diagnostics, USA) or ELISA (DSL, USA) in 442 samples. RESULTS: We obtained mid-trimester median values for each marker. The following are the comparative results for each test using the Immulite 2000 assay or ELISA (x) and the UniCel DxI 800 immunoassay (y): AFP, y=1.10x+0.01, r=0.925; uE3, y=0.28x+0.24, r=0.885; hCG, y=1.22x-3047.8, r=0.944; and DIA, y=0.86x+15.31, r=0.833. Assay results for each of the four markers showed good correlations. However, significant biases necessitated new median calculations of prenatal risk estimates in all four tests. CONCLUSIONS: We established gestational age-specific second-trimester median values for four markers in Korean samples using the UniCel DxI 800 immunoassay system. Despite significant bias, there were good correlations between the results obtained using the UniCel DxI 800 immunoassay and those obtained using the Immulite 2000 assay.

Maternal serum biochemical markers as a predictor for adverse pregnancy outcome

To establish reference values of assaying some maternal serum biochemical markers, namely; MSAFP. MSHCG, uE3 and PAPP-A: at 10-20 weeks gestation; among healthy pregnant women and observe the relationship of such markers to predict adverse pregnancy outcome. This is a prospective randomized controlled study conducted in the Obstetrics and Gynecology Departments at AL-Azhar and Cairo University Hospitals during a period of two and half years starting January 2003. Three hundreds healthy pregnant women from those attending the antenatal clinics were participated in this study. Their age ranged between 20-38 years. They all had a spontaneous pregnancy in singleton with gestational age of 10-20 weeks gestation at the time of study. This was confirmed by ultrasonic scanning. Pregnancy outcomes were obtained for all women. The incidence of adverse pregnancy outcome namely: miscarnage, preterm delivery, intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD]. pregnancy induced hypertension [PIH] and congenital malformation were evaluated. Blood samples were withdrawn and sera were separated for estimation of levels of maternal serum alpha fetoprotein [MSAFP], unconjugated estriol [uE3], free 3-human chorionic gonadotropin [beta-hCG] and pregnancy associated plasma protein-A [PAPP-A]; using time resolved flouroi mmunoassay technique. Our study showed, unexplained significant elevations of MSAFP and serum 3hCG levels with adverse pregnancy outcome [miscarriage, preterm delivery, IUGR, IUFD]. Low unconjugated estriol levels, was associated with adverse pregnancy outcome except for preterm delivery. Maternal serum levels of PAPP-A were found to be significantly decreased in all adverse pregnancy outcome except in PIH. Combinations of maternal serum markers for prediction of adverse pregnancy outcome were compared. Increased maternal serum AFP and 3hCG were significant only for miscarriage and preterm delivery, whereas increased MSAFP and decreased uE, was significant for all adverse pregnancy outcome except for preterm delivery. Increased levels of MSAFP and decreased levels of PAPP-A was only significant with PIH. Whereas increased levels of beta hCG with decreased uE3 levels was significant for all adverse pregnancy outcome except for preterm delivery and PIH. The combination of increased beta hCG levels and PAPP-A were not significant correlated to adverse pregnancy outcomes. combined maternal serum four markers can be used not only for the detection of fetal structural and chromosomal anomalies but also for early prediction and detection of high risk pregnancies

The prediction of adverse pregnancy outcome using low unconjugated estriol in the second trimester of pregnancy without risk of Down's syndrome

To investigate the relationship between low unconjugated estriol (uE3) levels in the second trimester and adverse perinatal outcomes in pregnancies without increased risk for Down's syndrome, 1,096 women under 35 years of age underwent a mid-trimester AFP-hCG-uE3 screening test between January 1995 and June 1998. Multiple pregnancies, maternal diabetes, smoking and elevation of AFP and hCG levels more than 2.0 multiple of median (MoM) were excluded from our study population. The results were divided into a low-uE3 group with uE3 levels at or below 0.75 MoM and a normal uE3 group with uE3 levels above 0.75 MoM. The risk for adverse pregnancy outcome was compared between the two groups and the role of low uE3 as a predictor of adverse pregnancy outcome was determined. The data were assessed using chi 2 or Fisher exact test and then logistic regression was used for the final analysis. The odds ratio (OR) and corresponding 95% confidence intervals (CI) were also calculated. Unconjugated E3 levels at or below 0.75 MoM was significantly associated with fetal growth restriction after adjustment for maternal age, weight, sampling weeks, AFP and hCG levels (OR 0.413, 95% CI 0.174-0.900; P = 0.035). Low uE3 levels in the second-trimester could help in the detection of fetal growth restriction by a low risk group in Down's syndrome. Careful gestational dating and serial clinical and sonographic assessment of fetal growth may be required for the clinician to manage these parturients.

Serum Estriol, human placental lactogen and fetal abdominal circumference as predictors of intra uterine growth retardation in pre-eclampsia

Intra-uterine growth retardation [IUGR] is one of the major causes of neonatal morbidity and mortality which is frequently associated with pre-eclampsia. In a trial to search for an ideal method to predict IUGR, this study was performed on 30 cases of pre-eclampsia [20 mild cases and 10 severe cases]. These patients were subjected to single estimation of estriol [E3] human placental lactogen [HPL] and ultrasonographic measurment of abdominal circumference [AC] at 32-36 weeks of gestation and the patients were followed up till time of delivery. This study showed that AC is the most sensitive parameter in prediction of IUGR than serum HPL and serum estriol where its specificity was 91.7% and sensitivity was 100%. Furtherome, it is a simple, non-invasive method and could be used as a routine method for screening of IUGR in high-risk pregnancy especially in pre-eclampsia

Human placental lactogen, estriol patern and the fetal growth

This study was done on 15 idiopathic intrauterine growth retardation [IUGR], 15 [IUGR] associated with hypertensive pregnancy. Determination of serum human placental lactogen [HPL] and estriol [E[3]] were performed serially in the third trimester. Serum levels of HPL [E[3]] were decreased in all [IUGR] pregnacies but more significant in [IUGR] with hypertensive pregnancy and also fetal and placental outcome in this cases showed significant decrease P < 0.02. In conclusion serial determination of serum E[3] and HPL in cases of IUGR and IUGR with hypertension was very important for early evaluation of this high risk groups, so proper therapy can be established

Evaluación hormonal del estado fetal: estriol total y somatomamotropina coriónica / Hormonal evaluation of fetal status: total estrioland chronic somatomanmotropin

Se presentan los resultados de 1,104 determinaciones de estriol total (E3) y 1,099 de somatomatropina coriónica (SMC) realizadas en forma seriada en el suero de embarazadas sanas (grupo testigo) y con gestaciones complicadas, en diferentes semanas del proceso reproductivo. Analizadas como grupo se obtuvieron significativamente menores valores en casos en que existió óbito fetal y toxemia, o cuando los recién nacidos fueron catalogados como hipotróficos; sin embargos, el valor pronóstico predicativo en el mejor de los casos fue de 39%. Los resultados se comentan en base a la fisiología de esas hormonas y a otros estudios previos, y se cuestiona la utilidad de solicitar esos análisis como parámetros de bienestar fetal

Estriol plasmático livre em gestantes normais / Plasma free estriol in normal pregnant women

Determinam-se as médias e as variaçöes das concentraçöes do estriol plasmático livre nas diferentes idades gestacionais, através da análise de 75 amostras obtidas de 75 gestantes sem patologias associadas, além de focalizar alguns aspectos fisiológicos e aplicabilidades deste método no acompanhamento de gestaçöes de alto-risco, na vigilância do bem-estar fetal

Human placental lactogen and estriol in high risk pregnancies

The plasma levels of hpl and estriol were measured in normal pregnants and complicated pregnacies using radio-immunoassay methods. It can be suggested that maternal plasma hpl and estriol values deviated from normal when the pregnancies complicated by conditions that diminish functional placental mass, low hpl and estriol values correlate to some extent with faetal outcome in complicated pregnancies. Elevated values in third trimester pregnancies may be helpful in identifying multiple gestations while hpl and estriol values are of little help in controlled diabetic where the major fetal risks are unrelated to chronic placental insufficiency. The clinical value of the. measurment of hpl and estriol is virtully identical. While the complication of both hpl estriol was found to be the best indicator of high risk pregnancies. Finaly from our results pregnancies complicated by IUGR, PET, hypertension, IUFD, post-maturity and diabetes mellitus where the fetus may be in jeopardy, hpl and estriol determination can be used by the obstetricions as an aid in deciding whether to allow a pregnancy to continue or to terminate it