Monitoring High Risk Pregnancy and Its Outcome

Abstract

Human Placental Lactogen (HPL) and Estriol (E3) levels in serum were measured by radioimmunoassay in 50 normal (group I), 50 diabetic (group II) and 50 pre-eclamptic women (group III) at 32 and 36 weeks. Ultrasonography was also done at 16, 18, 32, 36 weeks of pregnancy and immediately before delivery. The mean serum HPL and E2 showed progressive increase with the advance of pregnancy in all groups. However, the pre-eclamptic group showed lower mean serum HPL and E3 concentrations. While diabetic group showed higher serum HPL and E3 concentrations than the control group. There was a positive correlation between birth weight, placental weight and HPL levels at 32 and 36 weeks in all groups and between E3 level and birth weight in pre-eclamptic group only. A significant correlation was found between ultrasonic fetal weight and birth weight in all groups.

Introduction and Aim of the Work

A high risk pregnancy is defined as pregnancy in which there is a risk of a serious adverse outcome in the mother and/or the baby that is greater than the incidence of that outcome in the general population(1).

It has been recognized for many years that hypertension accompanying pregnancy can directly affect both the placenta and the fetus and may cause substantial maternal and fetal morbidity and mortality (2),(3). The incidence of morbidity and unfavourable perinatal outcome are significantly increased in diabetics when compared to non-diabetic pregnancies(3).

Antenatal tests of fetal well-being depend indirectly on changes in fetal and placental physiology(4). Two hormonal tests of fetal well-being are popular; Estriol and Human Placental Lactogen(5). Diagnostic ultrasound has emerged as an important tool for antepartum fetal surveillance(6). The technical and methodological development of diagnostic ultrasound has made possible a direct communication with the fetus(7).

The aim of this work is to study the role of human placental lactogen and free estriol levels in maternal serum and ultrasonography in normal, diabetic and pre-eclamptic pregnancy and their relation to the outcome of pregnancy.

Subjects and Methods

This study involved 150 pregnant women divided into three groups:

Group I: (50 cases) were normal pregnant women served as a control group.

Group II: (50 cases) were diabetic pregnant women. All patients of this group were insulin-dependant.

Group III: (50 cases) were pre-eclamptic pregnant patients. All the patients had been followed up starting from the first trimester and attended at a regular antenatal visits.

A special sheet for each patient was filled.

Ultrasonography was done for all the patients at 16, 18, 32, 36 weeks, and immediately before delivery. Fetal weight was estimated by ultrasound according to modified Shepard equation (25).

10 ml of maternal venous blood were collected at 32^nd and 36^th weeks where radioimmunoassay of HPL and E3 was carried out using the iodinated kits prepared by "Diagnostic Products Corporation, California, USA".

Immediately after delivery, the babies were rescitated and examined, weight and head circumference were recorded and Apgar scores were estimated at one and five minutes. Also the placenta was examined and its weights were recorded.

Results
(links to tables and figures will open in new windows)

Tables 1, 2, 3 and 4 represent the antenatal ultrasonic, biochemical and pregnancy outcome data of the studied groups. 

A significant correlation was found between ultrasonic fetal weight and birth weight in group I and group III (p<0.05). In group II the correlation was highly significant (p<0.02).

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