Ray D A, Yeast J D, Freeman R K
Am J Obstet Gynecol. 1986 Jun;154(6):1257-63. doi: 10.1016/0002-9378(86)90709-x.
This retrospective analysis of the use of serum estriol levels for antenatal assessment was performed in an effort to determine if routine, late third-trimester, daily serum estriol monitoring of insulin-dependent pregnant diabetic women can still be justified. Estriol profiles of 170 diabetic pregnancies, managed under a consistent protocol of weekly contraction stress tests and daily serum estriol assessments, were reviewed. A total of 4612 estriol determinations were performed. Nearly 4% of the estriol determinations showed a 35% fall from the mean of the previous three highest consecutive values. Forty-seven percent of the patients had at least one fall of this magnitude. Eighty-five percent of the fetal heart rate tests performed in association with an estriol fall were normal. A fall in estriol was not found to be associated with a higher risk of having a positive contraction stress test, either at the time the estriol fall was recognized or at any time during the patient's antepartum course. Although use of this strict protocol combining the use of weekly contraction stress tests and daily serum estriol determinations provided a safe method of antepartum assessment, there is little evidence to support the routine use of daily serum estriol monitoring in insulin-dependent pregnant diabetic women.
为了确定对胰岛素依赖型妊娠糖尿病妇女在妊娠晚期进行常规每日血清雌三醇监测是否仍合理，我们对血清雌三醇水平用于产前评估进行了回顾性分析。回顾了170例糖尿病妊娠的雌三醇情况，这些妊娠按照每周宫缩应激试验和每日血清雌三醇评估的一致方案进行管理。总共进行了4612次雌三醇测定。近4%的雌三醇测定值显示比前三个连续最高值的平均值下降了35%。47%的患者至少有一次这种幅度的下降。与雌三醇下降相关进行的胎儿心率测试中，85%结果正常。无论是在识别出雌三醇下降时，还是在患者产前过程中的任何时候，都未发现雌三醇下降与宫缩应激试验阳性风险增加有关。尽管使用这种结合每周宫缩应激试验和每日血清雌三醇测定的严格方案提供了一种安全的产前评估方法，但几乎没有证据支持对胰岛素依赖型妊娠糖尿病妇女常规使用每日血清雌三醇监测。
