Hormone load tests in the first half of pregnancy--a diagnostic and therapeutic approach.

In view of still unsolved problems concerning disturbances in early pregnancy, the efficacy of various substances with regard to endocrine systems in the first trimester of pregnancy has been investigated. Seventy-five women, who had been referred to our hospital for an authorized termination of pregnancy during weeks 7-9 of gestation, and 6 women between weeks 10 and 16 of gestation volunteered to take part in the study. After single administration of the test substances, blood was drawn from an indwelling catheter with one group of patients at hourly intervals over an 8-hour period, while with all other patients this was done at 3-hourly intervals over a 24-hour period. In all samples beta-HCG, progesterone (P), estradiol-17 beta (E2), and 17 alpha-hydroxyprogesterone (17-OHP) were determined. The following substances were studied in detail: HCG, allylestrenol, 17-hydroxyprogesterone caproate, tamoxifene, R 5020, betamethasone, and dehydroepiandrosterone sulfate (DHAS). Two hundred and seventy-one women with imminent abortion were either treated with allylestrenol (n = 130) or simple clinotherapy and no medication (n = 141). One hundred and two women had a miscarriage, while 168 carried to term. The serum concentrations of beta-HCG, P, E2 and estriol (E3) were determined serially. Twelve women with a history of repeated miscarriages were treated with vaginal progesterone suppositories. Five of them experienced another miscarriage. The serum concentrations of beta-HCG and P were determined serially. It could be shown that diagnostics in early pregnancy have been complemented by assessment of the E2-increase after DHAS loading. Maternal serum concentrations were not affected by administration of HCG and various progestational agents including allylestrenol. Only in the case of parenteral or vaginal application of progesterone could increased serum concentrations of this hormone be demonstrated. Progesterone substitution in early pregnancy may, therefore, be chosen under special conditions as possible therapeutic procedure.