Bashore R A, Westlake J R
Am J Obstet Gynecol. 1977 Jun 15;128(4):371-80. doi: 10.1016/0002-9378(77)90555-5.
The usefulness of plasma estriol concentrations in the management of high-risk pregnancy is controversial. In this study, serial plasma unconjugated estriol (E3) concentrations determined by radioimmunoassay were evaluated in 321 patients with high-risk pregnancy for correlation with fetal and neonatal performance. A plasma E3 concentration of 4 ng. per milliliter or less in late pregnancy correlated significantly with low one-and five-minute Apgar scores and selected neonatal problems in pregnancies complicated by chronic hypertension and intrauterine growth retardation, with a similar trend for pregnancies complicated by moderate and severe pre-eclampsia. Most perinatal deaths in the study were associated with acute problems which began during labor and delivery, or fetal death occurred before early intervention was practical. Therefore, the perinatal mortality rate is not likely to be influenced by the use of E3 values, and the perinatal mortality rate is not a realistic measure of the usefulness of plasma E3 values in management of high-risk pregnancy. Low plasma E3 values were not always ominous, and for this reason it is suggested that clinical indications and the results of other tests for fetal-placental function be considered along with plasma E3 values in the selection of patients for early delivery to reduce the possibility of inappropriate intervention.
血浆雌三醇浓度在高危妊娠管理中的作用存在争议。在本研究中，对321例高危妊娠患者采用放射免疫分析法测定了系列血浆非结合雌三醇（E3）浓度，以评估其与胎儿及新生儿情况的相关性。妊娠晚期血浆E3浓度低于4 ng/毫升与慢性高血压合并宫内生长受限妊娠中1分钟和5分钟阿氏评分低以及特定新生儿问题显著相关，子痫前期中度和重度妊娠也有类似趋势。本研究中的大多数围产期死亡与分娩期间开始的急性问题相关，或在早期干预可行之前就已发生胎儿死亡。因此，围产期死亡率不太可能受E3值的使用影响，且围产期死亡率并非衡量血浆E3值在高危妊娠管理中作用的实际指标。血浆E3值低并不总是预示不良，因此建议在选择早期分娩患者时，除血浆E3值外，还应考虑临床指征及其他胎儿 - 胎盘功能检查结果，以减少不适当干预的可能性。
