Concentration of placental protein 10 (PP10) in maternal serum and amniotic fluid throughout normal gestation and in pregnancy complicated by fetal growth retardation

PP10, a new placental glycoprotein, was studied by a specific and sensitive double-antibody radioimmunoassay in maternal serum and other body fluids throughout pregnancy. The mean value of serum PP10 in healthy nonpregnant individuals was approximately 10 microU/l. During normal pregnancy it rose to 3,500 microU/l. The rate of rise was obtained from 78 normal pregnancies with 279 single assay values from weeks 6-40. The shape of the curve resembled that for other placental proteins (HPL, SP1). PP10 levels in amniotic fluid were measured in 145 samples from weeks 13-55 of normal pregnancies and at term. The mean concentration was 500 microU/l until week 18 and then rose slowly. Cord blood contained only trace amounts. PP10 was not found in maternal urine. The concentration in maternal serum and amniotic fluid was higher in twin pregnancies than in singleton pregnancies. In 46 cases with low birth weights the PP10 levels in maternal serum were significantly lower than normal. Simultaneous measurements of PP10 and E3, HPL and SP1 were made in 17 individual follow-up's. PP10 was comparable with E3 and appeared to be better than HPL and SP1 in predicting intrauterine fetal growth retardation.     

Relation of placental prolactogen and E3 in the blood of pregnant women to placental grading by ultrasonography and its clinical significance

Serum HPL and E3 of normal pregnant women and some pathologic pregnancies were dynamically measured and the relationship between their levels and placental gradings were investigated. The peak values of HPL and E3 were found in 13.16 +/- 7.49 and 15.68 +/- 6.51 days before delivery. The serum concentrations of the two hormones in women with severe PIH syndrome, postdate pregnancy and intrauterine fetal growth retardation (IUGR) were lowered. E3 declined earlier than HPL Analysis of the HPL, E3 levels in comparison with placental grading showed that the decline of the two hormones was mainly found in patients with grade III placenta.     

Human placental lactogen and intrauterine growth retardation.

Serum human placental lactogen levels were measured after 36 weeks' gestation in 264 serum samples from 109 women with normal pregnancies and in 137 serum samples from 70 women with pregnancies complicated by fetal intrauterine growth retardation (IGR). The fetal and placental weights were significantly lower in the IGR groups while the maternal ages were not different. There was a significantly lower hPL value at each week from 36 to 41 (except for the 39th) in the IGR group. Sixty percent of the women with IGR had hPL values less than 6 mug/ml, and 18.6% were less than 4 mug/ml. It is suggested that a low serum hPL value obtained during the last month of pregnancy should alert the physician to the possibility of intrauterine problems, including IGR.     

Prognostic Value of Plasma Oestradiol-17β and Human Placental Lactogen in High-risk Pregnancies

Summary: Serial estimations of plasma oestradiol-17(E₂) and human placental lactogen (HPL) were made in 58 high-risk pregnancies. In pregnancies complicated by marked hypertension, intrauterine growth retardation, and intra-uterine death, plasma E₂ did not reflect fetal well-being accurately, unlike HPL which was accurate in predicting fetal outcome. In diabetic pregnancy, plasma E₂ and HPL levels were similar to those found in normal pregnancy.     

Second- and third-trimester serum levels of placental proteins in preeclampsia and small-for-gestational age pregnancies

BACKGROUND: Poor placentation may perpetuate preeclampsia, but the presence of a major placental pathology has been questioned in cases of preeclampsia where the newborn has an appropriate birthweight for gestational age. On the other hand, poor placentation is also observed in the absence of preeclampsia, in pregnancies with small-for-gestational-age (SGA) fetuses. In late gestation, maternal serum levels of placental protein hormones are changed in both preeclampsia and SGA, but no longitudinal pre-onset studies are available for pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta1-glycoprotein (SP1) or human placental lactogen (HPL). METHODS: In a nested case-control study we compared maternal serum levels of PAPP-A, SP1, HPL and placenta growth factor (PLGF) at 17, 25 and 33 weeks in pregnancies developing preeclampsia without fetal growth restriction (n = 28), or characterized by a growth-retarded fetus (n = 25), with gestation-matched controls (n = 65). The proteins were quantified using microplate enzyme immunometric assays and the serum levels at 17, 25 and 33 weeks compared between the three groups by nonparametric statistical tests. RESULTS: In pregnancies with subsequent preeclampsia PAPP-A, SP1, HPL and PLGF were reduced at 17 weeks of gestation whereas at 25 and 33 weeks only PLGF remained below the controls. In growth-restricted pregnancies PAPP-A, SP1 and HPL were reduced at 17 weeks, and only HPL continued to be strongly affected thereafter. CONCLUSION: The reduced serum levels of the placental proteins PAPP-A, SP1 and HPL in the early second trimester (17 weeks) in pregnancies with subsequent preeclampsia or with fetal growth restriction involve an underlying role for the placenta in either pathology independent from the other.     

Human placental lactogen and unconjugated estriol concentrations in twin pregnancy: monitoring of fetal development in intrauterine growth retardation and single intrauterine fetal death

Human placental lactogen and unconjugated estriol concentrations in maternal serum were evaluated in 100 uneventful twin pregnancies, and these values were compared with those observed in 16 twin pregnancies associated with intrauterine growth retardation or single intrauterine fetal death. In pregnancies associated with intrauterine growth retardation (n = 8), human placental lactogen levels were at the lower limit of normal range for singleton pregnancies, whereas estriol levels were normal in most cases. When one of the fetuses had died before week 33 of pregnancy (n = 5), both human placental lactogen and estriol levels were low and they were almost at the levels in singleton pregnancy. When intrauterine fetal death occurred after week 36 of pregnancy (n = 3), both hormone levels remained normal until term. Thus human placental lactogen rather than estriol is a good indicator of intrauterine growth retardation in twin pregnancy. Both human placental lactogen and estriol are useful for the monitoring of the surviving fetus in the case of single intrauterine fetal death.     

Interrelation between serum levels of beta-subunit human chorionic gonadotropin, human placental lactogen and free estriol during the third trimester of pregnancy

In order to evaluate changes in serum levels of beta-hCG during the third trimester of pregnant women, it was measured together with serum levels of hPL and free E3 by radioimmunoassay. We also investigated the correlation among these hormone levels and birth weights as well as placental weights. 155 blood samples were drawn once a week from the cubital vein of 27 normal pregnant women from 25 to 35 days menstrual cycles. Serum levels of beta-hCG increased as pregnancy proceed and reached their peak, 9.2 IU/ml, in the 37th week of pregnancy. Serum hPL levels were increased, reaching their peak, 7.3 micrograms/ml, in the 38th week of pregnancy. Serum free E3 levels were also elevated as pregnancy developed and reached their peak, 23.4 micrograms/ml, in the 41st week of pregnancy 41 week. In these serum hormone levels, significant (p less than 0.001) positive correlation were found in each pairing of these three hormones. The serum level of each of these three hormones showed a positive relationship with placental weight. Only the serum free E3 level showed a positive relationship to birth weight. These data suggest that beta-hCG have significant relationship with hPL and free E3. These three hormones have influenced birth weight and placental weight.     

妊娠高血压综合征患者血清β绒毛膜促性腺激素及胎盘催乳素水平测定及其临

目的　探讨血清β绒毛膜促性腺激素 (β hCG)及胎盘催乳素 (HPL)的临床意义及其在妊娠高血压综合征 (妊高征 )发病中的作用。方法　用放射免疫法测定 142例正常妊娠妇女 (正常妊娠组 )及 43例妊高征妇女 (妊高征组 ,其中轻度 16例 ,中度 12例 ,重度 15例 )血清 β hCG及HPL水平。结果　 (1)轻、中、重度妊高征妇女血清 β hCG分别为 (2 5 33± 17 80 ) μg/L、(33 12± 4 91) μg/L、(42 19± 17 47) μg/L ;正常妊娠妇女为 (12 33± 7 92 ) μg/L ,妊高征组与正常妊娠组比较 ,差异有极显著性 (P <0 0 0 1)。β hCG水平与妊高征病情严重程度呈正相关(r=0 6 77,P <0 0 5 )。 (2 )轻、中、重度妊高征妇女血清HPL分别为 (14 73± 3 2 6 )mg/L、(11 44± 4 0 2 )mg/L、(12 73± 4 18)mg/L ;正常妊娠妇女为 (12 78± 4 6 7)mg/L。妊高征组与正常妊娠组比较 ,差异无显著性 (P >0 0 5 )。HPL水平与妊高征病情严重程度无相关 (r=- 0 30 0 ,P >0 0 5 )。结论　β hCG可反映妊高征时滋养细胞功能紊乱的程度及病情严重程度 ,可作为妊高征病情的监测指标之一。HPL水平的变化不能作为妊高征的检测指标。     

Correlation between Human Placental Lactogen Levels and Glucose Metabolism in Pregnant Women with Intrauterine Growth Retardation

Twenty pregnant women with fetal growth retardation and 20 pregnant women with appropriate for gestational age fetuses (controls) were recruited after the 28th week of gestation. Samples were collected for estimation of serum insulin and human placental lactogen (HPL) levels in the fasting state and a glucose tolerance test was carried out on all the subjects. The results showed the glucose and HPL levels to be significantly lower in the fetal growth retardation group compared to controls. There were no differences in the fasting serum insulin levels in the 2 groups. Fetal growth retardation appears to be linked with the absence of development of the physiological 'diabetogenic' state in the second half of pregnancy. This maternal hypoglycaemic state is associated with low HPL levels and not with raised maternal insulin levels as measured in the fasting state.     

Value of Total Serum Oestriol and Human Placental Lactogen in the Assessment of Fetal-Placental Function

Serum levels of total oestriol and human placental lactogen (HPL) were measured in 360 pregnancies; in 182 there were abnormalities likely to be associated with increased fetal risk. A total of 217 estimations of oestriol and HPL were performed in 163 normal pregnancies to define the normal ranges. The value of both tests in the management of complicated pregnancies was assessed. Serum oestriol was found to be very efficient in the diagnosis of intrauterine growth retardation. In such cases, 76% of patients had unfavourable oestriol levels. Patients with mild pre-eclampsia had HPL levels similar to normal, but values decreased significantly in the presence of fetal distress. The mean serum oestriol level in patients with pre-eclampsia were lower than normal, and were further reduced in the presence of fetal distress. The importance of measuring serum oestriol levels at each antenatal visit is stressed in the detection of developing fetal complications; in such cases, 73% of patients had subnormal values. Both tests provided accurate assessments in the 8 patients with intrauterine death. Significant fetal-placental dysfunction was present in 55 patients, and 41 (75%) were predicted by serum oestriol, 23 (42%) by HPL, and 45 (82%) by the use of both tests. In the 142 complicated pregnancies that resulted in a favourable outcome, confirmation was obtained in 102 (72%) by serum oestriol and in 121 (86%) by HPL.     

Serum HPL, total estrogen excretion and serum oxytocinase in intrauterine retardation. Results of 3 evaluation procedures

The purpose of this study was to check the value of the determinations of human placental lactogen (HPL), urinary total estrogens and oxytocinase in 40 patients with fetal growth retardation among 253 single pregnancies using 3 methods of interpretation. The false-positive (abnormal) error of HPL was 40.4%. The sensitivity of urinary total estrogens was 22,5%, and of oxytocinase 30,8%. Therefore the intrauterine growth retardation can be predicted only in about a quarter of cases showing low levels or atypical profiles of these both biochemical determinations. The results suggest that the practical value is limited for all three determinations.     

Human placental lactogen serum levels in venous and capillary blood from women in late pregnancy

The concentration of human placental lactogen (HPL), in serum was measured in venous and capillary blood from 31 pregnant women. 14 women had uncomplicated pregnancies. The others had complications including preeclampsia, intrauterine growth retardation, and severe edema. The correlation between values of HPL in venous and capillary blood was high. In all cases the clinical information obtained on placental function was the same, whether HPL was measured in venous or capillary blood. The day-to-day variability was of the same order for capillary as for venous samples. It is concluded that capillary blood may well be used for measurement of HPL in pregnant women. Capillary blood could replace venous blood for measurement of HPL in the supervision of pregnancies complicated by preeclampsia or intrauterine growth retardation.     

Pregnancy-Specific β-1 Glycoprotein (SP-1) in Normal and Abnormal Pregnancy

Maternal serum levels of a pregnancy specific beta-1 glycoprotein (SP-1) were measured by radial-immunodiffusion in 369 normal pregnancies. Mean levels rose progressively to approximately 200 mg/l at 36 weeks of gestation followed by a plateau and a fall at term. The 95% confidence limits were established for SP-1 logarithmic correction of the positively skewed raw data and certain theoretical and practical advantages were demonstrated in the use of SP-1 compared with human placental lactogen (HPL) measurement in the assessment of fetal-placental growth and function. In a preliminary study of abnormal pregnancy states it was found that maternal serum SP-1 assay may aid in the early detection of retarded intrauterine growth, and that it provides a better monitoring system than HPL in this condition. SP-1 levles were normal in pregnancies complicated by hypertension without retarded intrauterine growth.     

Placental protein and hormone measurements in twin pregnancy

Summary. Maternal serum levels of human placental lactogen (hPL), schwangerschaftsprotein 1 (SP1), pregnancy-associated plasma protein A (PAPP-A), placental protein 5 (PP5) and total oestriol (E3) were measured serially in 35 twin pregnancies during the third trimester. Eighteen pregnancies had major complications including dysmaturity of one or both fetuses in nine, premature labour in six, and placental abruption in three. Serum levels of all five variables were higher than in singletons, this distinction being greatest for hPL and lowest for SP1 and E3. The levels of hPL, PP5 and E3 just before delivery were significantly correlated with the total birthweight, a correlation with placental weight being evident only for hPL and PP5. A significant correlation between the five biochemical variables at 33–34 weeks was only seen between hPL and PAPP-A. Protein and hormone levels in. the abnormal twin pregnancies were not apparently different from those in the normal twin pregnancies. These data suggest that only hPL levels biochemically reflect this extreme of fetal and placental growth, but that neither the levels of hPL nor any of the other biochemical indices examined are altered in abnormalities in twin pregnancy     

Placental protein and hormone measurements in twin pregnancy

Maternal serum levels of human placental lactogen (hPL), schwangerschaftsprotein 1 (SP1), pregnancy-associated plasma protein A (PAPP-A), placental protein 5 (PP5) and total oestriol (E3) were measured serially in 35 twin pregnancies during the third trimester. Eighteen pregnancies had major complications including dysmaturity of one or both fetuses in nine, premature labour in six, and placental abruption in three. Serum levels of all five variables were higher than in singletons, this distinction being greatest for hPL and lowest for SP1 and E3. The levels of hPL, PP5 and E3 just before delivery were significantly correlated with the total birthweight, a correlation with placental weight being evident only for hPL and PP5. A significant correlation between the five biochemical variables at 33-34 weeks was only seen between hPL and PAPP-A. Protein and hormone levels in the abnormal twin pregnancies were not apparently different from those in the normal twin pregnancies. These data suggest that only hPL levels biochemically reflect this extreme of fetal and placental growth, but that neither the levels of hPL nor any of the other biochemical indices examined are altered in abnormalities in twin pregnancy.     

Study of serum SP1 levels in early normal and abnormal pregnancies

The pregnancy-specific beta 1 glycoprotein (SP1) levels in the serum of normal and abnormal pregnancies were determined by radioimmunoassay in the first trimester. The results indicated that serum SP1 levels of normal pregnancies increased with the advancing gestational week; 67% of threatened abortions with low SP1 levels would finally abort and only 7% of those with normal SP1 levels would abort. Serum SP1 levels were of lower values in ectopic pregnancy and hydatidiform mole. Serum SP1 might be taken as a better index for estimating the fetal prognosis in threatened abortion and an auxiliary diagnostic means for ectopic pregnancy and hydatidiform mole.     

HPL-positive infiltrating trophoblastic cells in normal and abnormal pregnancy.

In a series of 24 pregnant women, placental bed biopsies were performed in the third trimester at cesarean section. All the resulting specimens contained infiltrating trophoblast with both small and giant cells, and eight also contained vascular trophoblast. On immunoperoxidase staining for HPL, some small interstitial trophoblastic cells were positive in 12 cases. Some cells of the vascular intramural trophoblast and practically all cells of the vascular intraluminal trophoblast were positive. Seven cases were normal pregnancies whereas 17 were complicated by arterial hypertension and/or fetal growth retardation. A significant correlation between abnormal pregnancy and absence of HPL-positive interstitial cells in the placental bed biopsy was found. This probably indicates a diminished overall number of HPL-positive interstitial cells in the group of abnormal pregnancies and might reflect some defect of interstitial trophoblast. Such a defect may play a role in the arrest of the physiological changes of pregnancy in spiral arteries, which has been described in pre-eclampsia and in many cases of idiopathic fetal growth retardation.     

Maternal plasma, human placental lactogen, alpha-fetoprotein, prolactin and growth hormone in early pregnancy

Human placental lactogen (HPL), alpha-fetoprotein, prolactin and growth hormones were assayed simultaneously twice weekly in 21 women from 4--16 weeks' gestation. Mean levels were established from 15 of the women for comparison with one woman with a twin pregnancy, two who aborted and three who received progestogen supplements. There was wide interpatient variation in all hormone levels excepting HPL. The mean levels of all except growth hormone showed an upward trend. Mean growth hormone levels were higher initially but remained within a 2--4 ng/ml range throughout. In the twin pregnancy, only HPL and alpha-fetoprotein levels were significantly raised. HPL was detected in one of the two women who aborted, whereas growth hormone was initially extremely high, falling precipitously prior to abortion in both women. Treatment with progestogen supplements did not appear to influence any of the hormones measured. This study suggests that serial estimations of HPL appear to be the most cost-effective guide to early fetal well-being of the four hormones measured.     

Novel placental and nonplacental serum markers in ectopic versus normal intrauterine pregnancy

OBJECTIVE: To evaluate whether the serum concentrations of novel placental markers and nonplacental markers differ in ectopic pregnancy when compared with normal intrauterine pregnancy. DESIGN: Prospective clinical study. SETTING: University hospital. PATIENT(S): Patients with confirmed ectopic pregnancy (EP) and control population with normal intrauterine pregnancy (IUP). INTERVENTION(S): Laparoscopy. MAIN OUTCOME MEASURE(S): Serum concentrations of placental markers: pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta(1)-glycoprotein (SP1), human placental lactogen (HPL), and HCG; and nonplacental markers: glycodelin, vascular endothelial growth factor (VEGF), and P. RESULT(S): The multiples of median of all markers (except VEGF) were decreased in EP when compared with the control group. Conversely, the serum values of VEGF were significantly increased in EP. VEGF showed a negative correlation with HCG and SP1, but not with PAPP-A, P, or the nonplacental markers. HCG, PAPP-A, SP1, and HPL strongly correlated with each other. But, in contrast to the above, P only correlated with HCG and, in contrast to the controls, with glycodelin. The combination of three independent markers in the formula VEGF/(PAPP-A x P) was found to be largely superior to the measure of any single marker. CONCLUSION(S): The "triple marker analysis" [VEGF/(PAPP-A x P] allows a clear discrimination between normal IUP and EP.     

Serum human placental lactogen (HPL) levels in patients with intact hydatidiform mole.

Serum human placental lactogen (HPL) levels in forty cases of intact hydatidiform mole were measured by radioimmunoassay. The HPL values were generally lower than normal pregnancies of the corresponding period of gestation. However, normal and occasionally higher than normal values were observed in a few cases. Serum HPL level alone is of some clinical use in the diagnosis of hydatidiform mole. When combined with human chorionic gonadotropin (HCG), a low HPL/HCG ratio for the corresponding period of amenorrhoea is a useful index in the diagnosis of hydatidiform mole.