Suppression des freien Plasmaöstriols bei der Risikoschwangerschaft nach Stimulation der mütterlichen Nebennierenrinde mit ACTH

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Abstract
The suppression of free plasma estriol in 12 high-risk pregnancies from the 32nd-39th wk of gestation was investigated. Four patients suffered from gestosis, 3 times combined with placental insufficiency and in addition twice with fetal growth retardation. Seven patients presented placental insufficiency, in 6 cases associated with fetal growth retardation. One patient exhibited severe anemia also together with fetal growth retardation. Blood was drawn every 30 min from 1700 h to 0200 h and at 0300 h. From 2000 h to 0200 h 0.25 mg ACTH 1-24 (Synacthen) was infused. Free plasma estriol was mesured by radioimmunoassay. Plasma cortisol was quantitated by the protein binding method. According to the estriol levels in the control period patients were divided in 2 groups (mean values above or below 6 ng/ml) and compared with normal pregnancies. Mean values in the control period from 1700 h-2000 h decreased from normal pregnancies (21.5 .+-. 9.3 ng/ml) to group I (8.6 .+-. 2.4 ng/ml and group II (3.8 .+-. 1.2 ng/ml) (P < 0.001). Indicating dynamic estriol production in the evening the maximum rise of estriol was in normal patients 7.9 ng/ml during this period. The maximum rise was in group I-3.0 ng/ml and in group II-1.2 ng/ml. During ACTH-infusion in all 3 groups estriol levels decreased significantly (P < 0.001). The mean decrease was in normal pregnancies-8.6 ng/ml (44%), in group I/2.7 ng/ml (38%) and in group II only 0.8 ng/ml (27%). Group II exhibited with 3 still births and 2 distressed newborns the highest rate of mortality and morbidity. In group I, 2 normal and 4 growth-retarded babies were delivered. Apparently fetal jeopardy is evidenced by low estriol values in the evening, the absence of episodic secretion and a diminished suppression under ACTH.