The value of urinar: oestrogen estimations and their
validity as a com; arisen wit: the three enzyme tests as
an assessment of fetal prognosis is discussed.
The basis for using these enzyme estimations as a
possible guide to fetal prognosis is reviewed.
The abnormal groups of patients studied were those with
nil 1, .n o . ; :rc rt
retarded babies4, fetal distress in labour; and those whose
pregnancies ended in a perinatal death.
The problems of the method used for estimating urinary
oestrogens, and the results obtained in 45 normal and 115
abnormal pregnancies are analysed and compared with the
findings of ot. e- workers. :he results of this study are
similar to these lnlin s, anc so form a valid comparison
with the three groups of enzyme estimations.
698 serial serum heat stable alkaline phosphatase (HfiiP)
estimations carried out daring 72 normal and 124 abnormal
pregnancies are analysed. ?he difficulties of drawing
comparisons with the results of other workers who used less
specific methods for estimating serum HSAP are stressed,
T e conclusions are that although the levels of this enzyme
specific to pregnancy, rise in steady linear fashion
during pregnancy, alterations in these levels do not give an adequate guide to fetal prognosis in cases of hypertension
or fetal growth retardation.
High levels of sertxm ' ' T found in the third trimester of
pregnancy are indicative of a poor fetal prognosis. The
reasons for this are obscure, but it is suggested that in
these pregnancies there may "be excessive trophoblast
proliferation and subsequent placental infarction.
The reason for a reduction in serum K J values in severely
hypertensive patients during the last few weeks of pregnancy,
may be a diminished amount of syncytio-trophoblast,
containing the placental iso-enzyme of alkaline phosphatase.
The large overlap of values between normal and abnormal
pregnancies considerably reduces their prognostic significance.
73"! serial histochemical estimations of neutrophil alkaline phosphase ( NAP ) were carried out during 103 normal and
123 abnormal pregnancies.
The values are found to be significantly lower than normal
in cases of mild, and mocer o tc severe hypertension, fetal
growth retardation, fetal '!istro38 and perinatal mortality.
There is a significant negative correlation between the NAP
values and the weeks of gestation in cases of moderate to
severe hypertension r crinatal mortality. The values,
in the hypertensive patients, fall several weeks prior to
the onset of hypertension.
Despite these reductions the prognostic value of the
estimations are much reduced, due to the large overlap with
the normal range.
Positive correlations are found in hypertensive pregnancies
between NAP scores on the one hand, and total urinary
oestrogen excretion and serum H3AP estimations on the other.
There is no correlation between the estimations in normal
It is suggested that the reduction in placental production
of oestrogens due to hypertensive damage may affect the NAP
scores directly, or secondarily by reducing the circulating
corticosteroid levels. Experiments showed that the alkaline
phosphatase found in neutrophils is unrelated to the placental
iso-enzyme and it is suggested that the correlation between
these apparently unrelated estimations is coincidental.
A method using appropriate experimental conditions for
estimating serum glucose-6-pho3phatase (G-6-Pase) is described.
356 serial serum G-6-Pase estimations carried out during
78 normal and abnormal pregnancies are analysed. There is
no trend of increasing values during the third trimester of
normal pregnancy, and there is no significant difference
between the mean values found during normal and abnormal
There is no correlation between serum G-S-Pase and serum
IIS AP estimations, but there is a negative correlation
between serum • :;e levels and total urinary oestrogen
The levels in late pregnancy do not seem to differ
significantly from those found in the non pregnant
A possible explanation of these facts is that G—6-Pase is
not liberated fro-:, damaged pi mental cells to the same extent
as I! AP because of its intra-cellul r situation. The
negative correlation between serum G-6-l'ase and total urinary
oestrogen excretion can be explained by transient high levels
of the former due to severe episodes of placental infarction
at times when urinary oestro on excretion i3 low.
Further elucidation of toeso problems is suggested.