British Journal of Obstetrics and Gynaecology April 1975. Vol. 82. pp. 272-277
AN EVALUATION OF HUMAN PLACENTAL LACTOGEN LEVELS IN HYPERTENSION OF PREGNANCY BY
ANNEM. KELLY P. ENGLAND J. D. LORIMER J. C . FERGUSON AND
A. D. T. GOVAN Department of Obstetrics and Gynaecological Research and Department of Obstetrics, Glasgow Royal Maternity Hospital, Rottenrow, GIasgow
Summary Maternal plasma levels of human placental lactogen (HPL) are decreased in hypertensive pregnancies and the concentration is related to the severity of the condition. Of infants who had HPL concentrations in the fetal danger zone (more than 2 SD's below normal mean) 75 per cent developed fetal distress, neonatal asphyxia or were light for dates. Patients who are identified in this way have lighter infants and placentae than their unidentified counterparts with normal HPL levels.
attained on two consecutive occasions. The 175 patients in the mild group had a reading of 90 to 99 mm. Hg, the 95 patients in the moderate group 100 to 109 mm. Hg and the 37 patients in the severe group had pressures greater than 110 mm. Hg, or more than 90 mm. Hg with proteinuria of at least 1 -0g./24 hours. A normal group of 429 patients has already been described by England et al. (1974), who also defined our criteria for fetal distress and neonatal asphyxia. A baby was considered to be light for dates when its birthweight was below the tenth percentile for the period of gestation (Battaglia and Lubchenco, 1967). Blood specimens were taken in most cases on more than one occasion after 32 weeks for HPL, urea and creatinine and 24 hour urines were collected for creatinine and protein determinations. The specimens for HPL were stored at -10 "C. prior to analysis and other investigations were performed within four
HYPERTENSION is a well recognized complication of pregnancy and associated with an increased perinatal mortality and morbidity (Butler and Bonham, 1963). The early work of Kaplan and Grumbach (1964) and Sciarra et al. (1963) which identified the placenta as the sole organ to produce HPL, directed much attention to its role as an indicator of placental function. In 1971, Spellacy et al. (1971) and Keller et al. (1971), in independent studies on hypertensive patients, described excellent results when using HPL to predict fetal mortality but they were not supported by Letchworth and Chard (1972) whose results were inconclusive.
PATIENTS AND METHODS The patients investigated were 308 with hypertension developing after the 28th week of pregnancy. They were divided into three groups depending on the highest diastolic blood pressure 212
HPL LEVELS IN HYPERTENSIVEPREGNANCY
hours. Plasma HPL was estimated by radioimmunoassay as previously described (England et al., 1974). Urea and creatinine were quantitated on the Auto Technicon I1 analyzers by the A.AII-01 and A,AII-I 1 methods respectively. Proteins in urine were precipitated with trichloracetic acid prior to quantitation with biuret reagent.
RESULTS Plasma HPL concentrations of normal and hypertensive patients from 32 weeks gestation appear in Table I. There is considerable overlap between the four groups and in comparing levels in the normal and mild hypertension groups the difference is only statistically significant at 34 to 36 weeks (p
AN EVALUATION OF HUMAN PLACENTAL LACTOGEN LEVELS IN HYPERTENSION OF PREGNANCY BY
ANNEM. KELLY P. ENGLAND J. D. LORIMER J. C . FERGUSON AND
A. D. T. GOVAN Department of Obstetrics and Gynaecological Research and Department of Obstetrics, Glasgow Royal Maternity Hospital, Rottenrow, GIasgow
Summary Maternal plasma levels of human placental lactogen (HPL) are decreased in hypertensive pregnancies and the concentration is related to the severity of the condition. Of infants who had HPL concentrations in the fetal danger zone (more than 2 SD's below normal mean) 75 per cent developed fetal distress, neonatal asphyxia or were light for dates. Patients who are identified in this way have lighter infants and placentae than their unidentified counterparts with normal HPL levels.
attained on two consecutive occasions. The 175 patients in the mild group had a reading of 90 to 99 mm. Hg, the 95 patients in the moderate group 100 to 109 mm. Hg and the 37 patients in the severe group had pressures greater than 110 mm. Hg, or more than 90 mm. Hg with proteinuria of at least 1 -0g./24 hours. A normal group of 429 patients has already been described by England et al. (1974), who also defined our criteria for fetal distress and neonatal asphyxia. A baby was considered to be light for dates when its birthweight was below the tenth percentile for the period of gestation (Battaglia and Lubchenco, 1967). Blood specimens were taken in most cases on more than one occasion after 32 weeks for HPL, urea and creatinine and 24 hour urines were collected for creatinine and protein determinations. The specimens for HPL were stored at -10 "C. prior to analysis and other investigations were performed within four
HYPERTENSION is a well recognized complication of pregnancy and associated with an increased perinatal mortality and morbidity (Butler and Bonham, 1963). The early work of Kaplan and Grumbach (1964) and Sciarra et al. (1963) which identified the placenta as the sole organ to produce HPL, directed much attention to its role as an indicator of placental function. In 1971, Spellacy et al. (1971) and Keller et al. (1971), in independent studies on hypertensive patients, described excellent results when using HPL to predict fetal mortality but they were not supported by Letchworth and Chard (1972) whose results were inconclusive.
PATIENTS AND METHODS The patients investigated were 308 with hypertension developing after the 28th week of pregnancy. They were divided into three groups depending on the highest diastolic blood pressure 212
HPL LEVELS IN HYPERTENSIVEPREGNANCY
hours. Plasma HPL was estimated by radioimmunoassay as previously described (England et al., 1974). Urea and creatinine were quantitated on the Auto Technicon I1 analyzers by the A.AII-01 and A,AII-I 1 methods respectively. Proteins in urine were precipitated with trichloracetic acid prior to quantitation with biuret reagent.
RESULTS Plasma HPL concentrations of normal and hypertensive patients from 32 weeks gestation appear in Table I. There is considerable overlap between the four groups and in comparing levels in the normal and mild hypertension groups the difference is only statistically significant at 34 to 36 weeks (p
