Coyle, M. G., Greig, M., & Walker, J. (1962). Blood-progesterone and urinary pregnanediol and oestrogens in foetal death from severe pre-eclampsia. Lancet (London, England), 2(7250), 275-277. https://doi.org/10.1016/s0140-6736(62)90176-9
Coyle MG, Greig M, Walker J. Blood-progesterone and urinary pregnanediol and oestrogens in foetal death from severe pre-eclampsia. Lancet. 1962;2(7250):275-277. doi:10.1016/s0140-6736(62)90176-9
Coyle, M. G., et al. "Blood-progesterone and urinary pregnanediol and oestrogens in foetal death from severe pre-eclampsia." Lancet (London, England), vol. 2, no. 7250, 1962, pp. 275-277.
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Urinary estrogens fell before fetal death in two preeclampsia cases
A 1962 case report of two women in their first pregnancy with severe preeclampsia found that urinary estrogens fell before fetal death in both women. Urinary pregnanediol and blood progesterone gave no guide to when fetal death would occur. Both women improved clinically, yet both fetuses died in the womb.
Key Findings
Both women, aged 23 and 24, improved clinically on conservative treatment intended to continue the pregnancy; the improvement was not reflected in fetal growth or survival, and both fetuses died in utero.
Urinary pregnanediol, a breakdown product of progesterone, remained unaltered before and after fetal death; blood progesterone fell slightly after fetal death in one woman and was maintained in the other.
In one woman, urinary estrogens fell steadily during the 3 weeks before fetal death; in the other, an estriol rise during diuretic treatment was followed by a steady fall until fetal death.
The authors report that the urinary estriol pattern seems to show placental function deteriorating despite clinical improvement, and call the general fall in urinary estrogens a better guide to worsening conditions.
At follow-up nearly a year later, both women were hypertensive and markedly overweight, and one still had some proteinuria.
Interpretation
The paper is a 1962 case report of two women in their first pregnancy who were admitted near the 30th week with severe preeclampsia. Hormone levels were measured repeatedly in 24-hour urine collections and in blood. The measurements describe the clinical course of both pregnancies from admission through fetal death and delivery. The authors word their reading of placental function with caution. They note that, without a blood pressure record from before pregnancy, the cases may have been preeclampsia superimposed on essential hypertension.
RRM Context
Restorative reproductive medicine reads hormone levels as signs of how the body is working. Following progesterone and estrogen across a pregnancy, as this 1962 report did, gives information on how the placenta is working.
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