Estrogens

Function: Estrogens affect uterine vasculature, placental steroidogenesis, and parturition.

Estradiol

Source:

■ Maternal ovaries for weeks 1 through 6 of gestation

■ Subsequently, the placenta secretes increasing quantities of estradiol synthesized from the conversion of circulating maternal and fetal DHEA-S.

■ After T1, the placenta is the major source of circulating estradiol.

Estrone

Source:

■ Maternal ovaries, adrenals, and peripheral conversion in the first 4 to 6 weeks of pregnancy

■ The placenta subsequently secretes increasing quantities.

Estriol

Source:

■ Continued production is dependent on the presence of a living fetus.

Progesterone

Source:

■ Corpus luteum before 6 weeks' gestational age

■ Thereafter, the placenta produces progesterone from circulating maternal low-density lipoprotein (LDL) cholesterol.

Function:

■ Affects tubal motility, the endometrium, uterine vasculature, and parturition

■ Inhibits T lymphocyte-mediated tissue rejection Cortisol

Source: Decidual tissue

Function: Suppresses the maternal immune rejection response of the implanted conceptus

Amniotic fluid AFP and maternal serum (MSAFP) are elevated in association with neural tube defects and low in trisomy 21.

MSAFP is decreased in pregnancies with Down's syndrome.

In women with threatened T1 abortions, estradiol concentrations are abnormally low for gestational age.

During T3, low estradiol levels are associated with poor obstetrical outcomes.

Abortion will occur in 80% of women with progesterone levels under 10 ng/mL.

Progesterone concentrations of < 5 ng/mL are diagnostic of fetal death in T1. Prompt diagnostic studies should be performed to distinguish between ectopic pregnancy and intrauterine fetal demise.

LDL Cholesterol

Source: Fetal adrenal gland Function:

■ Principal regulatory precursor of corpus luteum progesterone production

■ Principal lipoprotein utilized in fetal adrenal steroidogenesis

Protesteronr concentrations are significantly elevated in: women with hydratidiform mole complications of Rh isoimmunization.

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