Human Reproduction vol.7 no. 10 pp. 1467-1473, 1992
Influence of human chorionic gonadotrophin, oestradiol and progesterone on uteroplacental and corpus luteum blood flow in normal early pregnancy
Research Laboratory on Reproduction, Free University of Brussels (ULB) School of Medicine, 808 route de Lennik, 1070 Brussels, Belgium and 2Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London, London, UK 'To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Academic Hospital Erasme, 808 route de Lennik, 1070 Brussels, Belgium
A transvaginal colour and pulsed Doppler study was performed on 44 women with normal pregnancies between 5 and 16 weeks of gestation. Maternal levels of human cborionic gonadotrophin (HCG), free a-HCG subunit, free /3-HCG subunit, 17/3-oestradiol and progesterone were determined in sera obtained at the time of Doppler examination. Uterine peak systolk velocity (PSV) and a-HCG and 17/3-oestradlol levels increased significantly (P < 0.001) from the second to the fourth month of gestation, whereas uterine and spiral resistance index (RI) decreased significantly (P < 0.005 and P < 0.001, respectively) with gestational age. Levels of HCG and (3-HCG peaked significantly (P < 0.01) during the third month of gestation. Corpus luteum PSV and RI and progesterone levels did not vary significantly with gestational age. Multiple regression analysis showed that gestational age was the only significant (P < 0.05) contributor to uterine PSV and spiral RI variability. In addition to gestational age, 17/3-oestradiol had a significant (P < 0.001) influence on uterine RI. Both corpus luteum PSV and RI were significantly (P < 0.01 and P < 0.05, respectively) related to progesterone levels. Corpus luteum PSV was also significantly (P < 0.05) related to 17/3-oestradiol levels and RI to HCG levels. These results suggest that: (0 uterine PSV reflects the overall uterine blood supply which increases progressively with growth of the gestational sac; (ii) hormonal factors such as 17/3-oestradiol have a predominant role in regulating the uterine vascular resistance changes to blood flow associated with placentation; and (iii) blood flow regulation to the corpus luteum is independent of gestational age and mainly related to hormonal levels. Key words: circulation/corpus luteum/Doppler/placenta/ pregnancy
Introduction The recent advent of transvaginal colour Doppler imaging (CDI) has enabled accurate in-vitro investigation of the vascular network © Oxford University Press
of the female genital tract by detection of blood flow signals in small vascular branches (Jurkovic et al., 1992a). Velocimetry studies of uterine and ovarian vessels are, therefore, much faster and more accurate than those previously obtained using Doppler equipment. Implantation and subsequent pregnancy development requires adaptive changes of the uterine environment. In the early weeks of human gestation, the uterine circulation is progressively transformed into a low-resistance vascular network which increases the blood supply to the growing gestational sac. These pregnancy vascular changes have been closely related with the trophoblastic infiltration of the placental bed (Brosens et al., 1967; Pijnenborg et al., 1980, 1981, 1983). However, in several animal species the fall in uterine vascular resistance occurs without destruction or invasion of the maternal uterine tissue (Burton, 1992). Therefore, the vascular transformation secondary to placentation may also result from variations in circulating steroid and protein hormones. The influence and the mechanism by which these hormones modulate uterine and corpus luteum perfusion during early pregnancy remains to be elucidated. The aim of the present study was to define relationships between changes in uterine and corpus luteum vascularization as assessed by Doppler measurements and variations in intact human chorionic gonadotrophin (HCG), free a-HCG subunit, free /3-HCG subunit, 17/3-oestradiol and progesterone levels. Materials and methods Patients Forty-four pregnant women referred for ultrasonographic examination before termination of pregnancy for psycho-social reasons entered this study. All women were certain of the date of their last menstrual period and had never smoked. The pregnancies were between 5 and 16 weeks of gestation and had been clinically uncomplicated at die time of investigation. Menstrual age was confirmed by ultrasound measurements including crown—rump length until the end of the first trimester and biparietal diameter for pregnancies of > 12 weeks of gestation. After giving informed consent, each woman underwent Doppler examination and 10 ml of blood was collected from a forearm vein, prior to pregnancy termination. Serum samples were kept frozen at -20°C until assayed. Doppler investigations Doppler examination was performed by means of 5.0 MHz curvilinear transvaginal probe with pulsed and colour Doppler facilities (Aloka Colour Doppler SSD-680, Aloka Co., Japan). 1467
Downloaded from https://academic.oup.com/humrep/article-abstract/7/10/1467/664806 by University of Western Sydney user on 13 January 2019
E.Jauniaux1, D.Jurkovic2, J.Delogne-Desnoek and S.Meuris
E Jauniaui et al.
Hormonal assays All samples were assayed in duplicate and in a single assay for intact HCG, free a-HCG and /3-HCG subunits, 17/S-oestradiol and progesterone. Levels of intact HCG and free a-HCG and /3-HCG subunits were measured using solid-phase two-side immunoradiometric assays (BioMerieux, Mercy-rEtoile, France) which were calibrated against the First International Reference Preparations 75/537 for HCG-dimer, 75/569 for free a-HCG subunit and 75/551 for free /3-HCG subunit. Sensitivities were 1 IU/1 for HCG and 0.03 IU/1 for both free subunits. The intraassay coefficient of variation was
Influence of human chorionic gonadotrophin, oestradiol and progesterone on uteroplacental and corpus luteum blood flow in normal early pregnancy
Research Laboratory on Reproduction, Free University of Brussels (ULB) School of Medicine, 808 route de Lennik, 1070 Brussels, Belgium and 2Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London, London, UK 'To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Academic Hospital Erasme, 808 route de Lennik, 1070 Brussels, Belgium
A transvaginal colour and pulsed Doppler study was performed on 44 women with normal pregnancies between 5 and 16 weeks of gestation. Maternal levels of human cborionic gonadotrophin (HCG), free a-HCG subunit, free /3-HCG subunit, 17/3-oestradiol and progesterone were determined in sera obtained at the time of Doppler examination. Uterine peak systolk velocity (PSV) and a-HCG and 17/3-oestradlol levels increased significantly (P < 0.001) from the second to the fourth month of gestation, whereas uterine and spiral resistance index (RI) decreased significantly (P < 0.005 and P < 0.001, respectively) with gestational age. Levels of HCG and (3-HCG peaked significantly (P < 0.01) during the third month of gestation. Corpus luteum PSV and RI and progesterone levels did not vary significantly with gestational age. Multiple regression analysis showed that gestational age was the only significant (P < 0.05) contributor to uterine PSV and spiral RI variability. In addition to gestational age, 17/3-oestradiol had a significant (P < 0.001) influence on uterine RI. Both corpus luteum PSV and RI were significantly (P < 0.01 and P < 0.05, respectively) related to progesterone levels. Corpus luteum PSV was also significantly (P < 0.05) related to 17/3-oestradiol levels and RI to HCG levels. These results suggest that: (0 uterine PSV reflects the overall uterine blood supply which increases progressively with growth of the gestational sac; (ii) hormonal factors such as 17/3-oestradiol have a predominant role in regulating the uterine vascular resistance changes to blood flow associated with placentation; and (iii) blood flow regulation to the corpus luteum is independent of gestational age and mainly related to hormonal levels. Key words: circulation/corpus luteum/Doppler/placenta/ pregnancy
Introduction The recent advent of transvaginal colour Doppler imaging (CDI) has enabled accurate in-vitro investigation of the vascular network © Oxford University Press
of the female genital tract by detection of blood flow signals in small vascular branches (Jurkovic et al., 1992a). Velocimetry studies of uterine and ovarian vessels are, therefore, much faster and more accurate than those previously obtained using Doppler equipment. Implantation and subsequent pregnancy development requires adaptive changes of the uterine environment. In the early weeks of human gestation, the uterine circulation is progressively transformed into a low-resistance vascular network which increases the blood supply to the growing gestational sac. These pregnancy vascular changes have been closely related with the trophoblastic infiltration of the placental bed (Brosens et al., 1967; Pijnenborg et al., 1980, 1981, 1983). However, in several animal species the fall in uterine vascular resistance occurs without destruction or invasion of the maternal uterine tissue (Burton, 1992). Therefore, the vascular transformation secondary to placentation may also result from variations in circulating steroid and protein hormones. The influence and the mechanism by which these hormones modulate uterine and corpus luteum perfusion during early pregnancy remains to be elucidated. The aim of the present study was to define relationships between changes in uterine and corpus luteum vascularization as assessed by Doppler measurements and variations in intact human chorionic gonadotrophin (HCG), free a-HCG subunit, free /3-HCG subunit, 17/3-oestradiol and progesterone levels. Materials and methods Patients Forty-four pregnant women referred for ultrasonographic examination before termination of pregnancy for psycho-social reasons entered this study. All women were certain of the date of their last menstrual period and had never smoked. The pregnancies were between 5 and 16 weeks of gestation and had been clinically uncomplicated at die time of investigation. Menstrual age was confirmed by ultrasound measurements including crown—rump length until the end of the first trimester and biparietal diameter for pregnancies of > 12 weeks of gestation. After giving informed consent, each woman underwent Doppler examination and 10 ml of blood was collected from a forearm vein, prior to pregnancy termination. Serum samples were kept frozen at -20°C until assayed. Doppler investigations Doppler examination was performed by means of 5.0 MHz curvilinear transvaginal probe with pulsed and colour Doppler facilities (Aloka Colour Doppler SSD-680, Aloka Co., Japan). 1467
Downloaded from https://academic.oup.com/humrep/article-abstract/7/10/1467/664806 by University of Western Sydney user on 13 January 2019
E.Jauniaux1, D.Jurkovic2, J.Delogne-Desnoek and S.Meuris
E Jauniaui et al.
Hormonal assays All samples were assayed in duplicate and in a single assay for intact HCG, free a-HCG and /3-HCG subunits, 17/S-oestradiol and progesterone. Levels of intact HCG and free a-HCG and /3-HCG subunits were measured using solid-phase two-side immunoradiometric assays (BioMerieux, Mercy-rEtoile, France) which were calibrated against the First International Reference Preparations 75/537 for HCG-dimer, 75/569 for free a-HCG subunit and 75/551 for free /3-HCG subunit. Sensitivities were 1 IU/1 for HCG and 0.03 IU/1 for both free subunits. The intraassay coefficient of variation was
