By Tim Chard MD, FRCOG, Arnold Klopper MD, FRCOG (auth.)
Biochemical checks of fetal health ('placental functionality tests') were a part of regimen obstetric perform for greater than two decades. This booklet presents an outline of the present prestige of those assessments - the physiological foundation for his or her use, and their merits and barriers in scientific perform. enormous realization is given to interpretation, a subject matter which some time past has ended in a lot confusion either within the clinical literature and within the minds of clinicians. fresh advances are defined intimately, specifically the invention of an entire new iteration of placental items a few of which provide nice promise within the prediction of stipulations, reminiscent of placental abruption and untimely labour, which can't be pointed out via the other present parameters. ultimately, a collection of transparent ideas is recommend for the alternative of try out in lots of the universal problems of either early and past due being pregnant. The emphasis all through is on how the elemental biology of fetoplacental items dictates their use and interpretation in pathological conditions.
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Additional info for Placental Function Tests
This reference includes an excellent review of the subject. 3. ' 'Five foeto-placental function tests were studied ... plasma cystine aminopeptidase was the least sensitive indicator of foetoplacental dysfunction. ' ' ... ' Watson et al. 3). Other placental enzymes of potential clinical interest Three placental enzymes, although not measurable in peripheral maternal blood, are nevertheless of some clinical interest. The first of these is arylsulphatase. The oestrogens in the fetal circulation, particularly oestriol, are mainly present as sulphates.
3. The only unusual aspect of these data is the claim, as yet unconfirmed, that elevated HSAP levels are of diagnostic value (Merrett and Hunter 1973). g. heart muscle) release intracellular enzymes, measurement of which can be of great diagnostic value. 2. ' Curzen and Southcombe 1970 'Significant ... correlation ... between ... ' Merrett and Hunter 1973 •... ' Curzen and Varma 1971 'Serum HSAP determinations were found to be of no use in predicting fetal distress, the Apgar score at birth, or fetal dysmaturity.
Second, tests of 'statistical significance' are more difficult to carry out on non-parametric data than on normally distributed data; 'difficult', in this context, means that they cannot readily be performed on a hand-held calculator. With the advent of inexpensive microcomputers this is no longer a problem. Multiples of the median This is a variation of the non-parametric approach which to some extent solves the problem of defining extremes given a small data-base. g. 5 x median) will be equally accurate.
Placental Function Tests by Tim Chard MD, FRCOG, Arnold Klopper MD, FRCOG (auth.)