Is serum free estriol measurement essential in the management of hypertensive disorders during pregnancy?

A prospective study of antepartum fetal evaluation of 306 randomized hypertensive pregnancies was carried out. One hundred and fifty-four patients (group 1) were managed in accordance with a protocol (protocol A) which included non-stress test (NST), oxytocin challenge test (OCT), serum unconjugated (free) estriol measurements (E₃), and ultrasound measurement of the fetal head-to-abdomen circumference ratio ( H A c.r.). A second group (group 2), composed of 152 patients, was managed using another protocol (protocol B) which included the NST, OCT and ultrasound measurement of the fetal head-to-abdomen circumference ratio ( H A). We found a good correlation between the serial normal tests and the outcome of pregnancies. We obtained good results in patients with abnormal NST-OCT and meconium-stained amniotic fluid and in patients with repeated abnormal NST-OCT with clear amniotic fluid due to active management by early deliveries ignoring fetal lung maturity. This management increased the rate of cesarean section and prematurity. There was a low correlation between patients with abnormal serum free estriol as the only antepartum pathological test and the appearance of intrapartum fetal distress, low birth weight and perinatal morbidity and mortality. The contribution of serum free estriol (E₃) measurements in such patients was only of value in cases of intra-uterine fetal growth retardation, but its prediction rate was less than that of ultrasound measurement of head-to-abdomen circumference ratio. Our results indicate that hypertensive pregnancy management without serum free estriol measurement may be valuable and safe.