Intrauterine Fetal Growth Retardation: A Comparison of Human Placental Lactogen Urinary Oestriol and Biparietal Diameter Measurements

In a previous communication, Robinson et al. (1973) compared the value of five methods of fetal monitoring in respect of their ability to differentiate between normal and growth-retarded pregnancies in a small series of patients. These tests included sonar biparietal cephalometry, 24 h urinary oestriol assays and determination of serum oxytocinase, total alkaline phosphatase and heat-stable alkaline phosphatase activities. In order to evaluate the results, a preliminary scoring system was devised where points were allotted to the overall level and to the trend of the results. Using this system it was found that a combination of sonar cephalometry and urinary oestriol assays gave the most reliable prediction of intrauterine fetal growth retardation. No individual test satisfactorily separated the normal from the abnormal pregnancies and, in particular, the enzyme tests were found to be of little clinical value. During the course of the investigation, reports appeared stressing the apparent value of human placental lactogen (HPL) as a test of placental function (Keller et al., 1971; (Letchworth and Chard, 1972). It was, therefore, decided to measure the HPL concentration in the sera already collected and to apply to the results a scoring system similar to that previously described, and thereby to compare the resulting scores with those obtained using biparietal cephalometry and urinary oestriol assays.