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Estetrol (1,3,5(10)-estratrien-3,15α,16α,17β-tetrol; 15α-hydroxyestriol; E 4 ) is derived from both neutral and phenolic precursors which have undergone 15α-hydroxylation in the fetal liver or adrenal. Radioimmunoassays of total estrogens (TE), unconjugated estriol (E 3 ), and unconjugated estetrol (E 4 ) have been utilized to measure the concentrations of these estrogens in 46 amniotic fluid samples from 27 high-risk patients. Thirteen normal patients, 5 diabetic patients, and 9 patients with pregnancy complicated by Rh sensitization were studied. The concentration of TE in amniotic fluid in the uncomplicated pregnancies ranged from 11 to 65 μg per 100 ml. In most cases, the concentrations of E 3 and E 4 were similar, ranging from 0.5 to 2 per cent of the TE, as is expressed by a narrow range of E 3 :E 4 ratios extending from 0.8 to 4.5, with a mean of about 3.0. TE, E 3 , and E 4 concentrations in amniotic fluid obtained from pregnancies complicated by diabetes mellitus or Rh sensitization did not differ significantly from concentrations found in uncomplicated pregnancies of the same period of gestation. TE concentrations in 33 third-trimester serum samples from 6 patients ranged from 2 to 17 μg per 100 ml. In maternal serum, the concentration of unconjugated E, is usually much higher than the concentration of unconjugated E 3 , with an E 3 :E 4 ratio of approximately 9. TE concentration in amniotic fluid is similar to or higher than TE concentration in maternal serum; E 4 concentration is also higher in amniotic fluid; E 3 concentration is lower in amniotic fluid. There is little indication from this study that the concentration of unconjugated E 4 in amniotic fluid is of predictive value for the diagnosis of fetal compromise.

The patient was the fourth of affected male siblings. Cortisol (1.3 micrograms per cent), cortisone (9.6), and corticosterone sulfate (0.1) concentrations were low in cord blood. The larger amount of cortisone may have originated from maternal cortisol. Aldosterone was undetectable in cord blood, indicating lack of fetal secretion or maternofetal transfer. Unexpectedly normal concentrations of 11-deoxycorticosterone (DOC) sulfate in cord serum could represent maternal transfer of DOC, with subsequent fetal sulfurylation. Low estrone and estradiol concentrations in maternal and cord serum were consistent with absence of the fetal adrenals. Despite the low levels of the steroids, the propositus had a normal lecithin-sphingomyelin ratio at 38 weeks' gestation. Circulatory insufficiency developed within half an hour after birth and responded to gluco- and mineralocorticoid therapy. The three untreated siblings died between 14 and 67 hours of age. It is evident that early recognition of this condition may be lifesaving.

The inhibition of the pregnenolone Δ5–3Β-hydroxysteroid dehydrogenase-Δ5-4 isomerase systems in microsomes of human placenta or corpus luteum of pregnancy has been investigated using three steroidal substances: 2Α-cyano- 4,4,17Β-trimethylandrost-5-en-17Α-ol-3-one (cyanoketone), 2- hydroxymethylene, 17Α-methyl-5Α-androstan-17Β-ol-3-one (oxymetholone), and estradiol 17Β. The inhibition is of the competitive type with the synthetic steroids. The apparent Ki’s are approximately 0.3xl0-5 M and 0.2xI0-5 m for cyanoketone in the placental and ovarian systems, respectively, and the apparent Ki produced by oxymetholone is 0.6x10-6 m in the ovarian system, however, that for the placental system is much smaller, 5.5xl0-8 M. Approximately 50% inhibition was obtained in both systems with 2–5xl0-5 M estradiol-17Β. Oxymetholone may be useful for the inhibition of corpora luteal function in women.

The transfer of methicillin and dicloxacillin from maternal blood to fetal blood and amniotic fluid was studied in 105 patients. Significant levels of methicillin were detected in fetal serum within 30 minutes after discontinuing the maternal infusion, with equilibration between maternal and fetal serum levels within one hour. Dicloxacillin is associated with lower levels of antibiotic activity in the fetal serum and insignificant levels in the amniotic fluid. Equilibration between maternal and fetal levels did not occur. Protein binding of antibiotics results in a reduced rate of transfer from the maternal to the fetal compartment.

Intrauterine pressure recordings were made during the active phase of labor in 64 patients. On-line electronic integration of the area under the pressure curve was used as a measure of uterine activity. A total of 204 hours of labor including 4,224 individual contractions were analyzed by (1) average pressure (integrator method), (2) Montevideo units, (3) Alexandria units, and (4) frequency distribution. Comparisons were made between spontaneous labor, oxytocin-stimulated labor, and hypertonic saline-induced labor. Oxytocin-stimulated labor and hypertonic saline-induced labor show increases in amplitude and frequency of contractions when compared with spontaneous labor. Concomitant increases in total uterine activity were noted by all methods of measurement. In this series, both hypertonic saline-induced and oxytocin-stimulated labor are different from spontaneous labor whether measured in Montevideo units, Alexandria units, or average pressure. Electronic integration of the pressure signal is recommended as a method of measuring uterine activity in physical units (mm. Hg).

Electroacupuncture (ACP) during childbirth was used in 12 parturients. On the average, it produced 66 percent analgesia in 7 patients for 139 minutes while patients were in active, progressive labor. When ACP no longer could relieve pain, spinal, epidural, or double-catheter technic produced complete analgesia in all patients. ACP did not adversely affect the fetus or uterine contractions and had no harmful aftereffect on mother or neonate. However, its use as a routine method had disadvantages because analgesia was inconsistent, unpredictable, and incomplete. The technic was time-consuming, limited the patient's movement, added more wires and machinery, and interfered with electronic monitoring of the mother and fetus.