Fetal considerations. Metabolic clearance rate of maternal plasma dehydroisoandrosterone sulfate

Obviously this technique is not of immediate, practical use to the clinician, who often must decide within a matter of minutes or hours whether fetal jeopardy is severe enough to warrant early delivery. For investigative purposes, however, we believe measurement of the PC-DSE2 is a rewarding technique for assessing uteroplacental blood flow. Indeed it is the only method currently available that appears to reflect perfusion of the intervillous space. Although we do not foresee a time when clinicians will be able to request the measurement of PC-DSE2 to help in managing high risk pregnancies, analysis of the data accruing from its use in clinical investigations leads us to conclude, for instance, that maternal placental perfusion measured in this way is decreased by 50%-65% once one recognizes pregnancy-induced hypertension. This pattern is so consistently observed in previously normotensive primigravidas who have developed preeclampsia that we feel confident that nearly all such women have undergone a similar reduction in maternal placental perfusion by the time hypertension is detected. This information is of use to the clinician, since, without need to measure the PC-DSE2, he must realize at each encounter with pregnancy-induced hypertension that the fetus is in jeopardy, regardless of how mild the maternal involvement appears to be or how well the hypertension responds to bedrest. Thus for both maternal and fetal indications this complication of pregnancy must be managed aggressively, as outlined by Gilstrap et al. and by Pritchard in this issue.