Human placental lactogen levels with toxemia of pregnancy

CORRESPONDENCE

Human placental lactogen levels with toxemia of pregnancy To the Editors: In their article, "Hormone and enzyme levels in normal and complicated pregnancy," Dr. Ward and co-workers 1 note that low human placental lactogen ( HPL) levels have not previously been noted in pregnancy complicated with essential hypertension; however, a more careful review of the literature would have demonstrated this finding was reported several years ago.2 The conclusion that HPL levels are normal in preeclamptic toxemia ( 7 women studied) is not consistent with the results of other data showing normal to low HPL levels with this syndrome. 3 • 4 Perhaps the small sample size or the definition of the syndrome affected the results. The fact that HPL levels are low prior to fetal death confirms earlier observations suggesting that HPL may be a useful monitor of high-risk pregnancies. 5 William N. Spellacy, M.D. P. 0. Box 875 Biscayne Annex University of Miami Miami, Florida 33152

Lactogenic Hormones was held in 1971, the proceedings were published only in 1972. We were not aware of the symposium at the time of submission of the manuscript. Dr. Spellacy finds our study indicating normal human placental lactogen ( HPL) levels in preeclamptic toxemia is not consistent with his findings of normal to low HPL levels in this syndrome. Not only have normal and low levels of HPL been reported in this syndrome, but elevated levels have also been found! Singer and associates1 have reported that 50 per cent of their patients had significantly elevated levels of HPL. Therefore, I would conclude that HPL assays are of limited value in evaluating the obstetric status in this syndrome. We did not infer that HPL levels could not be a useful monitor for certain high-risk pregnancies. However, as stated in the article, we found that estriol estimations, although cumbersome, appeared to contribute more information in certain complicated pregnancies. H. Rockman, lv!.D. Associate Professor Department of Pathology The University of Chicago 950 E. 59th St. Chicago, Illinois 60637

REFERENCES

!. Ward, H., Rochman, H., Varnavides, L. A., and Whyley, G. A.: AM. J. OssTET. GYNECOL. 116: 1105, 1973. 2. Spellacy, W. N.: In Wolstenholme, G. E. W., and Knight, J., editors: Ciba Foundation Symposium on Lactogenic Hormones London 1971, J. & A. Churchill, Ltd., p. 223. ' 3. Spellacy, W. N., Teoh, E. S., Buhi, W. C., Birk, S. A., and McCreary, S. A.: AM. J. 0BSTET. GYNECOL. 109: 588, 1971. 4. Spellacy, W. N.: Clin. Obstet. Gynecol. 16: 298, 1973. 5. Spellacy, W. N., Teoh, E. S., and Buhi, W. C.: Obstet. Gynecol. 35: 685, 1970.

REFERENCE

1. Singer, W., Desjardins, P., and Friesen, H. G.: Obstet. Gynecol. 36: 222, 1970.

Metabolites of meperidine To the Editors: We have read with great interest the communication from our good friends in Memphis 1 in your April 15 issue. Their description of various metabolites in the degradation of meperidine was most intriguing and opens an aspect of the use of this drug in obstetrics that is quite novel to many of us. Unfortunately, it is very difficult to draw useful conclusions from data obtained with a

Reply to Dr. Spellacy To the Editors: In reply to Dr. Spellacy's letter, I would like to comment on certain of the points raised. Although the Ciba Foundation Symposium on

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