8/9/2019 Tests for Estriol Level
1/25
8/9/2019 Tests for Estriol Level
2/25
Estriol
8/9/2019 Tests for Estriol Level
3/25
y Estriol can be measured in maternal blood or urine and canbe used as a marker of fetal health and wellbeing. DHEA-Sis produced by the adrenal cortex of the fetus. This isconverted to estriol by the fetal liver.
y If levels of "unconjugated estriol" are abnormally low in apregnant woman, this may indicate a chromosomal or
congenital anomalies like Down syndrome or Edward'ssyndrome. It is included as part of the triple test &quadruple test for antenatal screening for fetal anomalies.
y Because many pathological conditions in a pregnantwoman can cause deviations in estriol levels, thesescreenings are often seen as less definitive of fetal-placental
health than non-stress testing. Conditions which cancreate false positives and false negatives in estriol testingfor fetal distress include preeclampsia, anemia andimpaired kidney function.
8/9/2019 Tests for Estriol Level
4/25
Triple Screen TestyAlso Known as Triple Test, MultipleMarker Screening andAFP Plus
yThe triple screen test is a maternal bloodscreening test that looks for three specificsubstances: AFP, hCG, and Estriol.
y It is a non-invasive procedure done througha blood test with little to no known risk tothe mother or developing baby.
8/9/2019 Tests for Estriol Level
5/25
8/9/2019 Tests for Estriol Level
6/25
8/9/2019 Tests for Estriol Level
7/25
yAFP: alpha-fetoprotein is a protein thatis produced by the fetus.
yhCG: human chorionic gonadotropin isa hormone produced within theplacenta
yEstriol: estriolis an estrogen producedby both the fetus and the placenta
8/9/2019 Tests for Estriol Level
8/25
What is a screening test?y It is very important to remember what a screening test
is before getting one performed. This will help alleviate
some of the anxiety that can accompany test results.Screening tests do not look only at results from theblood test. They compare a number of differentfactors (including age, ethnicity, results from bloodtests, etc...) and then estimate what a persons chances
are of having an abnormality. These tests DO NOTdiagnose a problem; they only signal that furthertesting should be done.
8/9/2019 Tests for Estriol Level
9/25
What are the risks and side effects
to the mother or baby?
yExcept for the discomfort of
drawing blood, there are noknown risks or side effects
associated with the triplescreen test.
8/9/2019 Tests for Estriol Level
10/25
8/9/2019 Tests for Estriol Level
11/25
yAll pregnant women should be offered the triplescreen, but it is recommended for women who:
y Have a family history of birth defects
yAre 35 years or older
y Used possible harmful medications or drugsduring pregnancy
y Have diabetes and use insulin
y Had a viral infection during pregnancyy Have been exposed to high levels of radiation
8/9/2019 Tests for Estriol Level
12/25
What does the triple screen test
look for?y The triple screen is measuring high and low levels
of AFP and abnormal levels of hCG and estriol.
The results are combined with the mother's age,weight, ethnicity and gestation of pregnancy inorder to assess probabilities of potential geneticdisorders.
y High levels of AFP = has a neural tube defect suchas spina bifida or anencephaly. However, the mostcommon reason for elevated AFP levels isinaccurate dating of the pregnancy.
8/9/2019 Tests for Estriol Level
13/25
y Low levels of AFP and abnormal levels of hCGand estriol = Trisomy 21( Down syndrome),Trisomy 18 (Edwards Syndrome) or anothertype of chromosome abnormality.
y primary reason for conducting the test is toSCREEN FOR GENETIC DISORDERS, theresults of the triple screen can also be used toidentify:
yA multiples pregnancyy Pregnancies that are more or less advanced
than thought
8/9/2019 Tests for Estriol Level
14/25
What do the triple test results
mean?
yIt is important to remember that thetriple test is a SCREENING TEST AND
NOT A DIAGNOSTIC TEST. This testonly notes that a mother is at a possibleriskof carrying a baby with a genetic
disorder. The triple screen test isknown to have a high percentage ofFALSE POSITIVE RESULTS.
8/9/2019 Tests for Estriol Level
15/25
y
Abnormal test results warrantadditional testing for making adiagnosis. A more conservativeapproach involves performing a secondtriple screen followed by a highdefinition ultrasound. If the testingstill maintains abnormal results, a
more invasive procedure likeamniocentesis may be performed.
8/9/2019 Tests for Estriol Level
16/25
What are the reasons for further
testing?yThe reasons to pursue further testing or notvary from person to person and couple to
couple. Performing further testing allows youto confirm a diagnosis and then provides youwith certain opportunities:y Pursue potential interventions that may exist
(i.e. fetal surgery for spina bifida)y Begin planning for a child with special needs
8/9/2019 Tests for Estriol Level
17/25
y
Start addressing anticipated lifestylechanges
y Identify support groups and resources
yMake a decision about carrying the childto term
ySome individuals or couples may elect notto pursue testing or additional testing for
various reasons:yThey are comfortable with the results no
matter what the outcome is
8/9/2019 Tests for Estriol Level
18/25
8/9/2019 Tests for Estriol Level
19/25
SALIVA TESTINGy an accurate and simple way for the ordinary
man or women to assess the current levels of
steroid hormonesySteroid Hormones in saliva reflect the
portion of circulating hormones in the
bloodstream that are unbound by serumbinding proteins (free or bioavailable) andtherefore are able to enter tissuesthroughout the body.
8/9/2019 Tests for Estriol Level
20/25
y Salivary Hormone Values, therefore, reflect the
biologically active (the unbound) portion available totarget cells. Blood hormone assays reflect both boundand free forms of hormones and do not provideinformation about the bioavailable fraction ofhormone, which can vary depending on the level of
blood hormone binding proteins.y Saliva Hormone Testing tells us the amount of
hormones in our body that are actually usable by ourcells; where as blood testing evaluates all circulatinghormones regardless of their availability to our cells -and most importantly anyone can take a Saliva Testfrom the comfort of their home. It's safe and easy todo.
8/9/2019 Tests for Estriol Level
21/25
8/9/2019 Tests for Estriol Level
22/25
8/9/2019 Tests for Estriol Level
23/25
y 3.MEN & WOMEN on any hormones need to allow 12- 24 hours after application or ingestion before taking
the test. The use of these hormones needs to be notedon the requisition form (eg. thyroid, estrogen, corticosteroids, progesterone cream). Testing while onhormones will tell you if your program is working.
8/9/2019 Tests for Estriol Level
24/25
8/9/2019 Tests for Estriol Level
25/25
Results
yIn urine: estrone = 1.5; estradiol =
1.8; estriol = 3.0(mcg/24 hoururine)
yIn plasma: estrone = 0.05; estradiol= 0.07; estriol = 1.0 (mcg/100ml)