背景:一名16周孕妇出现巨大的叶黄素囊肿,需要双侧卵巢切除术。妊娠进展顺利,分娩后自然泌乳。
方法:为了研究妊娠末期和产后卵巢对荷尔蒙分布的作用,我们测量了FSH,雌二醇(E2),非共轭雌酮(E1),非共轭雌三醇(E3),性激素结合球蛋白,黄体酮,在妊娠37周和8小时时,硫酸脱氢表雄酮和催乳素,4天,5周,产后2个月。
结果:这些激素在产后4天之前在卵巢完整的孕妇和产褥期妇女的预期范围内。产后5周,FSH增加到围绝经期范围(31.4IU/l),而雌激素保持在正常产褥期范围内(E2=239pmol/l;E1=102pmol/l),与双侧卵巢切除术后非孕妇的快速变化形成对比。2个月时,虽然部分母乳喂养,FSH,E2和E1接近更年期范围(68IU/l,136和70.2pmol/l),激素替代开始了。
结论:我们得出的结论是,在妊娠晚期和产褥期早期,不需要卵巢来维持正常的荷尔蒙状况。然而,产后5周FSH增加到围绝经期水平,尽管母乳喂养,提示泌乳期需要卵巢维持低FSH浓度。
BACKGROUND: A 16 week pregnant woman presented with massive theca-lutein cysts requiring bilateral oophorectomy. Pregnancy progressed uneventfully and spontaneous lactation ensued after delivery.
METHODS: To study the role of the ovary on the hormonal profile at the end of gestation and in post-partum, we measured FSH, estradiol (E2), unconjugated estrone (E1), unconjugated
estriol (E3), sex hormone-binding globulin, progesterone, dehydroepiandrosterone sulphate and prolactin at 37 weeks gestation and at 8 h, 4 days, 5 weeks, and 2 months post-partum.
RESULTS: These hormones were within the range expected for ovary-intact pregnant and puerperal women until 4 days post-partum. At 5 weeks post-partum, FSH increased to a peri-menopausal range (31.4 IU/l) while estrogens remained within the normal puerperal range (E2=239 pmol/l; E1=102 pmol/l), contrasting with their rapid changes in non-pregnant women after bilateral oophorectomy. At 2 months, while partially breastfeeding, FSH, E2 and E1 were closer to menopausal range (68 IU/l, 136 and 70.2 pmol/l respectively), and hormone replacement was started.
CONCLUSIONS: We conclude that the ovary is not required to maintain a normal hormonal profile in late pregnancy and early puerperium. However, the increase in FSH to peri-menopausal levels at 5 weeks post-partum, despite breastfeeding, suggests that the ovary is needed to maintain low FSH concentrations during lactation.