Transient parkinsonism: Induced by progesterone or pregnancy?

Critical appraisal of the efficacy, safety, and patient acceptability of hydroxyprogesterone caproate injection to reduce the risk of preterm birth

Prevention of preterm delivery is a major desiderate in contemporary obstetrics and a societal necessity. The means to achieve this goal remain elusive. Progesterone has been used in an attempt to prevent preterm delivery since the 1970s, but the evidence initially accumulated was fraught by mixed results and was based on mostly underpowered studies with variable eligibility criteria, including history of spontaneous abortion as an indication for treatment. More recent randomized controlled clinical trials restimulated the interest in progesterone supplementation, suggesting that progesterone may favorably influence the rate of preterm delivery. Preterm delivery is a complex disorder and consequently it is unlikely that one generalized prevention strategy will be effective in all patients. Further, an additional impediment in accepting progesterone as the "magic bullet" in the prevention of preterm delivery is that its mechanism of action is not fully understood and the optimal formulations, route of administration, and dose have yet to be established. We have concerned ourselves in this review with the most recent status of 17 alpha-hydroxyprogesterone caproate (17OH-PC) supplementation for prevention of preterm delivery. Our intention is to emphasize the efficacy, safety, and patient acceptability of this intervention, based on a comprehensive and unbiased review of the available literature. Currently there are insufficient data to suggest that 17OH-PC is superior or inferior to natural progesterone. Based on available evidence, we suggest a differential approach giving preferential consideration to either 17OH-PC or other progestins based on obstetric history and cervical surveillance. Progestin therapy for risk factors other than a history of preterm birth and/or a short cervix in the current pregnancy is not currently supported by the published evidence. The experience to date with 17OH-PC indicates that there are population subgroups that may be harmed by administration of 17OH-PC. Therefore, extending the use of 17OH-PC to unstudied populations or for indications that are not evidence-based is inadvisable outside of a research protocol.

Oromandibular dystonia and hormonal factors: twelve years follow-up of a case report

Oromandibular dystonia (OMD) is a focal neurological movement disorder characterized by involuntary sustained and often painful muscle contraction, usually producing repetitive movements or abnormal positions of the mouth, jaw and/or tongue. We report on a 30-year-old woman affected with OMD with a 12-year follow-up. Focal dystonia involved an involuntary activity of the lateral pterygoid muscles causing forceful jaw displacement in the maximal protrusive position. These episodes initially occurred during jaw function and increased up to an open-lock with bilateral pre-auricular pain. Dystonic spasms were absent during sleep and were reduced temporarily by sensory tricks. Treatment with botulinum toxin type A (BTX) was performed during three different sessions over a 1-year period. Electromyographic-guided BTX injections into the lateral pterygoid muscles were given with cannula electrodes. Botox reduced the involuntary activity of the muscles. Recurrence and exacerbation of dystonic symptoms occurred during the two pregnancies and completely disappeared immediately after both deliveries with prolonged symptom-free periods. During the last 8 years, the patient had a slight relapse of symptoms during flu attacks, periods of stress and during menses. The temporal pattern of these symptoms indicates a possible relationship between OMD and hormonal factors.

Progesterone administration induces preimplantation embryonic loss in mice

OBJECTIVE

To evaluate the effect of progesterone during early pregnancy on pregnancy maintenance in mice.

DESIGN

Experimental study or laboratory investigation.

SETTING

An established molecular reproduction laboratory, Department of Biotechnology, S.V. University.

ANIMAL(S)

Healthy virgin female Swiss albino mice of 8 weeks of age.

INTERVENTION(S)

After confirmation of the heat period, adult female mice were mated with mature healthy males to achieve pregnancy. Inseminated females received intraperitoneal injections of progesterone at doses of 0, 1, 3.5, 7, 15, 25, or 50 mg/kg body weight on the first, third, and seventh day of pregnancy.

MAIN OUTCOME MEASURE(S)

Preimplantation embryonic loss.

RESULT(S)

Pregnancy failure was evidenced by reduction in the number of embryos in females injected with 7 (25.12 %), 15 (38.44 %), 25 (100%), and 50 (100%) mg progesterone/kg body weight. In females with a successful pregnancy, the numbers of corpora lutea and postimplantation loss per dam were comparable across all groups. No increase in the incidence of malformed fetuses was found in any progesterone-treated groups.

CONCLUSION(S)

Administration of supranormal levels of progesterone during early pregnancy caused a reduction in the number of implantations and an increase in preimplantation loss in mice.