Serial analysis of plasma progesterone and pregnanediol in human pregnancy

A meta-analysis of randomized control trials of progestational agents in pregnancy

The continued use of progestational agents in attempts to achieve a normal outcome of pregnancy in women with a 'high-risk' pregnancy (previous miscarriage, stillbirth or present preterm labour) prompted this meta-analysis of randomized control trials of such therapy. Of 20 trials of a progestogen 15 had combinable data. Combined comparisons, using odds ratios with confidence intervals, were made of the rates of livebirths at term or preterm and the sum of term and preterm deliveries, miscarriages, stillbirths and neonatal deaths. All but one comparison failed to show a significant benefit. Only the preterm delivery versus the term delivery comparison approached statistical significance. There were average deficiencies of quality apparent in the studies, and a test for heterogeneity among the studies was positive, but these caveats do not diminish the conclusion that progestogens should not be used outside of randomized trials at present. If trials are done, they should include only women with demonstrated hormonal abnormalities who are carrying a live fetus as shown by ultrasonography.

Effect of ACTH infusion on induction of uterine contraction in prolonged human pregnancy in association with endocrine function

The role of hormonal interactions in the mechanism initiating labor in women was studied. The serum levels in women was studied. The serum levels of cortisol, progesterone, estradiol estriol, human chorionic somatomammotropin, and prolactin were measured simultaneously before, during and after infusion of ACTH at a rate of 50 microgram/h in 100 ml of physiological saline or infusion of physiological saline without ACTH (as control) at a rate of 100 ml/h into 14 pregnant women of 10 days or more beyond term. In five (group A) of the 10 women infused with ACTH. uterine contractions were induced within 5-15 min after beginning of ACTH infusion. Although the serum progesterone levels in group A were slightly, but not significantly, lower than those in the other five women (group B) in whom uterine contractions were not induced, the ratio of progesterone to estriol was 13/1 in group A and 18/1 in group B, respectively (P less than 0.05). The endocrine levels in group A may be favorable for the initiation of uterine contraction. The serum cortisol levels in group A were higher, but not significantly higher, than those in group B after ACTH infusion. And the serum estriol levels 6 h after ACTH infusion were significantly lower than control levels before ACTH infusion (P less than 0.01 in group A, P less than 0.05 in group B). To the contrast, in all the four control women infused with physiological saline only (group C), neither uterine contractions nor changes in the serum levels of ACTH and cortisol were found. This work may show that ACTH infusion induced uterine contractions by increased corticosteroids via placenta in lower ratio of progesterone to estrogen but it does not provide any precise information on the mechanism of initiation of human labor.

Hormones in human pregnancy. IV. Plasma progesterone

The plasma concentration of progesterone (P) has been measured by radioimmunoassay in maternal peripheral vein (M.P.V.) at early pregnancy and in M.P.V. umbilical artery (U.A.) and umbilical vein (U.V.) at term pregnancy. In early preganacy marked hour-to-hour fluctuation of plasma progesterone was noted. At term pregnancy plasma P levels of U.V. were higher than those of U.A. and the umbilical venous arterial differences of plasma P did not differ between male and femal fetuses. Administration of hydrocortisone and ACTH to patients scheduled to undergo cesarean section had no effect on M.P.V., U.A., and U.V. plasma P concentration. On the basis of the differences between U.V. and U.A. plasma P concentrations and reported umbilical flow it was estimated that the secretion rate of P into the fetal circulation is approximately 23 mg. per 24 hr. and would amount to approximately 10 per cent of the reported total daily production rate of P at term pregnancy. The fraction of P which is unbound to the plasma proteins was estimeated by equilibrium dialysis at 37 degrees C. The per cent unbound P in M.P.V. plasma of pregnant patients at term was not different from that of nonpregnant patients but was 40 per cent lower than that in umbilical cord plasma (P LESS THAN 0.01), and the ratio between the concentrations of unbound P and estradiol in M.P.V. increased as pregnancy progressed. Plasma P in re-eclamptic patients who subsequently sustained intrauterine fetal death had no value in assessing placental function.

Serum human chorionic gonadotropin and progesterone patterns in the last trimester of pregnancy: relationship to fetal sex

Concentrations of human chorionic gonadotropin (HCG) and progesterone were measured in the peripheral sera of 101 normal pregnant women between 25 and 41 weeks' gestation. HCG levels rose significantly with advancing gestation in the 43 female-bearers (r equals 0.516, p less than 0.001), whereas the 58 male-bearers showed no change (r equals 0.168, p greater than 0.1). Mean HCG levels were significantly higher in female- than in male-bearers (10.7 plus or minus standard error 1.0 versus 8.0 plus or minus 0.9 International Units per milliliter; p less than 0.05). Progesterone levels rose significantly in both female- and male-bearers. The calculated regression lines and mean levels (female-bearers 9.1 plus or minus 0.5; male-bearers 9.8 plus or minus 0.4 mug per deciliter) were not significantly different. There was no correlation between HCG and progesterone levels in either sex or in the entire group independent of gestational age. It is postulated that the lower HCG levels observed at term in male-bearers may result from an inhibitory influence of the higher progesterone and/or androgen concentrations in the male umbilical arterial circulation.