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Progesterone concentrations in maternal and fetal serum are lower during functional dystocia than in normal labor
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
1992 (English)In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 79, no 5, 752-759 p.Article in journal (Refereed) Published
Abstract [en]

Concentrations of progesterone and estradiol (E2) were measured in parturient serum and in fetal cord serum during normal labor and in women with functional dystocia. In the study group, there were no cases of cephalopelvic disproportion. In oxytocin-resistant dystocia, the course of labor could not be corrected with oxytocin. To ascertain the effect of oxytocin, we included a number of women whose labor had been induced with oxytocin, followed by normal cervical dilatation and descent of the fetus. All the parturients were grouped retrospectively into those with normal labor and those with dystocia, based on previous definitions. The serum concentrations of progesterone in both the fetal cord and maternal vein were found to be significantly lower in the oxytocin-resistant dystocia group than in women in spontaneous normal labor and those with oxytocin-induced labor and normal progression (P < .05-.005). Oxytocin had no evident effect on the serum concentration of either progesterone or E2, nor did concentrations vary following epidural blockade. Serum E2 concentrations in the maternal vein were similar in all delivery groups. Fetal cord E2 serum concentrations were similar in all vaginal deliveries. Women with the most severe oxytocin-resistant dystocia, delivered by cesarean, had significantly lower serum concentrations of E2 in fetal cord serum compared with the vaginally delivered women (P < .001).

Place, publisher, year, edition, pages
1992. Vol. 79, no 5, 752-759 p.
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-46970OAI: oai:DiVA.org:umu-46970DiVA: diva2:441637
Available from: 2011-09-17 Created: 2011-09-17 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Progesterone in human parturition: progesterone and 5α-pregnane-3,20-dione in relation to human myometrial activity
Open this publication in new window or tab >>Progesterone in human parturition: progesterone and 5α-pregnane-3,20-dione in relation to human myometrial activity
1991 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This study was undertaken to evaluate the relationship of progesterone and 5α-pregnane-3,20-dione (5αDHP), a major progesterone metabolite, to human parturition. The serum concentrations of 5αDHP prior to, during and following parturition were to be established, as well as its maternal and fetal concentration in different modes of delivery. Some of its effects in vitro were also to be studied. Progesterone was included primarily as a reference substance. 5α-pregnane-3α-ol-20-one (3αOH-DHP), a potent CNS depressant progesterone metabolite, was included in the in vitro study.

Progesterone: The maternal serum concentration of progesterone is stable during the last three weeks of pregnancy preceding spontaneous labor and through labor. The various modes of delivery studied were elective cesarean section; ocytocin resistant fuctional dystocia; normal, effective, induced labor; and normal, effective, spontaneous labor. The serum progesterone concentrations in dystocia and at elective cesarean section were lower than during normal labor (P<0.005 - p<0.001). Women with ineffectual or no labor at all had progesterone concentrations ranging between 77 and 48% in maternal serum and for umbilical cord serum 65-43% of those at normal labor. In normal labor, primiparous women had higher progesterone concentrations than parous women. When scrutinizing the literature, similar results were found, though interpreted differently. In the in vitro model, human term myometrial muscle strips constantly exposed to progesterone started to contract later (p<0.005), but with a higher frequency (p<0.01) than parallel controls deprived of progesterone. A new property of progesterone emerges when these results are combined with findings in the literature regarding progesterone. Progesterone in high concentrations are related to normal, effective labor.

5α-pregnane-3,20-dione (5αDHP): Mean serum 5αDHP concentrations declined significantly during the last week of pregnancy (p<0.005). During labor, the maternal 5αDHP serum concentration remained stable. No distinct differences according to parity or mode of delivery were evident. The 5αDHP serum concentration in the fetal compartment was double that in the maternal compartment. 5αDHP had only minor effects in the in vitro model. These findings suggest a minor change in 5αDHP production preceding the onset of spontaneous labor, which could contribute to the increased progesterone concentration noted.

5α-pregnane-3α-ol-20-one (3αOH-DHP): No major effects of 3αOH-DHP were seen in the in vitro model. Thus unlikely that it hampers myometrial smooth muscle activity.

In conclusion: Two generally accepted effects of progesterone in relation to parturition are; Decreasing concentrations induce labor while stable or increasing concentrations do have pregnancy maintaining properties. This study suggests a third property of progesterone in relation to human parturition. High and increasing progesterone concentrations seem to have uterotonic properties.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 1991. 41 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 321
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-46974 (URN)91-7174-623-4 (ISBN)
Public defence
1991-11-22, Hörsal B (Rosa salen), by 1D, Umeå regionsjukhus, 14:00 (English)
Available from: 2011-09-17 Created: 2011-09-17 Last updated: 2011-09-17Bibliographically approved

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Löfgren, MatsBäckström, Torbjörn

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