Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

Umbilical cord blood nutrients in low birth weight babies in relation to birth weight & gestational age.

BACKGROUND & OBJECTIVE: Low birth weight (LBW) babies are a vulnerable group and represent two outcomes--preterm birth (preterm LBW) and term with intrauterine growth retardation (term LBW). LBW babies are considered to have low nutrient reserve, but the extent of deficiency as compared to the normal babies and the differences between preterm LBW and term LBW are unclear. This study was carried out to look at key anthropometric, biochemical and clinical (ABC) parameters of LBW babies, both preterm and term, in comparison to a control group of term normal weight babies. METHODS: A group of 500 babies was selected at birth from a tertiary care teaching hospital and categorized into LBW (n = 251) with preterm LBW (n = 59), term LBW (n = 192) and term controls (n = 249). Two controls were dropped as tests could not be performed in the available cord blood sample. Key anthropometric and biochemical parameters were measured. Socio-economic status, age, parity, height and pre-delivery haemoglobin of the mothers were also recorded. RESULTS: The maternal characteristics were comparable in the three groups. Socio-economically, majority of them belonged to lower middle or upper lower class (Class III and IV) representing the non affluent. All the anthropometric measurements and nutrients measured namely total protein, albumin, cholesterol, triglycerides, calcium, magnesium, zinc and iron were significantly lower in LBW babies compared to term control babies. These values were lowest in preterm LBW followed by term LBW. Total iron binding capacity (TIBC) showed inverse association with iron. Some of the babies including control babies had protein, albumin, calcium and iron below the normal range and mean albumin, calcium and iron levels were below the normal range in all the three subsets. INTERPRETATION & CONCLUSION: Preterm and term LBW babies are born with significantly lower nutrient reserves at birth compared to term control babies. Normal weight babies from the non affluent sections also have low nutrients especially albumin, calcium and iron. As these levels are liable to be further lowered by recurrent infections and inappropriate feeding habits, nutritional surveillance, extra feeding and supplements like calcium and iron are recommended for such vulnerable babies to promote optimum growth and to prevent deficiencies. This is important as currently, there are no clear or uniform recommendations for extra feeding and nutrient supplements to LBW babies and no supplements other than exclusive breast feeding are recommended for term normal birth weight babies. Extra nutritional inputs for LBW and selected non affluent babies along with care of the prospective and prenatal mothers for ensuring adequate transfer of nutrients to the offspring seem necessary. Such interventions can be integrated with the existing health care programmes to reach all the beneficiaries.