Low saliva progesterone concentrations are associated with spontaneous early preterm labour (before 34 weeks of gestation) in women at increased risk of preterm delivery.

Saliva progesterone and oestriol concentrations were determined weekly from 24 weeks of gestation in women at increased risk of preterm delivery. Samples were analysed from 28 women with spontaneous onset of labour and delivery before 37 weeks of gestation, and 64 who delivered at term. Saliva progesterone was lower in the 12 women delivering before 34 weeks than in those delivering later, between 34 and 37 weeks (P = 0.007) or at term (P = 0.009). Measurement of saliva progesterone may be of value in the prediction of early preterm labour and in determining which women might benefit from progesterone supplementation.

Oestriol and oestradiol increase cell to cell communication and connexin43 protein expression in human myometrium.

Oestradiol increases the protein expression of connexin43 (Cx43) gap junctions in myometrium but the effect of oestriol on gap junction expression has not been described previously. Oestriol is the most abundant free oestrogen in pregnant women and there is a marked surge in oestriol concentrations before term and idiopathic preterm labour. In order to determine whether oestriol may have a physiological action on the myometrium, cultured human myometrial cells obtained from non-pregnant hysterectomy specimens were exposed to 10 nmol/l oestradiol or oestriol. Intercellular communication between myometrial cells was investigated by microinjection of confluent cultured cells with the gap junction-permeant tracer Cascade Blue. There was a progressive increase in coupling after exposure to oestradiol or oestriol (P < 0.0005). An increase in Cx43 protein expression was demonstrated by immunocytochemistry after 1 h (P < 0.01) and 3 days (P < 0.01) exposure, and by Western blotting after 1 h (P < 0.01) and 3 days (P < 0.05) exposure, to both oestradiol and to oestriol. We conclude that oestriol increases gap junction communication in human myometrium by increasing gap junction expression. Elevated oestriol concentrations may thus play a role in the initiation of labour in women, by increasing cell-cell communication in the myometrium.

Salivary estriol as risk assessment for preterm labor: a prospective trial.

OBJECTIVE: Increased understanding of human parturition allows for novel approaches to (1) identification of women at increased risk for preterm birth and (2) development and controlled testing of etiology-based strategies to prevent preterm birth. STUDY DESIGN: Five hundred forty-two women were enrolled at five study sites in a prospective evaluation of salivary estriol in samples obtained weekly beginning at 22 weeks' gestation (Salest, Biex, Inc., Boulder, Colo.). Estriol concentrations were determined with a well-characterized enzyme-linked immunoassay. Women adjudged at either high risk or low risk for prematurity were evaluated through to delivery. RESULTS: A total of 267 women submitted serial samples that were analyzed; 241 women with singleton pregnancies submitted sufficient samples. Twenty-three women with singleton fetuses went into idiopathic preterm labor (without prior rupture of membranes) and were delivered preterm (mean 35 weeks' gestation); 182 were delivered at term (> or = 37 weeks' gestation). Mean (geometric) estriol concentrations were higher from 24 to 34 weeks in women with singleton pregnancies delivering preterm (p < 0.05). A surge in estriol concentrations occurred approximately 3 weeks before the onset of labor in both women delivering at term and those delivering preterm. This increase occurred approximately 4 weeks earlier in women delivered preterm versus term. Receiver-operator curve analyses showed that exceeding a 2.3 ng/ml saliva estriol level was associated with occurrence of preterm labor (71% sensitivity, 77% specificity, 23% false-positive rate). CONCLUSION: Detection of an early estriol surge or increased level (> or = 2.3 ng/ml) may be clinically helpful in identifying women at elevated risk for preterm labor and birth, allowing for evaluation of biologically based interventions in controlled trials.

Maternal plasma progesterone levels fall after rectal administration of estriol.

Maternal plasma unconjugated estriol (E3), progesterone (P), and estradiol (E2) levels were measured at 30-min intervals for 6 h after the rectal administration of a 100-mg E3 or placebo suppository to 28 pregnant women at term. Mean plasma unconjugated E3 levels showed a sustained rise approximately 50% above baseline levels 2 h after rectal E3 administration (P < 0.003). There was a simultaneous sustained fall of approximately 20% in mean plasma P levels (P < 0.05); the fall in mean P levels was greatest in the women who delivered within 48 h of E3 suppository administration (P < 0.05). There was no change in mean plasma E2 levels. This study demonstrates that a significant rapid increase in maternal circulating E3 levels can be obtained by the rectal administration of E3, and that this increase in maternal E3 levels is associated with a decrease in circulating P levels.

Laparoscopic ovarian diathermy: an effective treatment for anti-oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome.

OBJECTIVE: To determine the long term efficacy of laparoscopic ovarian diathermy in the management of refractory anovulatory infertility in women with the polycystic ovary syndrome. DESIGN: Open study of 50 women treated over a period of 3 years and 3 months, with follow up until 18 months after the last woman was treated. SETTING: Teaching Hospital. SUBJECTS: Fifty consecutive women with refractory anovulatory infertility (mean duration 5.3 (SD 3.5) years). All had been treated unsuccessfully with anti-oestrogens and more than half with gonadotrophins. INTERVENTIONS: Laparoscopic ovarian diathermy. MAIN OUTCOME MEASURES: Ovulatory cycles and pregnancies. RESULTS: Forty-three women (86%) ovulated following ovarian diathermy; the mean time to ovulation was 23 (SD 6.2) days. Three nonresponders ovulated following anti-oestrogen treatment to which they were previously resistant. Thirty-three women have conceived 58 pregnancies; 22 had no treatment other than ovarian diathermy prior to their first post-operative conception; in seven an anti-oestrogen was given because of lengthening cycles; two were treated elsewhere with gonadotrophins without prior postdiathermy anti-oestrogen therapy and conceived; four had the operation repeated and two of these conceived. Twenty-six women conceived within the first 8 post-operative months. Forty-two pregnancies ended in the birth of normal live healthy babies, eight are ongoing and eight miscarried. Of the 22 women who had no pelvic abnormality other than polycystic ovaries, 19 (86%) have had one or more successful pregnancies. CONCLUSION: Laparoscopic ovarian diathermy is a very effective treatment for anti-oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome and should be considered as the next step in those who fail to respond to anti-oestrogen treatment.

Lack of normal increase in saliva estriol/progesterone ratio in women with labor induced at 42 weeks' gestation.

Saliva specimens were collected approximately every 6 hours from day 280 to day 294 by 16 women who labored on day 294. There was a normal rise in the mean saliva estriol/progesterone ratio in the six who went into labor spontaneously but no change in the 10 whose labor was induced.

The pathogenesis of the ovarian hyperstimulation syndrome (OHS): a possible role for ovarian renin.

Two patients with severe ovarian hyperstimulation syndrome are described. Increased plasma concentrations of immunoradiometrically determined total renin are shown, together with greatly increased plasma levels of active renin and aldosterone. These very high values for total renin, renin activity and aldosterone were not suppressed when extracellular compartments were greatly expanded; the values subsequently declined to normal levels, despite the use of diuretics. This suggested that the renin was of non-renal origin since its production was apparently unaffected by influences which control juxtaglomerular secretion. The high concentrations of the renin-angiotensin-aldosterone system suggest that it contributes to the genesis of the ovarian hyperstimulation syndrome.

The increase in plasma and saliva cortisol levels in pregnancy is not due to the increase in corticosteroid-binding globulin levels.

Total and free cortisol levels are significantly elevated in pregnancy, but the reasons for this are not clear. The relationships between the diurnal variation in saliva (free) cortisol and baseline levels of total cortisol, corticosterone-binding globulin (CBG), progesterone, and estrogens were studied in several groups of women (normal nonpregnant, taking a combined oral contraceptive pill, after superovulation therapy, during early and late pregnancy, and postpartum). Saliva cortisol levels were significantly elevated in late pregnancy throughout the day, with preservation of diurnal variation. Total cortisol and CBG levels were also significantly raised in pregnancy, but total cortisol levels were normal in women taking a combined oral contraceptive pill in spite of significantly elevated CBG. There was no relationship between saliva cortisol and progesterone levels, and it is unlikely that the increase in cortisol is due to displacement of cortisol from CBG by progesterone. Cortisol levels fell slowly postpartum over several days, making it improbable that the increase in cortisol is solely due to elevated CRH levels. It appears that increased free and total cortisol levels in pregnancy are related to resetting of the sensitivity of the hypothalamic-pituitary-adrenal axis and not merely to raised CBG, progesterone, or CRH levels.

Serial adrenal ultrasonography in normal neonates.

Six serial ultrasound scans were performed on each of 12 healthy term babies on days 1, 3, 5, 11, 21, and 42 of extrauterine life in order to determine normal neonatal values for various adrenal parameters. Measurements were made of transverse and anteroposterior diameters, of circumference and area in the transverse plane, and of longitudinal length of the adrenals and kidneys. There was a significant decrease in all adrenal parameters of 22%, 25%, 25%, 44%, and 34%, respectively, between days 1 and 5 (p less than .002) and of 46%, 39%, 46%, 67%, and 55%, respectively, between days 1 and 42 (p less than .00005), whereas the kidneys increased in size over the same period.

Laparoscopic ovarian diathermy in the management of anovulatory infertility in women with polycystic ovaries: endocrine changes and clinical outcome.

Twenty-one nulliparous oligomenorrheic women with polycystic ovaries, complaining of infertility (mean duration 6 years) refractory to medical treatment, underwent laparoscopic ovarian diathermy. Eleven had adhesions and/or endometriosis. Regular ovulatory cycles ensued in 17 women (81%). In 9 responders there was a transient rise in mean follicle-stimulating hormone from 5.0 +/- 0.4 (standard error of the mean [SEM]) to 6.7 +/- 0.5 mIU/mL on postoperative day 1 and a fall in testosterone from 2.6 +/- 0.2 to 1.9 +/- 0.2 nmol/L by day 8. Luteinizing hormone fell from 19 +/- 1.2 to 10.4 +/- 1.2 mIU/mL by the follicular phase of the next cycle. Eleven women have conceived 13 pregnancies; 3 miscarried, 7 were delivered at term and 3 are ongoing. Ovarian diathermy is a useful option in women with polycystic ovaries complaining of refractory anovulatory infertility.

Diurnal variation of plasma and saliva oestrogen, progesterone, cortisol and plasma dehydroepiandrosterone sulphate in late pregnancy.

The diurnal variation of plasma oestrone (E1), oestradiol (E2), oestriol (E3), progesterone (P), cortisol (F) and dehydroepiandrosterone sulphate (DHAS) and saliva E1, E2, E3, P and F was investigated in matched plasma, and saliva samples were obtained hourly from 08.00 to 24.00 h and at 04.00, 07.00 and 08.00 h from nine pregnant women (3 at 30, 3 at 34 and 3 at 38 weeks gestation). A diurnal variation in plasma and saliva cortisol levels was found in all subjects and in plasma DHAS in 8 out of 9 subjects. No consistent diurnal variation was found at any gestation in any of the other hormones in plasma or saliva. There was a significant correlation between saliva E3 and P levels at 30 weeks gestation but no other consistent correlations between hormone levels were found at any gestation.

Saliva oestriol, oestradiol, oestrone and progesterone levels in pregnancy: spontaneous labour at term is preceded by a rise in the saliva oestriol:progesterone ratio.

Saliva steroid levels reflect the unbound unconjugated (free, biologically active) plasma hormone levels. Saliva oestriol (E3), oestradiol (E2), oestrone (E1) and progesterone levels were estimated by radioimmunoassay in saliva samples obtained twice a week from 18 weeks gestation until 38 days before delivery and then daily until the spontaneous onset of labour at term from 20 normal pregnant women. The overall percentage increases in the median concentrations of E3, E2, E1 and progesterone were 718, 370, 80 and 214%, respectively, in the last 20 weeks and 149, 82, 24 and 41%, respectively, in the last 6 weeks of pregnancy. The median E3:progesterone ratio rose slowly from 0.65 at 20 weeks before delivery to 1.0 at 5 weeks before delivery and then rapidly to 1.65 one day before the spontaneous onset of labour. There was an increase in the E3:progesterone ratio from less than 1 to greater than 1 before labour in every subject.

Increased saliva oestriol to progesterone ratio before preterm delivery: a possible predictor for preterm labor?

Saliva oestriol, oestradiol, and progesterone concentrations were measured in 23 women who went into spontaneous preterm labour. The patients fell clinically and biochemically into two groups. The 13 who went into preterm labour with intact membranes had a saliva oestriol to progesterone ratio greater than one in every case and greater than the 95th centile for their length of gestation in 12 cases; by contrast, all those who went into spontaneous preterm labour after prolonged rupture of the membranes had an oestriol to progesterone ratio less than one and below the 50th centile for their period of gestation in the one to four days before delivery. Saliva oestradiol to progesterone ratios were randomly distributed throughout the normal range in both groups. It appears that preterm labour without prior prolonged rupture of the membranes is, like term labour, preceded by an increase in the saliva oestriol to progesterone ratio. It may therefore be possible to use this ratio to predict preterm labour.

A comparison of saliva, plasma unconjugated and plasma total oestriol levels throughout normal pregnancy.

Saliva unconjugated, plasma unconjugated and plasma total oestriol (E3) levels were measured longitudinally, by radioimmunoassay, in 25 normal women from 13 weeks gestation until delivery. The increase in salivary unconjugated oestriol closely paralleled that of plasma unconjugated oestriol and to a lesser extent that of plasma total oestriol. In each patient the percentage value of salivary E3/plasma unconjugated E3 x 100 was virtually constant throughout pregnancy but this percentage varied from one patient to another (mean 14.4%). The overall correlation coefficient (r) for salivary and plasma unconjugated E3 was 0.90. The variability in salivary levels in samples collected at daily, hourly, 15 min and 5 min intervals (12.7, 13.4, 10.1 and 9.3%) was similar to that previously described for plasma unconjugated E3. There was no distinct pattern in diurnal variation. It seems probable that measurement of salivary E3 could adequately replace that of plasma unconjugated E3 in the assessment of fetoplacental function.

Increasing saliva (free) oestriol to progesterone ratio in late pregnancy: a role for oestriol in initiating spontaneous labour in man?

Oestriol and progesterone concentrations were measured in samples of saliva obtained daily from six normal women during the final four weeks before the spontaneous onset of labour. Progesterone concentrations were found to plateau whereas oestriol concentrations continued to rise so that the mean ratio of saliva oestriol to progesterone increased from 0.80 to 1.43 between 29 days and one day before labour. Saliva oestriol concentrations were 15 times higher than saliva oestradiol concentrations. As saliva steroid concentrations reflect the unbound unconjugated (free) plasma steroid concentrations these data suggest that a changing ratio of oestriol to progesterone may play a part in initiating spontaneous labour in man.

Oestrone, oestradiol and oestriol glucosiduronates and sulphates in human puerperal plasma and milk.

Conjugated and unconjugated oestrone, oestradiol and oestriol were measured in simultaneous milk and plasma samples obtained from 21 women in the early post-partum period. Conjugated oestrogens comprised more than 90% of the total oestrogen content of both milk and plasma. Oestrone glucosiduronate was the major oestrogen metabolite in milk (33%), the levels being significantly higher (P less than 0.01) than in plasma. Oestriol glucosiduronates were the predominant oestrogen metabolites (63%) in plasma.