J.P. Sauvage

The significance of the human corpus luteum in pregnancy maintenance: I. Preliminary studies☆

Following the total removal of luteal tissue, circulating plasma progesterone, intrauterine pressure, oxytocin response, and clinical progress in abortion were determined sequentially in 12 first-trimester pregnant patients. 3 patients were ovariectomized for the removal of ovarian cysts and 9 were luteectomized during tubal ligation in an attempt to terminate pregnancy in spontaneous abortion. 7 patients had corpora lutea which averaged 21 plus or minus 1mm in diameter at operation when performed at Day 49 plus or minus 2 (mean S.E.) of pregnancy. These patients responded to ovariectomy or luteectomy by a continuing decrease in progesterone, evolution in intrauterine pressure, oxytocin response, progress in cervical dilitation and, abortion. Abortion occurred with a mean lapse time of 5 plus or minus 1 days after operation. In contrast, 5 patients whose corpora lutea averaged only 11 plus or minus 1mm in diameter when removed at Day 61 plus or minus 4 of pregnancy showed only transient decrease in progesterone after operation. This decrease was followed by an increase in progesterone; no progress in the evolution of intrauterine pressure, oxytocin response, cervical dilatation, and abortion. It appears that so long as the corpus luteum serves as the major source of progesterone, it is indispensable in the maintenance of pregnancy in human subjects as it is in the clinical model animal, the rabbit. However, with the shift of progesterone production from the corpus luteum to the placenta (the luteoplacental shift) the human corpus luteum becomes dispensable. These findings identify the corpus luteum and its secretory product, progesterone, as feasible targets of fertility control strategy.

The Evolution of Uterine Activity During Human Pregnancy

Recording intrauterine pressure in parturient patients firmly established the fact that uterine activity must reach a certain magnitude in order to initiate and promote clinical progress (Caldeyro-Barcia, 1960; Hendricks, 1960; Burnhill et al., 1962 a; Csapo et al., 1963 a; Csapo, 1964 a). This conclusion stands irrespective of the stage of gestation, the circumstances of the initiation of labor, or even the experimental conditions of the study. However, the methods of recording uterine activity and the analysis of the tracings being different, no general agreement has been reached as to what constitutes labor activity. Yet meaningful quantitation of the intrauterine pressure and the characterization of the quality of uterine activity is mandatory, if pressure tracings are to be used for diagnostic and prognostic purposes, or for the assessment of the regulatory conditions of labor. The biological process through which the uterine activity of labor develops, the “Evolution Process”, is the subject of the present study, prompted by the anticipation that the actiiity of labor may be better characterized by considering the nature of its evolution throughout pregnancy. By this study the complex

The efficacy and acceptability of intravenously administered prostaglandin F2α as an abortifacient

The efficacy and acceptability of PGF2alpha (prostaglandin F2alpha) as an abortifacient has been examined during intravenous infusion in 15 obstetrically normal midtrimester patients. Infusions of up to 200 mcg/minute of PGF2alpha induced complete abortions in 3 and incomplete abortions in an additional 3 patients. 4 patients failed to abort. All patients experienced undesirable side effects, i.e., nausea, vomiting, and diarrhea, in various degrees. This form of therapy cannot be recommended for routine therapeutic use; however, current clinical studies complemented by model experiments in animals suggest that the efficacy and acceptability of PGF2alpha can be increased by topical, intrauterine administration. Preliminary deductions pertinent to the mechanism of the abortifacient effect of PGF2alpha have been made based on measurements of intraamniotic pressure, circulating estradiol-17 beta, and progesterone levels.

Adrenoceptors involved in the contractile activity of isolated pregnant rat uterus

Cumulative log dose-response curves of soterenol, isoproterenol, phenylephrine and norepinephrine on isolated pregnant rat uterus at different days of gestation, were investigated. Soterenol produced a sustained inhibition of spontaneous motility during the whole pregnancy and this effect was blocked by butoxamine. The affinity of myometrium for the beta 2-adrenoceptor agonist was parallel to the concentration of progesterone in plasma during pregnancy. Isoproterenol, norepinephrine and phenylephrine caused dual, alpha- and beta-mediated responses, their relative dominance varied with the concentration and the days of pregnancy, alpha-Adrenoceptor effects of the amines coincided with increased plasma concentrations of estrogens, whereas beta ones were in parallel with the increment of plasma progesterone. It is concluded that: (a) there exist in the pregnant rat uterus beta 2-receptor-mediated responses influenced by the length of gestation; and (b) the concentration-pregnancy-dependent biphasic actions of isoproterenol, norepinephrine or phenylephrine suggest that their variable hormone-modulated ability interacts with both alpha- and beta-adrenoceptive uterine sites.

The relationship between progesterone, uterine volume, intrauterine pressure, and clinical progress in hypertonic saline—induced abortions

Abstract During hypertonic saline—induced abortions, intrauterine pressure (IUP) and plasma progesterone (P) have been measured and the uterine volume (V) estimated in 13 patients. During the initial third of the instillation-abortion time, the decrease in P was proportionately greater than the increase in IUP, indicating that P withdrawal precedes the evolution of IUP and clinical progress. In 2 additional patients, with low P levels, the evolution of IUP and abortion have been induced by a mere increase in V, using isotonic (rather than hypertonic) saline. In these 2 patients P withdrawal only manifested when the evolution of IUP approached completion. Since the changes in P did not account fully for the changes in IUP, the ratio V/P was calculated at various phases of hypertonic saline—induced abortion. It then became apparent that whenever V increases or P decreases markedly, without compensatory changes in P or V, the IUP evolves and pregnancy terminates. It is concluded that current concepts in myometrial regulation may be advanced by quantitating V and P in individual patients whose IUP is measured.

A high-risk pregnancy management protocol

A simple hihg-risk pregnancy management protocol is presented. Three basic quantitative tests of fetal-placental function are utilized. The advantages and proper application and interpretation of these laboratory tools are discussed. Perinatal outcome is analyzed in the initial 225 high-risk pregnancies managed according to the protocol. Over 94% of the infants achieved 5 minute Apgar scores of 8 or above. The corrected perinatal mortality rate was only 8.8 per 1,000 live births.