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

M.A Rubin,D Naidon,A.M Pereira,C.K Konopka,E.N Morais,J.F Oliveira,C.F Mello

doi:10.1590/1414-431x20122453

M.A Rubin, D Naidon + Show 5 more

Open Access

https://doi.org/10.1590/1414-431x20122453

Copy DOI

Abstract

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.

Highlights

Prostaglandins, PGF2 and PGE2, play an essential role in the process of human parturition by stimulating myometrial contractions [1] and cervical effacement [2]
A general trend towards a decrease in estrogen levels from admission to labor was found in the current study irrespective of outcome classification, no differences between groups were found in the post hoc analysis, confirming similar literature findings showing that estrogen levels do not change between the last weeks of gestation and labor [10] or preceding labor when compared to immediately before birth [13]
Some studies have found no differences in maternal progesterone levels during spontaneous labor [12,13]

Summary

Introduction

Prostaglandins, PGF2 and PGE2, play an essential role in the process of human parturition by stimulating myometrial contractions [1] and cervical effacement [2]. Due to these properties, dinoprostone, a PGE2 analog, has become the gold standard for the induction of labor in patients with high risk pregnancies [3]. Up to 33% of the patients who do not reach labor spontaneously do not respond to induction with prostaglandins and/or oxytocin [4]. Progesterone-mediated quiescence seems to involve the maintenance of a decreased inflammatory responsiveness, no study has addressed whether inflammatory mediators can alter progesterone, estradiol and Received June 10, 2012.

Objectives

Methods

Conclusion