Fetal Prolactin Research Articles

Melatonin and the development of circadian and seasonal rhythmicity

We have investigated whether the maternal melatonin rhythm provides the fetus with either a circadian or seasonal 'signal' during development. Our findings provide evidence that melatonin can generate and entrain the early evening peak in the daily rhythm of fetal breathing movements. In contrast, daily variations in maternal and fetal prolactin concentrations are present in pinealectomized ewes, are altered by changes in the time of onset of darkness, but are unaltered by changes in the phase of the daily melatonin rhythm. The mechanisms that generate and control the daily prolactin rhythm before and after birth are therefore unknown. It is clear from a number of studies that the duration of the nocturnal melatonin signal provides the adult and fetal sheep with photoperiodic information. We investigated whether there are differences in the fetal plasma concentrations of prolactin in ewes held in long and short photoperiods after surgical disconnection of the fetal hypothalamus and pituitary and demonstrated that there was a fetal prolactin response to the external photoperiod in sheep fetuses in which the hypothalamo-pituitary axis was either intact or surgically disconnected. We have suggested that one potential extrahypothalamic site of action of maternal melatonin is at the pars tuberalis of the fetal pituitary. It appears therefore that there are a number of different mechanisms for the neuroendocrine transmission of information about the time of day and duration of the external photoperiod to the sheep fetus throughout late gestation.

Influence of Estradiol and Fetal Stress on Luteinizing Hormone, Follicle-Stimulating Hormone, and Prolactin in Late-Gestation Fetal Sheep

Background: Hypotension and reduced cerebral blood flow secondary to brachiocephalic occlusion (BCO) stimulate various homeostatic physiological and endocrine responses. Our previous studies have also suggested a role of estradiol in augmenting the fetal stress response to BCO. Objectives: We tested the hypothesis that gonadotropins and/or prolactin (PRL) are upregulated in fetal pituitary in response to fetal stress and play a role in the response to BCO-induced stress. Methods: We performed 3 studies: one in which we measured ovine fetal pituitary PRL, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) mRNA throughout the latter half of gestation in order to better understand the ontogenetic changes upon which dynamic responses are superimposed; one in which we measured these mRNA abundances in response to BCO and/or estrogen treatment, and one in which we measured plasma LH responses to BCO in chronically catheterized late-gestation fetal sheep. Results: PRL gene expression is increased dramatically in the last 20% of gestation. LH and FSH mRNAs were unchanged except for a transient dip in the expression of LH in the last few days before the normal time of spontaneous parturition. Chronic treatment with estradiol decreased LH and FSH mRNA, but increased PRL mRNA abundance after BCO. In contrast, BCO alone increases the abundance of LH, but not FSH or PRL mRNA in fetal pituitary. Plasma LH concentrations were not increased in response to BCO. Conclusions: We conclude that the late-gestation fetal sheep responds to hypotensive stress with increases in LH mRNA but not LH secretion. LH, FSH and PRL changes are therefore unlikely to contribute to the fetal response to cerebral hypoperfusion.

Regulation of baboon fetal pituitary prolactin expression by estrogen.

We previously showed that fetal adrenal fetal zone growth was increased and the number of follicles in the fetal ovary reduced in baboons in which estradiol was suppressed by treatment with the aromatase inhibitor letrozole between mid and late gestation periods. Because adrenal/ovarian development was restored in animals treated with letrozole and estradiol, and both tissues express estrogen receptor, we proposed that estrogen regulates fetal adrenal/ovary development via a direct action. However, because prolactin can modulate fetal adrenal and adult pituitary/ovarian function, the current study determined whether estrogen action involved estradiol-regulated changes in fetal prolactin/luteinizing hormone (LH) expression. Fetal prolactin levels and the number of prolactin-positive fetal pituitary cells (per 0.37 mm(2)) were increased (P < 0.01) between mid (6 +/- 1 ng/ml; 15.8 +/- 2.4) and late (257 +/- 28 ng/ml; 57.3 +/- 5.1) gestation, reduced (P < 0.01) in late-gestation fetuses in which estradiol was suppressed (>95%) by letrozole (61 +/- 11 ng/ml; 19.3 +/- 2.0), and minimally but not significantly increased by letrozole and estradiol (99 +/- 11 ng/ml; 32.7 +/- 5.2). In contrast, the number of LH-positive fetal pituitary cells decreased (P < 0.01) between mid (48.8 +/- 9.5) and late (17.4 +/- 3.2) gestation, remained elevated (P < 0.01) in estrogen-suppressed animals (56.6 +/- 5.1), and was partially but not significantly decreased by letrozole-estradiol (28.8 +/- 5.2). We conclude that estrogen regulates fetal pituitary prolactin and LH expression and fetal prolactin levels. However, because prolactin and LH expressions in estrogen-suppressed fetuses were inversely related to previously demonstrated changes in adrenal/ovarian development, we propose that estrogen regulates the fetal ovary and adrenal gland directly and not via action on the fetal pituitary gland.

Hormonal Regulation of Prolactin Cell Development in the Fetal Pituitary Gland of the Mouse

The developmental process of prolactin (PRL) cells in the fetal pituitary gland was studied in mice. Although PRL cells were hardly detectable in the pituitary gland of intact fetuses, a treatment with 17beta-estradiol (E(2)) in vitro induced a number of PRL cells that varied drastically in number depending on the stage of gestation with a peak at embryonic d 15. This effect was specific to E(2), with epidermal growth factor, insulin, and forskolin failing to induce PRL cells. Although both estrogen receptor (ER)alpha and ERbeta were expressed in the fetal pituitary gland, the results from ER knockout models showed that only ERalpha mediates E(2) action on PRL cells. A few PRL cells were observed in ERalpha-deficient mice as well as in their control littermates, suggesting that estrogen is not required for the phenotype determination of PRL cells. Unexpectedly, the effect of E(2) on the induction of PRL cells in vitro was diminished after embryonic d 15. Present results suggest that the exposure of fetal PRL cells to glucocorticoids (GCs) results in a reduction of sensitivity to E(2). The mechanism underlying the down-regulation of estrogen sensitivity by GCs was found not to be down-regulation of ER levels, induction of annexin 1, a GC-inducible inhibitor of PRL secretion, or a decrease in the number of PRL precursors by apoptosis. The effect of GCs appeared within 2 h and did not require a de novo protein synthesis. GCs are considered to be involved in the mechanisms of silencing pituitary PRL in gestation possibly through a novel mechanism.

Prolactin and the expression of suppressor of cytokine signaling-3 in the sheep adrenal gland before birth

The fetal pituitary-adrenal axis plays a key role in the fetal response to intrauterine stress and in the timing of parturition. The fetal sheep adrenal gland is relatively refractory to stimulation in midgestation (90-120 days) before the prepartum activation, which occurs around 135 days gestation (term=147+/-3 days). The mechanisms underlying the switch from adrenal quiescence to activation are unclear. Therefore, we have investigated the expression of suppressor of cytokine signaling-3 (SOCS-3), a putative inhibitor of tissue growth in the fetal sheep adrenal between 50 and 145 days gestation and in the adrenal of the growth-restricted fetal sheep in late gestation. SOCS-3 is activated by a range of cytokines, including prolactin (PRL), and we have, therefore, determined whether PRL administered in vivo or in vitro stimulates SOCS-3 mRNA expression in the fetal adrenal in late gestation. There was a decrease (P<0.005) in SOCS-3 expression in the fetal adrenal between 54 and 133 days and between 141 and 144 days gestation. Infusion of the dopaminergic agonist, bromocriptine, which suppressed fetal PRL concentrations but did not decrease adrenal SOCS-3 mRNA expression. PRL administration, however, significantly increased adrenal SOCS-3 mRNA expression (P<0.05). Similarly, there was an increase (P<0.05) in SOCS-3 mRNA expression in adrenocortical cells in vitro after exposure to PRL (50 ng/ml). Placental and fetal growth restriction had no effect on SOCS-3 expression in the adrenal during late gestation. In summary, the decrease in the expression of the inhibitor SOCS-3 after 133 days gestation may be permissive for a subsequent increase in fetal adrenal growth before birth. We conclude that factors other than PRL act to maintain adrenal SOCS-3 mRNA expression before 133 days gestation but that acute elevations of PRL can act to upregulate adrenal SOCS-3 expression in the sheep fetus during late gestation.

Overnourishing pregnant adolescent ewes preserves perirenal fat deposition in their growth-restricted fetuses

Overnourishing the adolescent sheep promotes rapid maternal growth at the expense of the gravid uterus. The growth of the placenta is impaired and results in the premature delivery of low-birthweight lambs. The present study details fetal adipose tissue development in these growth-restricted pregnancies. Singleton pregnancies were established by embryo transfer and, thereafter, adolescent ewes were offered a high (H; n = 12) or moderate (M; n = 14) level of a complete diet until necropsy on Day 131 of gestation. Fetal weight was lower (P < 0.001) in H compared with M groups. High maternal intake preserved brain and perirenal fat weight (P < 0.003), whereas relative weights of the heart, lungs, spleen and liver were unaltered. High nutrient intake resulted in significantly elevated maternal plasma concentrations of insulin, leptin, prolactin and glucose, no significant changes in fetal insulin, leptin or non-esterified fatty acids and attenuated fetal prolactin concentrations. Irrespective of nutritional intake, maternal plasma leptin, prolactin and glucose concentrations were negatively correlated with fetal weight and were positively correlated with fetal perirenal fat proportion (all P < 0.01). The mRNA expression for leptin, prolactin receptor and uncoupling protein (UCP) 1 in fetal perirenal fat was equivalent between groups, but, irrespective of maternal nutrition, UCP1 mRNA levels were negatively correlated with fetal weight (P < 0.01). Thus, overnourishing pregnant adolescent sheep preserves fat deposition in their growth-restricted fetuses, which may have implications for neonatal thermogenesis and for programming of postnatal adiposity.

Differential regulation of suppressor of cytokine signaling-3 in the liver and adipose tissue of the sheep fetus in late gestation

It is unknown whether the JAK/STAT/suppressor of cytokine signaling-3 (SOCS-3) intracellular signaling pathway plays a role in tissue growth and metabolism during fetal life. We investigated whether there is a differential profile of SOCS-3 expression in the liver and perirenal adipose tissue during the period of increased fetal growth in late gestation and the impact of fetal growth restriction on SOCS-3 expression in the fetal liver. We also determined whether basal SOCS-3 expression in the fetal liver and perirenal adipose tissue is regulated by endogenous fetal prolactin (PRL). SOCS-3 mRNA abundance was higher in the liver than in the pancreas, spleen, and kidney of the sheep fetus during late gestation. In the liver, SOCS-3 mRNA expression was increased (P < 0.05) between 125 (n = 4) and 145 days (n = 7) gestation and lower (P < 0.05) in growth-restricted compared with normally grown fetal sheep in late gestation. The relative expression of SOCS-3 mRNA in the fetal liver was directly related to the mean plasma PRL concentrations during a 48-h infusion of either a dopaminergic agonist, bromocriptine (n = 7), or saline (n = 5), such that SOCS-3 mRNA expression was lower when plasma PRL concentrations decreased below approximately 20 ng/ml [y = 0.99 - (2.47/x) + (4.96/x(2)); r(2) = 0.91, P < 0.0001, n = 12]. No relationship was shown between the abundance of phospho-STAT5 in the fetal liver and circulating PRL. SOCS-3 expression in perirenal adipose tissue decreased (P < 0001) between 90-91 (n = 6) and 140-145 days (n = 9) gestation and was not related to endogenous PRL concentrations. Thus SOCS-3 is differentially expressed and regulated in key fetal tissues and may play an important and tissue-specific role in the regulation of cellular proliferation and differentiation before birth.

Prolactin (PRL)-releasing peptide stimulates PRL secretion from human fetal pituitary cultures and growth hormone release from cultured pituitary adenomas.

The hypothalamic peptide PRL-releasing peptide (PrRP) has recently been cloned and identified as a ligand of an orphan pituitary receptor that stimulates in vitro PRL secretion. PrRP also induces PRL release in rats in vivo, especially in normal cycling females. However, no information on the effects of PrRP in the human is available. To elucidate the role of PrRP in regulating human anterior pituitary hormones, we used human PrRP-31 in primary cultures of human pituitary tissues, including fetal (20--27 weeks gestation) and normal adult pituitaries, as well as PRL- and GH-secreting adenomas. PrRP increased PRL secretion from human fetal pituitary cultures in a dose-dependent manner by up to 35% (maximal effect achieved with 10 nM), whereas TRH was slightly more potent for PRL release. Coincubation with estradiol resulted in enhanced fetal PRL response to PrRP, and GH release was only increased in the presence of estradiol. Although PRL secretion from PRL-cell adenomas was not affected by PrRP, PrRP induced PRL release from cultures of a GH-cell adenoma that cosecreted PRL. PrRP enhanced GH release in several GH-secreting adenomas studied by 25--27%, including GH stimulation in a mixed PRL-GH-cell tumor. These results show for the first time direct in vitro effects of PrRP-31 on human pituitary cells. PrRP is less potent than TRH in releasing PRL from human fetal lactotrophs and is unable to release PRL from PRL-cell adenomas in culture, but stimulated GH from several somatotroph adenomas. Thus, PrRP may participate in regulating GH, in addition to PRL, in the human pituitary.

Maturation of cytokine receptors in preparation for birth

The elucidation of the tissue-specific profile of expression of the prolactin (PRL) and growth hormone (GH) receptors during embryonic and fetal development in a range of species has provided a new impetus for the delineation of the specific roles of the hormone ligands for these receptors in development. During late gestation, there is a requirement to shift from a phase of predominant cellular proliferation, where placental nutrient supply is a dominant influence on organ and body growth, to one of functional differentiation, which is required for independent homoeostasis after birth. In this review we discuss the interactions between the pre-partum increases in cortisol and thyroid hormones and the synthesis, secretion and actions of fetal PRL and GH. We also review the changes that occur in the tissue-specific expression of the PRL and GH receptors before birth which may play an important role in precocial species in the successful transition of the fetus to extra-uterine life.

Maturation of cytokine receptors in preparation for birth.

The elucidation of the tissue-specific profile of expression of the prolactin (PRL) and growth hormone (GH) receptors during embryonic and fetal development in a range of species has provided a new impetus for the delineation of the specific roles of the hormone ligands for these receptors in development. During late gestation, there is a requirement to shift from a phase of predominant cellular proliferation, where placental nutrient supply is a dominant influence on organ and body growth, to one of functional differentiation, which is required for independent homoeostasis after birth. In this review we discuss the interactions between the pre-partum increases in cortisol and thyroid hormones and the synthesis, secretion and actions of fetal PRL and GH. We also review the changes that occur in the tissue-specific expression of the PRL and GH receptors before birth which may play an important role in precocial species in the successful transition of the fetus to extra-uterine life.

Restriction of fetal growth has a differential impact on fetal prolactin and prolactin receptor mRNA expression.

Prolactin is present in the fetal circulation and prolactin receptors are expressed in a wide range of fetal tissues. The factors which regulate the synthesis and secretion of prolactin, and the expression of its receptors before birth, are poorly understood. We have investigated whether experimental restriction of placental growth in the sheep has an impact on the prolactin axis in the growth restricted fetus. The majority of uterine endometrial caruncles were removed before pregnancy in 10 ewes (placental restriction; PR group). Placental, fetal liver and kidney weights were reduced in the PR compared to the control group (n = 10). The ratio of fetal prolactin mRNA : 18S rRNA was significantly lower (P < 0.01) in the PR group (1.83 +/- 0.45, n = 6) than in the control group (4.11 +/- 0.54, n = 6). The ratio of prolactin mRNA : 18S rRNA in the fetal pituitary was positively correlated with fetal and with placental weight. Using stepwise linear regression, it was determined that the level of fetal prolactin mRNA : 18S rRNA expression was best described (as judged by the maximum adjusted R2) by prolactin mRNA: 18 S rRNA = - 3.0378 + 0.17 PO2 + 2.772 glucose (adjusted R2 = 0.765, F = 17.53, P < 0.001). Fetal plasma prolactin concentrations were significantly reduced (P < 0.05) in the PR group compared to control animals between 109 and 141 days gestation. Fetal prolactin receptor (PRLR) mRNA transcripts encoding long (PRLR1) and short forms (PRLR2) of PRLR were present in the liver and kidney of animals in the PR and control groups at 140-141 days gestation. PR did not alter the levels of PRLR1 or PRLR2 mRNA in the fetal liver or kidney. The suppression of the synthesis and secretion of prolactin in the growth restricted fetus may limit the action of prolactin on the growth and metabolism of key fetal organs during suboptimal intrauterine conditions

Restriction of Fetal Growth has a Differential Impact on Fetal Prolactin and Prolactin Receptor mRNA Expression

AbstractProlactin is present in the fetal circulation and prolactin receptors are expressed in a wide range of fetal tissues. The factors which regulate the synthesis and secretion of prolactin, and the expression of its receptors before birth, are poorly understood. We have investigated whether experimental restriction of placental growth in the sheep has an impact on the prolactin axis in the growth restricted fetus. The majority of uterine endometrial caruncles were removed before pregnancy in 10 ewes (placental restriction; PR group). Placental, fetal liver and kidney weights were reduced in the PR compared to the control group (n = 10). The ratio of fetal prolactin mRNA : 18S rRNA was significantly lower (P &lt; 0.01) in the PR group (1.83 ± 0.45, n = 6) than in the control group (4.11 ± 0.54, n = 6). The ratio of prolactin mRNA : 18S rRNA in the fetal pituitary was positively correlated with fetal and with placental weight. Using stepwise linear regression, it was determined that the level of fetal prolactin mRNA : 18S rRNA expression was best described (as judged by the maximum adjusted R2) by prolactin mRNA: 18 S rRNA = − 3.0378 + 0.17 PO2 + 2.772 glucose (adjusted R2 = 0.765, F = 17.53, P &lt; 0.001). Fetal plasma prolactin concentrations were significantly reduced (P &lt; 0.05) in the PR group compared to control animals between 109 and 141 days gestation. Fetal prolactin receptor (PRLR) mRNA transcripts encoding long (PRLR1) and short forms (PRLR2) of PRLR were present in the liver and kidney of animals in the PR and control groups at 140–141 days gestation. PR did not alter the levels of PRLR1 or PRLR2 mRNA in the fetal liver or kidney. The suppression of the synthesis and secretion of prolactin in the growth restricted fetus may limit the action of prolactin on the growth and metabolism of key fetal organs during suboptimal intrauterine conditions

Structural and ultrastructural studies of GH, PRL and SMT cells in goat fetus (Capra hircus) using immunocytochemical methods.

The first data based on immunolabeling techniques of goat fetus adenohypophysis show that the structure and ultrastructure of growth hormone (GH)-, prolactin (PRL)-, and GH- plus PRL-secreting cells (SMT cells) in fetuses aged 100 days differ from those in the adult. Both cell number and cell size are smaller in the fetus, and the percentage of dark cells decreases with development. The data do not support the hypothesis that SMT cells represent the common origin of GH- and PRL-cells.

Maternal-to-fetal transfer of thyrotropin-releasing hormone in vivo

Our purpose was to determine the transplacental transfer of thyrotropin-releasing hormone at the time of fetal blood sampling. Four hundred micrograms of thyrotropin-releasing hormone was given intravenously to 13 pregnant women between 24 and 35 weeks' gestation and maternal-to-fetal transfer of thyrotropin-releasing hormone was determined at fetal blood sampling 1 to 93 minutes later. The fetal thyrotropic response to thyrotropin-releasing hormone was determined by measuring thyroid-stimulating hormone, thyroxine, and prolactin. For comparison, endogenous fetal and maternal levels of thyrotropin-releasing hormone, thyroid-stimulating hormone, thyroxine, and prolactin levels were determined in a further 20 patients undergoing fetal blood sampling between 19 and 35 weeks' gestation. The concentration of thyrotrophin-releasing hormone was measured by radioimmunoassay and thyroid-stimulating hormone, thyroxine, and prolactin by chemiluminescence assay. Thyrotropin-releasing hormone was undetectable in the maternal circulation, whereas endogenous levels were detectable in the fetus from 19 weeks' gestation (median 150; range 50 to 276 pmol/L) and did not correlate with gestational age. After thyrotropin-releasing hormone injection as an intravenous bolus, peak levels in the mother were attained at 3 minutes (50,000 pmol/L). Maximal transplacental transfer of thyrotropin-releasing hormone occurred within 5 minutes of maternal administration but accounted in fetal blood for only 0.01% of initial dose administered (median 250; 30 to 550 pmol/L). Thyrotropin-releasing hormone-stimulated fetal peak thyroid-stimulating hormone levels occurred within 13 minutes and were higher than maternal values (p < 0.001). There was no change in fetal prolactin level with thyrotropin-releasing hormone therapy. Although maternally administered thyrotropin-releasing hormone crosses the placenta sparingly, it still elicits a thyroid-stimulating hormone but not a prolactin response in the human fetus.

Prolactin receptor expression in the developing mouse embryo.

We have examined the developmental pattern of prolactin receptor expression in the mouse by reverse transcription-polymerase chain reaction, in situ hybridization, and radioligand binding and have found two unexpected aspects of temporal regulation. First, high levels of prolactin receptor mRNA were detected in mouse embryos at day 8 and day 18, but levels decreased between these days to a minimum at approximately day 14. In contrast, placental prolactin receptor mRNA levels remained constant throughout this gestational period. Second, on embryonic day 16 the mRNA encoding the long form of the prolactin receptor is more abundant in the fetal liver than any of the short receptor form mRNAs, but by day 18 a switch occurs and the mRNA encoding one of the short receptor forms becomes the predominant receptor mRNA in that tissue. Expression of the receptor mRNA and protein is widespread throughout the fetus, with especially high levels in developing bone and cartilagenous structures, the thymus and pituitary, the tongue and skeletal muscle, and certain regions of the brain. The pattern of expression of prolactin receptor in the fetal mouse suggests an important role for the placental lactogens, the major ligands for fetal prolactin receptors, in fetal growth and development.

Effect of constant light on fetal and maternal prolactin rhythms in sheep

Effect of constant light on fetal and maternal prolactin rhythms in sheep

Effect of constant light on fetal and maternal prolactin rhythms in sheep.

A 24-h rhythm of plasma PRL is present in fetal sheep. This rhythm is synchronized to an environmental clue (zeitgeber). We determined whether the light-dark cycle (L:D) is a zeitgeber for the fetal PRL rhythm and, if so, whether the mother might convey this zeitgeber to the fetus. We kept nine ewes (twin pregnancies) in constant light (L:L) and five ewes (singleton) in 14:10 L:D from 110 days gestation. Fetuses and mothers were catheterized at 119 days gestation. Blood samples were taken hourly for 24 h after 16 days under L:L or L:D. A mean 24-h rhythm of PRL was found (by RIA) in fetuses under L:D, but not in those under L:L. However, fetuses under L:L showed individual 24-h PRL rhythms (cosinor analysis) whose acrophases were distributed around the clock. Nonsynchronized rhythms persisted after 23 and 30 days of L:L. Acrophases of PRL rhythms within a set of twins were closer than those between sets, suggesting that twins were responding to a common signal. These findings indicate that the L:D cycle is a zeitgeber for the PRL rhythm in fetal sheep and suggest that the mother might convey the zeitgeber.

Response of prolactin to different photoperiods after surgical disconnection of the hypothalamus and pituitary in sheep fetuses.

The aim of this study was to determine the impact of surgical disconnection of the fetal hypothalamus and pituitary on the fetal prolactin response to different photoperiods. Disconnection of the hypothalamus (HPD) or a sham operation was carried out at around day 110 of gestation (term = 145 +/- 3 days). Before surgery, pregnant ewes were maintained under a photoperiod of 12 h light:12 h dark. After surgery, ewes carrying HPD fetuses (n = 10) or intact fetuses (n = 13) were exposed to either a long day (16 h light:8 h dark) or a short day (8 h light:16 h dark) regimen until day 143 of gestation. Thyrotrophin-releasing hormone (50 micrograms) was administered intrafetally at days 130-135 of gestation and chlorpromazine (a dopaminergic antagonist) was administered to all sheep fetuses at days 141-142 of gestation. Mean fetal prolactin concentrations were significantly higher in the long day group (HPD: 37.3 +/- 11.3 ng ml-1; intact: 71.0 +/- 16.2 ng ml-1) than in the short day group (HPD: 9.0 +/- 4.8 ng ml-1; intact: 34.2 +/- 16.0 ng ml-1). In the intact group, fetal prolactin concentrations increased significantly between day 6 and day 30 of exposure to either photoperiod. However, in the HPD group, fetal prolactin increased with increasing exposure to the long day photoperiod and decreased with increasing exposure to the short day photoperiod.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of cervico-vaginal fetal fibronectin and prolactin for the prediction of prematurity in asymptomatic women

A comparison of cervico-vaginal fetal fibronectin and prolactin for the prediction of prematurity in asymptomatic women

A comparison of fetal fibronectin, prolactin, and cervical examination for the prediction of preterm delivery in symtomatic patients

A comparison of fetal fibronectin, prolactin, and cervical examination for the prediction of preterm delivery in symtomatic patients