title: Use of progesterone and progestin analogs for inhibition of preterm birth and other uterine contractility disorders.
abstract: In this paper we focus on preterm birth as a uterine contractility disorder caused by hypercontractility of the -myometrium. We describe changes in uterine function during term and preterm labor and delivery. We also examine the usefulness of measurement of uterine electromyographic (EMG) activity, noninvasively monitored from the -abdominal surface of pregnant patients. The use of progesterone treatment for preterm birth is discussed and we conclude that present therapies with progesterone could be improved by changing the route of administration. -Finally we show the results of recent studies that show that progesterone injections completely inhibit uterine EMG activity when given several days to hours before normal delivery. These studies illustrate how progesterone suppresses labor at term or preterm, probably through repression of genes which control excitability and conduction of electrical activity. However, direct profusion of soluble progesterone into the uterine cavity has little immediate inhibitory action and this may demonstrate that progesterone has no direct, nongenomic effects, at least in the rat model used. Further studies are required to determine the effects of progesterone on human uterine EMG activity and whether progesterone treatments will prevent preterm birth.
authors.affiliation: Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA 85004.
authors.forename: R E
authors.initials: RE
authors.lastname: Garfield
authors.affiliation: Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA 85004.
authors.forename: L
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA 85004.
authors.forename: S-Q
authors.initials: SQ
authors.lastname: Shi
keywords: Preterm birth; myometrial contractility; preterm labor; progesterone; uterine EMG; uterine contractility
references.citation: Am J Obstet Gynecol. 2008 Oct;199(4):391.e1-7
references.pmid: 18928984
references.citation: Ann Biomed Eng. 2007 Mar;35(3):465-73
references.pmid: 17226089
references.citation: Acta Obstet Gynecol Scand. 2011 Feb;90(2):150-7
references.pmid: 21241260
references.citation: Ann N Y Acad Sci. 1995 Jun 12;761:202-23
references.pmid: 7625722
references.citation: Science. 1977 Dec 2;198(4320):958-60
references.pmid: 929182
references.citation: Obstet Gynecol. 1997 Jul;90(1):102-11
references.pmid: 9207823
references.citation: Ann N Y Acad Sci. 1997 Sep 26;828:238-53
references.pmid: 9329845
references.citation: Mol Hum Reprod. 2000 Apr;6(4):382-9
references.pmid: 10729322
references.citation: Obstet Gynecol. 2003 Jun;101(6):1254-60
references.pmid: 12798533
references.citation: Am J Obstet Gynecol. 2008 Feb;198(2):235.e1-4
references.pmid: 18226633
references.citation: Am J Obstet Gynecol. 2003 Feb;188(2):419-24
references.pmid: 12592250
references.citation: Oxf Rev Reprod Biol. 1988;10:436-90
references.pmid: 3072507
references.citation: Am J Obstet Gynecol. 2007 May;196(5):453.e1-4; discussion 421
references.pmid: 17466698
references.citation: Am J Obstet Gynecol. 2011 Mar;204(3):228.e1-10
references.pmid: 21145033
references.citation: Am J Obstet Gynecol. 2011 Jul;205(1):82.e15-20
references.pmid: 21497789
references.citation: Mol Hum Reprod. 2011 Apr;17(4):233-42
references.pmid: 21131300
references.citation: Am J Obstet Gynecol. 1998 Mar;178(3):588-93
references.pmid: 9539530
references.citation: Am J Obstet Gynecol. 1981 Jun 1;140(3):254-60
references.pmid: 7246625
references.citation: Am J Physiol. 1989 Jan;256(1 Pt 1):C130-41
references.pmid: 2912131
references.citation: Hum Reprod Update. 1998 Sep-Oct;4(5):673-95
references.pmid: 10027621
references.citation: Am J Obstet Gynecol. 1998 Apr;178(4):811-22
references.pmid: 9579450
references.citation: J Matern Fetal Neonatal Med. 2004 May;15(5):297-301
references.pmid: 15280119
references.citation: Ultrasound Obstet Gynecol. 2011 Jul;38(1):18-31
references.pmid: 21472815
references.citation: Am J Obstet Gynecol. 1996 Feb;174(2):744-53
references.pmid: 8623816
references.citation: Am J Obstet Gynecol. 2005 Jul;193(1):23-9
references.pmid: 16021054
references.citation: Am J Physiol. 1985 Jul;249(1 Pt 1):C20-31
references.pmid: 3925788
references.citation: Am J Obstet Gynecol. 2010 May;202(5):455.e1-9
references.pmid: 20452487
references.citation: Am J Obstet Gynecol. 1984 Jul 1;149(5):485-91
references.pmid: 6742016
references.citation: N Engl J Med. 2003 Jun 12;348(24):2379-85
references.pmid: 12802023
references.citation: Ann N Y Acad Sci. 1994 Sep 30;734:387-413
references.pmid: 7978941
references.citation: Am J Obstet Gynecol. 1982 Jan 1;142(1):21-7
references.pmid: 7055167
references.citation: J Gen Physiol. 1982 Sep;80(3):353-75
references.pmid: 7142952
references.citation: J Perinat Med. 1998;26(6):413-36
references.pmid: 10224598
references.citation: Am J Obstet Gynecol. 1987 Nov;157(5):1281-5
references.pmid: 3688092
references.citation: Physiol Rev Suppl. 1962 Jul;5:213-27
references.pmid: 14470252
references.citation: Biophys J. 1996 Sep;71(3):1324-34
references.pmid: 8874006