Use of progesterone and progestin analogs for inhibition of preterm birth and other uterine contractility disorders

Keywords:

preterm birth, preterm labor, progesterone, uterine contractility, uterine EMG, myometrial contractility. 

R.E. Garfield, L. Shi, S-Q. Shi
Department of Obstetrics and Gynecology, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA 85004.

Correspondence at: robert.garfield@chw.edu

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.