Author/Editor     Gravett, Michael G
Title     Intrauterine infection and preterm delivery: insights into endocrine and immune mechanisms
Type     članek
Source     In: Novak-Antolič Ž, editor. Prezgodnji porod in nedonošenček. Zbornik prispevkov 8. Novakovi dnevi z mednarodno udeležbo; 2001 maj 31-jun 2; Maribor. Ljubljana: Slovensko zdravniško društvo, Združenje za perinatalno medicino,
Publication year     2001
Volume     str. 124-38
Language     eng
Abstract     In summary, preterm labor associated with intrauterine infection differs fundamentally from idiopathic preterm labor. Infection-induced preterm labor is characterized by seguential increases in amniotic fluid pro inflammatory cytokines and prostaglandins, followed by increases in uterine contractility. While there is evidence of fetal HPA activation, characterized by increases in fetal cortisol and adrenal androgens, there are no increases in placental estrogen biosynthesis characteristic of spontaneous parturition. It is likely that labor proceeds by alternative mechanisms involving direct stimulation of prostaglandin synthesis by pro inflammatory cytokines. If confirmed in human pregnancy, these fundamental differences in the pathophysiology of preterm labor may have profound implications for the diagnosis and management of preterm labor. For instance, salivary estriol has been demonstrated to be elevated among patients with idiopathic preterm labor. Based upon our observations, we would not expect salivary estriol to be elevated among patients with infection-induced preterm labor. It is possible, therefore, that salivary estriol, alone or in combination with other tests could, be utilized as a non-invasive test to distinguish between those patients with and without intrauterine infection. The recognition of the multifactorial etiologies and different pathophysiologic mechanisms of preterm labor also has therapeutic implications. Since estrogens serve to up regulate maternal oxytocin secretion and myometrial oxytocin receptors, oxytocin antagonists may be more useful in treating pretrm labor not associated with infection. (Abstract truncated at 2000 characters).
Descriptors     LABOR, PREMATURE
PREGNANCY COMPLICATIONS, INFECTIOUS
ENDOMETRITIS
MATERNAL-FETAL EXCHANGE
PREGNANCY
AMNIOTIC FLUID
CYTOKINES
PROSTAGLANDINS E