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Progesterone: Its Regulatory Effect on the Myometrium
FERTILITY AND STERILITY
Copyright., 1971 by The Williams & Wilkins Co.
Vol. 22, No.4, April 1971 Printed in U.SA.
Book Reviews Progesterone: Its 1legulatory Effect timing of its own delivery through changes on the Myometrium. Ed. by G. E. W. in steroid metabolism within the fetoplaWOLSTENHOLME, AND J. KNIGHT. Ciba cental unit. They remind us of the associaFoundation Study Group 34. The Wil- tion of enlarged fetal adrenal glands and liams & Wilkins Company, Baltimore, "unexplained" premature labor and the 1969, 187pp.,$7.00. association of the adrenal hypoplasia of This is the 34th in a series of book-form anencephalic fetuses and postmaturity. summaries of Study Conferences spon- They point out that prolonged pregnancy sored by Ciba. The meeting was held on is associated with persistently low levels of uterine contractility throughout gestaMay 14, 1969. The book opens with a eulogy to the tion and with a low urinary estriol excrelate Dr. Brenda Schofield by Professor tion at the 34th and 37th weeks. 5) T. D. Kerenyi, C. A. Pinto-Dantas, O. E. C. Amoroso and by Professor A. Csapo. de Sousa, and E. Darze report on studies The format of these meetings is the of activity of the nonpregnant uterus durpresentation of a paper followed by a dising the menstrual cycle and in response to cussion. exogenous progesterone. They contend The first and last presentations, "The that single 50 mg. intramuscular injections Four Direct Regulatory Factors of Myoof progesterone result in suppression of metrial Function" (Csapo) and "Uterine uterine activity for at least 24 hr. Activity in Late Pregnancy" (Wood) are 6) M. O. Pulkkinen discusses studies on fine review articles complete with 92 references. In between there are six articles. patients having therapeutic abortions by Three of these six articles deal with ani- intra-amniotic saline injections. He asserts that simultaneous measurements of intramal studies. 1) W. G. Wiest reports that the blocking uterine pressures and plasma progesterone effect of progesterone on the uterine mus- levels in these patients revealed that a fall cle of rats resides in the progesterone mol- in progesterone levels precedes the evolution of uterine activity. ecule itself. The raison d'etre for publication of 2) D. G. Porter states that progesterone has no effect on the uterine muscle activ- these study meetings is not the articles, for ity of guinea pigs, even in large doses, and they contain negligible new information. whether or not the animal was pregnant. They are for the most part recapitulations 3) J. M. Marshall discusses the finding of previously published work. The value that in rabbits, the response of the uterus to the reader resides in the discussions, to stimulation of its adrenergic nerves or where the participants criticize, analyze, to the administration of adrenergic amines and speculate on the individual presentais excitatory in estrogen-dominated and in- tions. Herein are the nuggets and pearls, hibitory in progesterone-dominated ani- and at this meeting some very important statements are found in the discussions. mals. Three are devoted to human studies. The central theme of this meeting (as 4) A. C. Turnbull and A. B. M. Ander- was that of the 1961 meeting funded by son review the evidence suggesting that Ciba: Progesterone and the Defense Mechthe fetus makes a vital contribution to the amsm of Pregnancy) is Professor Csapo's 278
April 1971
BOOK REVIEWS
perseverance in asserting that progesterone is the controller of myometrial regulation. Most of the six presentations are offered in support of this thesis. In the discussions, attacks on this support are vigorous and most enlightening: 1) Dr. I. F. Sommerville presents his studies which show that the plasma concentration of progesterone in peripheral venous blood does not fall significantly prior to spontaneous labor in women. 2) Csapo and Pulkkinen contend that in abortions induced by intra-amniotic saline, there is a decrease in plasma progesterone concentration 4 hr. after the saline injection and before there is a significant increase in uterine activity. To this contention, Turnbull asserts that in his experience in over 200 cases of saline terminations of pregnancy, uterine contractions begin to appear within 40 min. after the saline is injected. He also states that intra-amniotic saline causes a hypernatremia which may interfere with the measurement of progesterone and that these women are very thirsty and drink a great deal; thus they may increase their serum volume, accounting for an apparent fall in plasma progesterone levels. Dr. Short points out that Pulkkinen's data do not answer the crucial question whether progesterone levels fall significantly before or after the increase in uterine contractility. He states that his studies on uterine vein blood revealed that uterine contractions preceded any significant fall in the progesterone concentration. Short also reminds us that although there is a spectacular rise of progesterone in the peripheral blood during human pregnancy, there is no such increase in the pregnant monkey. He asserts that peripheral blood levels of progesterone may be much less informative than progesterone levels in the uterus. In many species, such as the cow and the goat, where the concentrations of progesterone are no higher during pregnancy
279
than in the nonpregnant state, the animals manage their pregnancies quite happily. Why pay $7.00 for this little 187 page booklet? In my opinion, it's worth the price-if you enjoy reading evidence presented to infuse Professor Csapo's long ballooning theory of progesterone dominance and then see critical needles collapse it; if you wish to learn how even more inscrutable is the question of progesterone's influence on the myometrium; if you cherish a nice up-to-date review of all the pertinent information on what initiates labor (Carl Wood's concluding presentation). JOHN V. KELLY, M.D.
Methods in Experimental Embryology of the Mouse. KEEN A. RAFFERTY. The Johns Hopkins Press, Baltimore, 1970, 93 pp., $8.50. This book contains a brief description of many of the technics employed today or available for manipulating and handling the early mouse embryo. The author begins with a short section on instruments, equipment, and materials. This is followed by sections on oocytes, ovulation and superovulation, recovering ova, microinjection of ova, and transfer of ova. Other sections cover such things as embryo fusion, culture of individual blastomeres, implantation in vitro, and the culture of implanted embryos. The book will be found useful by anyone planning to perform experiments on early mouse embryos. This includes professional or graduate students who plan only to do a few experiments as well as experienced investigators who plan to use a new and unfamiliar technic. The book will also be a useful starting point for training new technicians since it is written in clear and simple terms. The only caution I have for those who read and use the book is that the contents
280
BOOK REVIEWS
should be used as a starting point of learning. Other references, supporting publications, and particularly new contributions to the area must be sought out to supplement the material contained in the book.
Vol. 22
In summary, the book is highly recommended to all those who will use early mouse embryos in experimental procedures. RALPH L. BRINSTER, PH.D.
r
Copyright., 1971 by The Williams & Wilkins Co.
Vol. 22, No.4, April 1971 Printed in U.SA.
Book Reviews Progesterone: Its 1legulatory Effect timing of its own delivery through changes on the Myometrium. Ed. by G. E. W. in steroid metabolism within the fetoplaWOLSTENHOLME, AND J. KNIGHT. Ciba cental unit. They remind us of the associaFoundation Study Group 34. The Wil- tion of enlarged fetal adrenal glands and liams & Wilkins Company, Baltimore, "unexplained" premature labor and the 1969, 187pp.,$7.00. association of the adrenal hypoplasia of This is the 34th in a series of book-form anencephalic fetuses and postmaturity. summaries of Study Conferences spon- They point out that prolonged pregnancy sored by Ciba. The meeting was held on is associated with persistently low levels of uterine contractility throughout gestaMay 14, 1969. The book opens with a eulogy to the tion and with a low urinary estriol excrelate Dr. Brenda Schofield by Professor tion at the 34th and 37th weeks. 5) T. D. Kerenyi, C. A. Pinto-Dantas, O. E. C. Amoroso and by Professor A. Csapo. de Sousa, and E. Darze report on studies The format of these meetings is the of activity of the nonpregnant uterus durpresentation of a paper followed by a dising the menstrual cycle and in response to cussion. exogenous progesterone. They contend The first and last presentations, "The that single 50 mg. intramuscular injections Four Direct Regulatory Factors of Myoof progesterone result in suppression of metrial Function" (Csapo) and "Uterine uterine activity for at least 24 hr. Activity in Late Pregnancy" (Wood) are 6) M. O. Pulkkinen discusses studies on fine review articles complete with 92 references. In between there are six articles. patients having therapeutic abortions by Three of these six articles deal with ani- intra-amniotic saline injections. He asserts that simultaneous measurements of intramal studies. 1) W. G. Wiest reports that the blocking uterine pressures and plasma progesterone effect of progesterone on the uterine mus- levels in these patients revealed that a fall cle of rats resides in the progesterone mol- in progesterone levels precedes the evolution of uterine activity. ecule itself. The raison d'etre for publication of 2) D. G. Porter states that progesterone has no effect on the uterine muscle activ- these study meetings is not the articles, for ity of guinea pigs, even in large doses, and they contain negligible new information. whether or not the animal was pregnant. They are for the most part recapitulations 3) J. M. Marshall discusses the finding of previously published work. The value that in rabbits, the response of the uterus to the reader resides in the discussions, to stimulation of its adrenergic nerves or where the participants criticize, analyze, to the administration of adrenergic amines and speculate on the individual presentais excitatory in estrogen-dominated and in- tions. Herein are the nuggets and pearls, hibitory in progesterone-dominated ani- and at this meeting some very important statements are found in the discussions. mals. Three are devoted to human studies. The central theme of this meeting (as 4) A. C. Turnbull and A. B. M. Ander- was that of the 1961 meeting funded by son review the evidence suggesting that Ciba: Progesterone and the Defense Mechthe fetus makes a vital contribution to the amsm of Pregnancy) is Professor Csapo's 278
April 1971
BOOK REVIEWS
perseverance in asserting that progesterone is the controller of myometrial regulation. Most of the six presentations are offered in support of this thesis. In the discussions, attacks on this support are vigorous and most enlightening: 1) Dr. I. F. Sommerville presents his studies which show that the plasma concentration of progesterone in peripheral venous blood does not fall significantly prior to spontaneous labor in women. 2) Csapo and Pulkkinen contend that in abortions induced by intra-amniotic saline, there is a decrease in plasma progesterone concentration 4 hr. after the saline injection and before there is a significant increase in uterine activity. To this contention, Turnbull asserts that in his experience in over 200 cases of saline terminations of pregnancy, uterine contractions begin to appear within 40 min. after the saline is injected. He also states that intra-amniotic saline causes a hypernatremia which may interfere with the measurement of progesterone and that these women are very thirsty and drink a great deal; thus they may increase their serum volume, accounting for an apparent fall in plasma progesterone levels. Dr. Short points out that Pulkkinen's data do not answer the crucial question whether progesterone levels fall significantly before or after the increase in uterine contractility. He states that his studies on uterine vein blood revealed that uterine contractions preceded any significant fall in the progesterone concentration. Short also reminds us that although there is a spectacular rise of progesterone in the peripheral blood during human pregnancy, there is no such increase in the pregnant monkey. He asserts that peripheral blood levels of progesterone may be much less informative than progesterone levels in the uterus. In many species, such as the cow and the goat, where the concentrations of progesterone are no higher during pregnancy
279
than in the nonpregnant state, the animals manage their pregnancies quite happily. Why pay $7.00 for this little 187 page booklet? In my opinion, it's worth the price-if you enjoy reading evidence presented to infuse Professor Csapo's long ballooning theory of progesterone dominance and then see critical needles collapse it; if you wish to learn how even more inscrutable is the question of progesterone's influence on the myometrium; if you cherish a nice up-to-date review of all the pertinent information on what initiates labor (Carl Wood's concluding presentation). JOHN V. KELLY, M.D.
Methods in Experimental Embryology of the Mouse. KEEN A. RAFFERTY. The Johns Hopkins Press, Baltimore, 1970, 93 pp., $8.50. This book contains a brief description of many of the technics employed today or available for manipulating and handling the early mouse embryo. The author begins with a short section on instruments, equipment, and materials. This is followed by sections on oocytes, ovulation and superovulation, recovering ova, microinjection of ova, and transfer of ova. Other sections cover such things as embryo fusion, culture of individual blastomeres, implantation in vitro, and the culture of implanted embryos. The book will be found useful by anyone planning to perform experiments on early mouse embryos. This includes professional or graduate students who plan only to do a few experiments as well as experienced investigators who plan to use a new and unfamiliar technic. The book will also be a useful starting point for training new technicians since it is written in clear and simple terms. The only caution I have for those who read and use the book is that the contents
280
BOOK REVIEWS
should be used as a starting point of learning. Other references, supporting publications, and particularly new contributions to the area must be sought out to supplement the material contained in the book.
Vol. 22
In summary, the book is highly recommended to all those who will use early mouse embryos in experimental procedures. RALPH L. BRINSTER, PH.D.
r