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Salivary hormones and parturition in healthy, primigravid women
BRIEF COMMUNICATIONS
59
Salivary hormones and parturition in healthy, primigravid women C.R. Marrs a,⁎, D.P. Ferraro a , C.L. Cross b a b
Department of Psychology, University of Nevada, Las Vegas, USA School of Public Health, University of Nevada, Las Vegas, USA
Received 1 March 2007; accepted 22 March 2007
KEYWORDS Parturition; Labor; Progesterone; Estradiol; Estriol
Hormonal predictors of labor initiation are of considerable interest but are not clearly elucidated. Current hypotheses suggest a surge in the ratio of estriol to progesterone from b 1 to N 1 marks the impending onset of labor [1–3]. Little research exists examining relationships between other steroid hormones and parturition in healthy, uncomplicated, late-term pregnancies [4]. The purpose of this study was to assess prospectively associations between salivary progesterone, DHEAS, testosterone, estrone, estradiol, and estriol concentrations and parturition. Twenty-four healthy, medication free, primigravid women were recruited from area childbirth education classes and gave their informed consent to participate. This study was approved by the UNLV institutional review board. Pre-prandial, un-stimulated saliva samples were collected from participants at 9:00 am at 37 weeks +/−2 days of pregnancy. Specimen were mailed via two-day courier to AllVia Diagnostic Lab in Phoenix, AZ for analysis, enzyme immunosorbent assays. Pearson's bivariate correlations were calculated to
Table 1
determine relationships between salivary hormones and length of gestation. Normality was tested using Shapiro–Wilks, p b .05. The mean age of the participants was 29.63, SD 4.16. The average length of gestation was 277 days +/− 6.68 days. Participants were tested at 259 days +/− 2 days. The mean number of days from test time to delivery was 18 days. All participants began labor naturally without assistance. After labor initiated 11 women required medical intervention either via medication (n = 9) or cesarean section (n = 2) to deliver. Thirteen women delivered without assistance. All delivered healthy infants. The intra- and inter-assay coefficients of variation did not exceed 10% except for inter-day estrone (16.25%). Descriptive hormone data are presented in Table 1. Progesterone was correlated with longer pregnancies (r = .414, p b .05) while estradiol was associated with shorter pregnancies (r = − .519, p b .01). No significant correlations between estriol values or the mean ratio of estriol to progesterone (.57) and delivery was found. No other hormone was correlated with parturition. Researchers have identified a pre-delivery surge of estriol either alone [3] or relative to progesterone [1,2] associated with labor initiation, suggesting that fetal input contributes to the onset of labor and that an estriol surge marks impending delivery. Our study does not support these findings. Here, progesterone and estradiol, but not estriol either alone or relative to progesterone were associated with parturition in healthy, late-
Salivary hormone values at 37 weeks of pregnancy
pg/mL
pH
Progesterone
DHEAS
Testosterone
Estrone
Estradiol
Estriol
Mean SD Minimum Maximum n
6.09 0.35 5.2 6.9 24
1128.07 567.52 221.6 2272.3 24
1103.11 1171.13 135.5 5774 24
34.97 30.38 2.6 88.3 23⁎
36.75 13.76 1.7 72.5 24
15.9 13.76 6.5 37.2 24
468.32 219.35 199.6 989.5 24
⁎One participant had undetectable testosterone levels. ⁎ Corresponding author. Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Pkwy Box 455030, Las Vegas, Nevada 89154-5030, USA. Tel.: +1 702 895 0547; fax: +1 702 895 0635. E-mail address: [email protected] (C.R. Marrs). doi:10.1016/j.ijgo.2007.03.032
60 term pregnancies. This suggests more of a maternal and/or placental role in parturition in healthy, late term pregnancies than previously acknowledged.
References [1] Darne J, McGarrigle HHG, Lachlelin GCL. Increased saliva oestriol to progesterone ratio before idiopathic preterm delivery: a possible predictor for preterm labour. BMJ 1987;294:270–2.
BRIEF COMMUNICATIONS [2] Darne J, McGarrigle HHG, Lachlelin GCL. Saliva oestriol, oestadiol, oestrone and progesterone levels in pregnancy: spontaneous labour at term is preceded by a rise in the saliva oestriol: progesterone ratio. Br J Obstet Gynaecol 1987;94:227–35. [3] Heine RP, McGregor JA, Goodwin TM, Artal R, Hayashi RH, Robertson PA, et al. Serial salivary estriol to detect an increased risk of preterm birth. Obstet Gynecol 2000;96:490–7. [4] Doganay M, Erdemoglu E, Avsar AF, Aksakal OS. Maternal serum levels of dehydroepiandrosterone sulfate and labor induction in postterm pregnancies. Int J Gynecol Obstet 2004;85:245–9.
Electronic door interference mimicking distress in fetal monitoring A. Imai ⁎, H. Toyoki, T. Furui Department of Obstetrics and Gynecology, Gifu University School of Medicine, Yanagido, Japan Received 29 March 2007; accepted 2 April 2007
KEYWORDS Fetal distress; Electronic fetal monitoring; Electromagnetic interference
Continuous electronic fetal monitoring is used widely to assess pathophysiological events affecting the fetus. It is generally realized that electromagnetic waves can interfere with medical equipment [1,2]. There is insufficient research on electromagnetic interference with electronic fetal monitoring. We report a case of false fetal monitoring triggered by the signals from an automatic labor/delivery room door. A 34-year-old Japanese primigravida with history of myomectomy four years previously was scheduled to undergo elective cesarean. The prenatal course was uneventful. At 37 weeks and 4 days, premature contractions were managed by ritodrine hydrochloride. External electronic fetal heart rate monitoring (Series 50XM; Philips Medical Systems, Tokyo, Japan) detected a prolonged fetal heart rate deceleration (Fig. 1). Emergency cesarean section was considered but concurrent use of external ultrasound Doppler revealed a
⁎ Corresponding author. Department of Obstetrics and Gynecology, Gifu University School of Medicine, Yanagido, Gifu 501-1194, Japan. Tel.: +81 58 230 6349; fax: +81 58 230 6348. E-mail address: [email protected] (A. Imai). doi:10.1016/j.ijgo.2007.04.023
reactive fetal heart rate pattern with baseline rate between 120 and 160 beats/min. A similar monitoring discrepancy occurred twice within 2 h. The following day, the patient was delivered by low transverse cesarean section of a male infant weighing 3402 g with Apgar scores of 8 and 10 at 1 and 5 min, respectively. Clinical engineers measured the electric field intensity in the areas where the equipment was affected. Data analysis showed that wireless signals or electromagnetic waves emitted by an automatic labor/delivery room door were at a similar frequency as the communication channels specified by the fetal monitoring system or directly interfered through an underfloor ground wire. Unlike the actions of mobile phones and wireless local area network (LAN) [1,2], very little information is available concerning the ability of an electromagnetic-producing system to interfere with hospital equipment. This case shows that there was signal distortion and false alarm in an electronic monitoring system. Electromagnetic wave testing of medical electronic equipment to be used in areas of signal production should be considered during installation. Care must be taken that fetal monitoring artifacts are not confused with fetal distress.
References [1] Hanada E, Hoshino Y, Kondou T. Safe introduction of in-hospital wireless LAN. Medinfo 2004;11:1426–9. [2] Stroud DB, Huang Y, Hansen L, McKenzie R. Walkie talkies cause more electromagnetic interference to medical equipment than mobile phones. Australas Phys Eng Sci Med 2006;29:315–20.
59
Salivary hormones and parturition in healthy, primigravid women C.R. Marrs a,⁎, D.P. Ferraro a , C.L. Cross b a b
Department of Psychology, University of Nevada, Las Vegas, USA School of Public Health, University of Nevada, Las Vegas, USA
Received 1 March 2007; accepted 22 March 2007
KEYWORDS Parturition; Labor; Progesterone; Estradiol; Estriol
Hormonal predictors of labor initiation are of considerable interest but are not clearly elucidated. Current hypotheses suggest a surge in the ratio of estriol to progesterone from b 1 to N 1 marks the impending onset of labor [1–3]. Little research exists examining relationships between other steroid hormones and parturition in healthy, uncomplicated, late-term pregnancies [4]. The purpose of this study was to assess prospectively associations between salivary progesterone, DHEAS, testosterone, estrone, estradiol, and estriol concentrations and parturition. Twenty-four healthy, medication free, primigravid women were recruited from area childbirth education classes and gave their informed consent to participate. This study was approved by the UNLV institutional review board. Pre-prandial, un-stimulated saliva samples were collected from participants at 9:00 am at 37 weeks +/−2 days of pregnancy. Specimen were mailed via two-day courier to AllVia Diagnostic Lab in Phoenix, AZ for analysis, enzyme immunosorbent assays. Pearson's bivariate correlations were calculated to
Table 1
determine relationships between salivary hormones and length of gestation. Normality was tested using Shapiro–Wilks, p b .05. The mean age of the participants was 29.63, SD 4.16. The average length of gestation was 277 days +/− 6.68 days. Participants were tested at 259 days +/− 2 days. The mean number of days from test time to delivery was 18 days. All participants began labor naturally without assistance. After labor initiated 11 women required medical intervention either via medication (n = 9) or cesarean section (n = 2) to deliver. Thirteen women delivered without assistance. All delivered healthy infants. The intra- and inter-assay coefficients of variation did not exceed 10% except for inter-day estrone (16.25%). Descriptive hormone data are presented in Table 1. Progesterone was correlated with longer pregnancies (r = .414, p b .05) while estradiol was associated with shorter pregnancies (r = − .519, p b .01). No significant correlations between estriol values or the mean ratio of estriol to progesterone (.57) and delivery was found. No other hormone was correlated with parturition. Researchers have identified a pre-delivery surge of estriol either alone [3] or relative to progesterone [1,2] associated with labor initiation, suggesting that fetal input contributes to the onset of labor and that an estriol surge marks impending delivery. Our study does not support these findings. Here, progesterone and estradiol, but not estriol either alone or relative to progesterone were associated with parturition in healthy, late-
Salivary hormone values at 37 weeks of pregnancy
pg/mL
pH
Progesterone
DHEAS
Testosterone
Estrone
Estradiol
Estriol
Mean SD Minimum Maximum n
6.09 0.35 5.2 6.9 24
1128.07 567.52 221.6 2272.3 24
1103.11 1171.13 135.5 5774 24
34.97 30.38 2.6 88.3 23⁎
36.75 13.76 1.7 72.5 24
15.9 13.76 6.5 37.2 24
468.32 219.35 199.6 989.5 24
⁎One participant had undetectable testosterone levels. ⁎ Corresponding author. Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Pkwy Box 455030, Las Vegas, Nevada 89154-5030, USA. Tel.: +1 702 895 0547; fax: +1 702 895 0635. E-mail address: [email protected] (C.R. Marrs). doi:10.1016/j.ijgo.2007.03.032
60 term pregnancies. This suggests more of a maternal and/or placental role in parturition in healthy, late term pregnancies than previously acknowledged.
References [1] Darne J, McGarrigle HHG, Lachlelin GCL. Increased saliva oestriol to progesterone ratio before idiopathic preterm delivery: a possible predictor for preterm labour. BMJ 1987;294:270–2.
BRIEF COMMUNICATIONS [2] Darne J, McGarrigle HHG, Lachlelin GCL. Saliva oestriol, oestadiol, oestrone and progesterone levels in pregnancy: spontaneous labour at term is preceded by a rise in the saliva oestriol: progesterone ratio. Br J Obstet Gynaecol 1987;94:227–35. [3] Heine RP, McGregor JA, Goodwin TM, Artal R, Hayashi RH, Robertson PA, et al. Serial salivary estriol to detect an increased risk of preterm birth. Obstet Gynecol 2000;96:490–7. [4] Doganay M, Erdemoglu E, Avsar AF, Aksakal OS. Maternal serum levels of dehydroepiandrosterone sulfate and labor induction in postterm pregnancies. Int J Gynecol Obstet 2004;85:245–9.
Electronic door interference mimicking distress in fetal monitoring A. Imai ⁎, H. Toyoki, T. Furui Department of Obstetrics and Gynecology, Gifu University School of Medicine, Yanagido, Japan Received 29 March 2007; accepted 2 April 2007
KEYWORDS Fetal distress; Electronic fetal monitoring; Electromagnetic interference
Continuous electronic fetal monitoring is used widely to assess pathophysiological events affecting the fetus. It is generally realized that electromagnetic waves can interfere with medical equipment [1,2]. There is insufficient research on electromagnetic interference with electronic fetal monitoring. We report a case of false fetal monitoring triggered by the signals from an automatic labor/delivery room door. A 34-year-old Japanese primigravida with history of myomectomy four years previously was scheduled to undergo elective cesarean. The prenatal course was uneventful. At 37 weeks and 4 days, premature contractions were managed by ritodrine hydrochloride. External electronic fetal heart rate monitoring (Series 50XM; Philips Medical Systems, Tokyo, Japan) detected a prolonged fetal heart rate deceleration (Fig. 1). Emergency cesarean section was considered but concurrent use of external ultrasound Doppler revealed a
⁎ Corresponding author. Department of Obstetrics and Gynecology, Gifu University School of Medicine, Yanagido, Gifu 501-1194, Japan. Tel.: +81 58 230 6349; fax: +81 58 230 6348. E-mail address: [email protected] (A. Imai). doi:10.1016/j.ijgo.2007.04.023
reactive fetal heart rate pattern with baseline rate between 120 and 160 beats/min. A similar monitoring discrepancy occurred twice within 2 h. The following day, the patient was delivered by low transverse cesarean section of a male infant weighing 3402 g with Apgar scores of 8 and 10 at 1 and 5 min, respectively. Clinical engineers measured the electric field intensity in the areas where the equipment was affected. Data analysis showed that wireless signals or electromagnetic waves emitted by an automatic labor/delivery room door were at a similar frequency as the communication channels specified by the fetal monitoring system or directly interfered through an underfloor ground wire. Unlike the actions of mobile phones and wireless local area network (LAN) [1,2], very little information is available concerning the ability of an electromagnetic-producing system to interfere with hospital equipment. This case shows that there was signal distortion and false alarm in an electronic monitoring system. Electromagnetic wave testing of medical electronic equipment to be used in areas of signal production should be considered during installation. Care must be taken that fetal monitoring artifacts are not confused with fetal distress.
References [1] Hanada E, Hoshino Y, Kondou T. Safe introduction of in-hospital wireless LAN. Medinfo 2004;11:1426–9. [2] Stroud DB, Huang Y, Hansen L, McKenzie R. Walkie talkies cause more electromagnetic interference to medical equipment than mobile phones. Australas Phys Eng Sci Med 2006;29:315–20.