Adolf E. Schindler

PRIZEWINNER OF PROFESSOR IOSEB JORDANIA INTERNATIONAL PRIZE-2007

PROGESTERONE AND PROGESTERONE AND PROGESTINS INPROGESTINS IN

PREGNANCY: DIAGNOSTIC AND PREGNANCY: DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONSTHERAPEUTIC CONSIDERATIONS

Institute for Medical Research and Education, Institute for Medical Research and Education,

Essen, GermanyEssen, Germany

Progesterone is essential for implantation and Progesterone is essential for implantation and maintenance of pregnancy. Progesterone is the dominant maintenance of pregnancy. Progesterone is the dominant hormone throughout pregnancy. Among the manifold hormone throughout pregnancy. Among the manifold actions progesterone is essential for the protection of the actions progesterone is essential for the protection of the allogenic conceptus from immunological rejection by the allogenic conceptus from immunological rejection by the mother. At first, production and secretion of progesterone mother. At first, production and secretion of progesterone is determined by placental HCG. However, later is determined by placental HCG. However, later progesterone continuous to rise throughout pregnancy progesterone continuous to rise throughout pregnancy independent from the HCG serum levels. Indeed, there is independent from the HCG serum levels. Indeed, there is at the beginning of pregnancy a HCG-doubling time, which at the beginning of pregnancy a HCG-doubling time, which is prolonged in pregnancy failure (orthotopic as well as is prolonged in pregnancy failure (orthotopic as well as ectopic). ectopic).

Lack of normal HCG-doubling time indicates:

Ectopic location of the gestation

Trophoblast abnormalities

Disturbed placentation

Genetic aberrations

It is important to note that there is a luteal-placental shift around week 8 to 10 of gestation, which can be associated with a decrease of circulating amount of progesterone and this can lead to bleeding, uterine contractions and finally to abortion. The renewed increase indicates placental progesterone production, since the Corpus luteum function fades away.

The major endocrine causes of spontaneous or recurrent abortions are:

1. Corpus luteum insufficiency

2. Defective luteo-placental-shift

3. Placental insufficiency.

Which clinical conditions may be effectively treated by progesterone or progestins?

1. Spontaneous abortions

2. Habitual abortion

3. Premature labor

4. Hypertension in pregnancy

At present the following preparations are available for clinical use in pregnancy:

1.Micronized progesterone (vaginal)

2.Dydrogesterone (Oral) Duphaston®

3.17-a Hydroxyprogesterone caproate (i.m.)

Treatment schedules for the various clinical conditions will be outlined and the results discussed.

90 CME credits Intercontinental Academy of Medical-Social Sciences (IAMSS) OGASHNumber 90 (ninety) IAMSS International CME credits are recognized by Post Congress IAMSS OGASH Awards Commission Chairperson, IAMSS Presidium Chairperson, Hon. Academician of OGASH, Academician Secretary of OGASH Prof / Dr IRMA de LUCA BRUNORI MD., PhD.

Verified the achievement & award of the proceeding author Adolf E. Schindler Post Congress IAMSS OGASH Awards Commission Chairman,

IAMSS Presidium Chairperson,Hon. Academician of OGASH

Academician Prof./Dr. Malkhaz Mizandari MD., PhD. CERTIFIES

the achievement of n. 90 International credits (IAMSS)