cosyntropin and Abortion--Spontaneous

ACTH-depot therapy is one of the therapeutic methods in threatening abortion or premature labor, introduced by Prof. R. Klimek in the 60-ies of the last century. Administration of syntetic ACTH is the method of first choice in treatment of neuroendocrinologically complicated pregnancy, safe for mother as for infant. The first trials of application of this method disclosed good results determined by very high birth rate of at term pregnancies (96%) and delivery of live infants, in comparison to 18.5% or 37% supported pregnancies treated conservatively, in the same group of women previously. Because hypothalamic hormones induce synthesis of enzyme-oxytocinase, it becomes possible to observe the development of pregnancy in women treated with ACTH-depot by CAP-level determination. In women with hypothalamic hypofunction, level of oxytocinase is low, increasing slowly, sometimes even its decrease is observed. Current multiple ACTH-depot doses: 0.5 mg i.m. are routinely used, instead of hitherto applied series of 3 injections in the second and third trimester. Number of doses depend on: levels of oxyto-cinase, rate of its increase, reactivity of patient and progression of pregnancy. Administration of ACTH-depot seems to be more beneficial than aministration of corticoids, because this hormone does not cross the placenta, but increases the production of endogenic hormones. Unwelcome symptoms of ACTH-depot treatment are similar to those observed in course of the corticold therapy, but they are less expressed. Development of features connected with hypercatabolism of proteins like: muscular atrophy, striae and osteoporotic changes, are not observed. Only single therapy with ACTH-depot causes regression of clinical symptoms of threatening premature labor, without necessity of tocolitic treatment. Thanks to steroidogenesis, normalisation of the number of preterm labors and respiratory disorders decreases.

Topics: Abortion, Spontaneous; Adrenocorticotropic Hormone; Biomarkers; Cosyntropin; Cystinyl Aminopeptidase; Female; Humans; Hypothalamic Diseases; Infant, Newborn; Live Birth; Pregnancy; Pregnancy Complications; Pregnancy Proteins; Pregnancy, High-Risk