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30 Issues L. & Med. 159 (2015)
The Use of Isomolecular Progesterone in the Support of Pregnancy and Fetal Safety

handle is hein.journals/ilmed30 and id is 167 raw text is: The Use of Isomolecular Progesterone in the Support of Pregnancy and Fetal Safety Thomas W Hilgers, M.D., Dip ABOG, ABLS, SRS, CFCMC;* Catherine E. Keefe, M.D., Dip ABOG; Kristina A. Pakiz, M.D., Dip ABOG Introduction Progesterone support in pregnancy has been in use for over 60 years, having received its start in the 1940s. Its initial use was in patients who had habitual spon- taneous abortion caused by luteal phase deficiency More recently, the administration of progesterone later in pregnancy has been considered to be justified because of an observed decrease in circulating progesterone with the onset of labor,' an association of premature labor with decreased progesterone concentrations,2 and the observation that progesterone has a tocolytic effect.' A considerable boost to the use of progestational agents to reduce preterm delivery was received with the publication of two papers which showed a sigificant reduction in preterm delivery rates with the prophylactic administration of either progesterone or 17-a hydroxyprogesterone caproate. Recently it has been shown, however, that its use is not universal.4 This may be related to the significant late sequelae that were documented following the in utero exposure of the fetus to the potent steroid diethylstilbestrol (DES) and that this bad experience cast a long shadow,5 In spite of this, the use of proges- * Clinical Professor, Department of Obstetrics & Gynecology, Creighton University School of Medi- cine; Director Pope Paul VI Institute for the Study of Human Reproduction, Omaha, NE Turnbull A, Patten P, Flynt A, Keirse J, Jeremy J, Anderson A: Significant Fall in Progesterone and Rise in Estradiol Levels in Human Peripheral Plasma Before Onset of Labor. Lancet 1974; i: 101. 2 Csapo A, Pohanka 0, Kaihola H: Progesterone Deficiency and Premature Labour. Br MedJ 1974; i:137. 3Ferre F Usan M, Janssen SY: Oral Administration of Micronized Natural Progesterone in Late Human Pregnancy: Effects on Progesterone and Estrogen Concentrations in the Plasma, Placenta and Myometri- um. AmJ Obset Gynec 1985; 148:26. 1 Ness A, Dias T, Damus K, et al: Impact of the Recent Radomized Trials on the Use of Progesterone to Prevent Preterm Birth: A 2005 Follow-up Survey AmJ Obstet Gynec 2006; 195:1174. Green MF: Progesterone and Preterm Delivery - Deji Vu All Over Again. N Engl J Med 2003; 348:2453.

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