Dehydroepiandrosterone sulfate (DHAS) is now used for a dynamic test of placental function by many obstetricians. While practicing this test, the authors found that DHAS markedly promoted so-called "cervical ripening". To study this problem, DHAS of 50 or 100 mg in multiple doses were injected into 132 Japanese pregnant women in their 38th--42nd week of gestation. The change in Bishop score was carefully recorded. Bishop score in the injected groups of primiparae (100 mg) began to rise much sooner than the control groups (p less than 0.01 on seventh day and 14th day). However, such significant difference in the rise of Bishop score was not noted in the multiparae and primiparae with 50 mg. Although the rise of score is not significant, the duration (day) from injection to delivery was shorter in the injected group than the control group (t=2.1529, p less than 0.05 in primiparae with 50 mg, t=3.8829, p less than 0.01 with 100 mg, t=2.1029, p less than 0.05 in multiparae with 50 mg). In some of these cases, labor began or delivery was finished within 24 hrs. Among the factors of Bishop score, mainly the effacement, consistency and dilatation of the cervix were remarkably improved by DHAS injection (p less than 0.01 and less than 0.05). Side effects of any type were not seen in the mothers and foetuses. As a conclusion, DHAS injection in considered to produce favorable conditions for delivery in women with "unripe cervix" by softening the soft birth canal. Furthermore, it is suggested that DHAS might play an important role in triggering labor.
Seventy-five pregnant women in the 38th to 41st weeks of gestation were given a single intravenous injection of 200 mg of dehydroepiandrosterone sulfate (DHAS). The changes in estriol, 17beta-estradiol and progesterone levels in the serum, the uterine cervix and the myometrium of the placenta-implanting site were then determined. Estriol levels remained unchanged both in serum and tissue, but the level of 17beta-estradiol increased sharply both in serum and tissue after four hours. The increases of 17beta-estradiol in the serum and the portio vaginalis of the same patient were well correlated (r = 0.79898), but the percentage of increase was much higher in the portio vaginalis than in the serum (p less than 0.001). Serum progesterone levels did not change initially, but always decreased within four or eight hours in cases in which labor had started or delivery was accomplished within 24 hours (p less than 0.01 at four hours). The total amount of collagenase was determined in ten subjects before and after the administration of DHAS. The total collagenase activity was elevated by an average of 152.3%. The peak of activity was accelerated from the fourth to the second day (p less than 0.001) of the culture. A probable mechanism of DHAS action in accelerating cervical ripening is presented.
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