Shinar Shiri, Many Ariel, Maslovitz Sharon
Lis Maternity Hospital, Obtsterics and Gynecology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Lis Maternity Hospital, Obtsterics and Gynecology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Eur J Obstet Gynecol Reprod Biol. 2016 Feb;197:83-5. doi: 10.1016/j.ejogrb.2015.11.028. Epub 2015 Nov 29.
Oxytocin, a nanopeptide secreted by the posterior pituitary gland, has well-established uterotonic activity. Its role in initiating the vigorous and regular contractions of the first stage of labor is still controversial. We report four cases of panhypopituitarism who had spontaneous onset of labor, undermining the role of maternal oxytocin in the first phase of labor.
Four women with no residual pituitary function conceived through ovulation induction and were treated throughout pregnancy with thyroid replacement therapy, desmopressin and glucocorticoids. In all cases pituitary function was undetectable in repeated blood tests. We report their course of pregnancy and delivery.
All four pregnancies progressed to term with hormonal replacement therapy. All cases went into spontaneous labor. Two women delivered vaginally unassisted by pharmacological intervention and two delivered by cesarean sections during active labor due to obstetrical indications. Three suffered postpartum hemorrhage. Lactation did not ensue in all four cases.
Endogenous pituitary oxytocin is probably not obligatory for initiation of labor in the first phase of parturition.
催产素是一种由脑垂体后叶分泌的九肽，其子宫收缩活性已得到充分证实。然而，它在启动分娩第一阶段有力且规律的宫缩中所起的作用仍存在争议。我们报告了4例全垂体功能减退症患者自发临产的病例，这对母体催产素在分娩第一阶段的作用提出了质疑。
4名无垂体功能残余的女性通过诱导排卵受孕，并在整个孕期接受甲状腺替代治疗、去氨加压素和糖皮质激素治疗。所有病例经多次血液检查均未检测到垂体功能。我们报告了她们的妊娠和分娩过程。
所有4例妊娠在接受激素替代治疗后均足月分娩。所有病例均自发临产。2名女性未经药物干预自然阴道分娩，2名女性因产科指征在活跃期行剖宫产。3例发生产后出血。4例均未出现泌乳。
内源性垂体催产素可能并非分娩第一阶段启动宫缩所必需的。
