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We studied the effect of vaginal progesterone (P) treatment during the luteal phase of patients who had had a tubal pregnancy (TP) and were planning another, in a prospective, randomized, double-blind trial. The outpatient clinics of two University hospitals and three central hospitals had 135 patients treated for tubal pregnancy: 100 with grossly normal fallopian tubes (supposing an accidentally abnormal luteal phase as a possible etiology of their first TP) and 35 with signs of earlier pelvic inflammatory disease (PID etiology). They were treated with vaginal P (25 mg b.i.d.) or placebo during cycle days 16-24, for 10 months. Serum P levels after a single vaginal or oral dose were compared. The rates of conception, delivery, spontaneous abortion and recurrent TP were recorded, and fetal and placental weight measured. Both vaginal and oral formulas of P provoked a physiological (24-43 nmol/l) rise in serum concentrations. P and placebo-treated cycles resulted in a nearly equal number of pregnancies (33/37 resp.). Of the 55 infants born 53 were to mothers without signs of earlier PID (53/100); only 2 (2/35) to mothers in whom signs had been present. Recurrent TP occurred in 9% of all pregnancies. Four out of six recurrent TPs were patients with signs of PID (4/35), but two were without such signs (2/100): one occurred during placebo and one during P-treated cycle. Prophylactic P treatment of patients at risk of recurrent TP does not improve fertility or prevent recurrent TP. This indicates, that the functional etiology of recurrent TP, as compared to infection, is not important.

Progesterone substitution in the rat during pregnancy days 17-21 or administration 6 h before spontaneous delivery constricted the fetal ductus arteriosus. The rapid whole-body freezing technique was used. Indomethacin-induced constriction of the fetal ductus arteriosus was not affected by progesterone treatment.

During fetal life human lungs have a high progesterone concentration (average 380 ng/g at 14 weeks of gestation and 635 ng/g at 32 weeks). At 30 h of age, this concentration had decreased to 185 ng/g. During the first 72 h of life, some infants with respiratory distress syndrome (RDS) had a higher amount of progesterone in their lungs than infants with diseases other than RDS. In newborns with RDS, serum transcortin (binding progesterone) was close to the normal value, but serum progesterone concentration 57% below normal. The hypothesis that, in addition to surfactant, lung tissue smooth muscle (regulated among other things by progesterone and prostaglandins) may control lung function at birth is strengthened by the fact that RDS can be provoked by progesterone in the rabbit and that fatty acids and prostaglandins are abnormal in human RDS.

Seventeen newborns suffering from RDS (verified by X-ray and clinical parameters) had a mean plasma progesterone of 13.9 +/- 1.2 ng/ml (mean +/- S.E.) at 24h of age. This is only 62% of the normal level (22.6 +/- 1.5 ng/ml).

On the 30th day of pregnancy, the experimental fetuses in 19 rabbits were injected intraperitoneally with 0.1-1.0 mg progesterone (P). The control fetuses in the contralateral uterine horn were treated with the solvent, sesame oil. Both the experimental and control fetuses were delivered 10 min after treatment by hysterotomy to measure the P concentration of their lung tissue and observe their respiration during the initial 2 h of postnatal life. In comparison with the controls, the experimental newborns had greatly elevated P levels and showed typical respiratory distress syndrome, confirmed by histology.

The administration of ampicillin to three women in the last trimester of pregnancy caused a transient reduction in the plasma concentration of total conjugated estriol and of estriol-16alpha-glucuronide, as measured by a specific radioimmunoassay. Similar changes were seen in plasma conjugated estrone and estradiol levels, but the effect seemed to be more prolonged. In most cases, the reduction in plasma conjugated estrogens was greatest on the second and third day of ampicillin administration, the pattern being similar to that described previously for urinary estriol and other estrogens. There were no obvious differences in the ampicillin effect between the morning and afternoon plasma levels. Ampicillin caused no consistent change in the plasma levels of unconjugated estrone, estradiol, and estriol or in plasma progesterone. These results are discussed with consideration of our present understanding of the effect of ampicillin on the intestinal metabolism and enterohepatic circulation of steroids.

We analyzed 22 human oviducts by the suction electrode method for electrical activity (preceding and reflecting the mechanical activity), as related to serum progesterone levels. Eleven patients had high progesterone levels (greater than or equal to 20 nmol/L), but the other 11 patients had low levels. When the serum progesterone level was low, the oviductal electrophysiologic characteristics were those associated with poor ovum transfer: low probability of prouterine propagation of the activity at the fimbrial end of the tube: high-frequency but low number of electrical bursts, reflecting possible weak propulsive force; and a high occurrence rate of sine-wave-like activity and inactive areas where ovum retention can occur. These phenomena could be related to the higher incidence of ectopic pregnancies in patients with luteal phase defect.