Fourth World Conference on Early Pregnancy CONTINUUM BETWEEN IMPLANTATION AND PERINATAL EVENTS

Luteal Function As The Main Determinant Of Pregnancy Outcome: Successful Prevention Of Spontaneous Abortion, Prematurity And IUGR

Siklósi G., Ács N., Demendi Cs., Börzsönyi B., Gimes G., Bakos L., Olajos F., Marcsek Z

Second Department of Obstetrics and Gynaecology, Semmelweis University Budapest

Presentation

Objective

The aim of our study was to investigate the relationship of luteal function (determining primarily the circumstances of early placentation) and pregnancy outcome.

Study design

This relationship was analyzed in 450 pregnancies of 325 patients suffering from infertility due to luteal insufficiency (LI) conceived without any treatment or treated by clomiphene citrate. Luteal function (LF) was characterized by the mean of 3 serum progesterone (P) values measured every other day between the 4^th and 9^th day before menstruation or after ovulation.

Results

The luteal P values were significantly (p<0.01) different in cases of spontaneous abortions and premature and mature deliveries respectively (14.2±5.8, 19.3±1.7 and 26.3±7.0 ng/ml, mean±SD). A significant correlation (p<0.001) was found between the luteal mean P value and the duration of pregnancy (weeks) as well as between the P means measured in the luteal phase, during the luteoplacental shift and also during the 4^th and 5^th months of pregnancy. The incidence of spontaneous abortion, premature delivery and IUGR in pregnancies conceived with P values above the physiological mean (21 ng/ml) was significantly (p<0,001) lower (1.2%, 1.8%, 2.1%, n=332, including twins) especially among singleton pregnancies (1.2%, 0.6%, 1.2%, n=319) than in the general population (12.0%, 9.8%, 10.0%) and in the untreated control group (41.2%, 33.3 % and 33.3%).

Conclusion

These data suggest that the conditions of implantation and early placentation are of decisive significance for the further development of the fetoplacental unit and consequently for the outcome of pregnancy and that LI of varying degree is the principal common cause of different forms of adverse pregnancy outcome (APO). Preconceptional normalization of folliculo-luteal function could reduce the different forms of APO by about 80-90%.

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