Increase in prostaglandin bioavailability precedes the onset of human parturition

The traditional paradigm that prostaglandins (PGs) are of central importance in the initiation of labor has been challenged. A group of investigators has recently reported that the amniotic fluid concentrations of PGE₂ and PGF(2α) increase only late in the course of labor implying that 'the accumulation of prostaglandins in amniotic fluid is an after-effect of labor and not indicative of a role of these compounds in the initiation of human parturition'. The present study was conducted to determine whether amniotic fluid prostaglandin concentrations increase prior to the onset of human labor, the central question in this controversy. Three amniocenteses were performed in 17 women with intrahepatic cholestasis of pregnancy - the first two prior to the onset of labor and the third during early spontaneous labor. PGE₂ and PGF(2α) were measured with sensitive and specific radioimmunoassays. Amniotic fluid concentrations of PGE₂ and PGF(2α) increased prior to the onset of spontaneous labor. An additional increase in the concentrations of PGE₂ and PGF(2α) was found in samples obtained in early labor. We conclude that an increase in prostaglandin bioavailability precedes the onset of spontaneous human parturition.