[Prenatal ACTH-depot therapy]. / Prenatalna terapia ACTH-depot.

ACTH-depot therapy is one of the therapeutic methods in threatening abortion or premature labor, introduced by Prof. R. Klimek in the 60-ies of the last century. Administration of syntetic ACTH is the method of first choice in treatment of neuroendocrinologically complicated pregnancy, safe for mother as for infant. The first trials of application of this method disclosed good results determined by very high birth rate of at term pregnancies (96%) and delivery of live infants, in comparison to 18.5% or 37% supported pregnancies treated conservatively, in the same group of women previously. Because hypothalamic hormones induce synthesis of enzyme-oxytocinase, it becomes possible to observe the development of pregnancy in women treated with ACTH-depot by CAP-level determination. In women with hypothalamic hypofunction, level of oxytocinase is low, increasing slowly, sometimes even its decrease is observed. Current multiple ACTH-depot doses: 0.5 mg i.m. are routinely used, instead of hitherto applied series of 3 injections in the second and third trimester. Number of doses depend on: levels of oxyto-cinase, rate of its increase, reactivity of patient and progression of pregnancy. Administration of ACTH-depot seems to be more beneficial than aministration of corticoids, because this hormone does not cross the placenta, but increases the production of endogenic hormones. Unwelcome symptoms of ACTH-depot treatment are similar to those observed in course of the corticold therapy, but they are less expressed. Development of features connected with hypercatabolism of proteins like: muscular atrophy, striae and osteoporotic changes, are not observed. Only single therapy with ACTH-depot causes regression of clinical symptoms of threatening premature labor, without necessity of tocolitic treatment. Thanks to steroidogenesis, normalisation of the number of preterm labors and respiratory disorders decreases.

[Influence of ACTH-depot doses on neuroendocrine gestosis treatment]. / Wplyw dawkowania acth-depot na leczenie neuroendogennej gestozy.

OBJECTIVE OF THE STUDY: Two dosing methods of ACTH-depot therapy were compared dependently on gestational age and sequence of applied injections. It has been concluded that better efficacy was observed in single doses method comparing to serial doses in 2nd trimester. MATERIAL AND METHODS: Retrospectively, 380 pregnancies were analyzed, in which ACTH-depot therapy was applied using 0,5 mg doses. In 140 subjects (Group I, 1990-1991) 3 injection series every 2nd day with additional antibiotic (i.e. Monural 3g) were administrated. In the rest 240 (Group II, 1997-2002) single doses were applied during the whole period of pregnancy due to recurrent vomiting or decreased CAP1 serum levels under 0,8 micromol/l/min and CAP2 under 1,4 micromol/l/min in 1st trimester and compulsory in ACTH serum levels under 5,0 pg/ml. RESULTS: Clinical results can be compared with oxytocinase and ACTH serum levels, what allows to understand enzymatic control of internal maternal state. Role of ACTH not only in lung maturation, but also in onset of labor was proved in the mechanism of influence on immunologic tolerance. In hormonal threatening pregnancies enzymatic component is less helpful in predicting birth date because of common irregular oxitocinase pattern in such patients. On the other hand constant enzymatic increase proves effectiveness of ACTH-depot therapy in neurendocrine-gestoses, or in insulin-requiring pregnant patients. CONCLUSIONS: Acquired results of neonatal state proved that: 1. in pregnancies after infertility treatment early application of substitutional hormonotherapy wsith single doses of 0,5 mg ACTH-depot in early gestational weeks is more efficient method of ACTH dosing than 3 injections method in 2nd trimester 2. serum prelabour oxitocinase levels were precise factors of clinical results.