Endocrinology of preterm labor.

The clinical importance of preterm labor and delivery dictates that we understand the physiology and diagnostic usefulness of endocrine as well as other agents that may be helpful in this regard. Clearly, estrogen and progesterone establish the environment that allows parturition and probably preterm labor to occur. The use of salivary estriol, though not a foolproof test, is becoming more frequent and is commercially available. Fibronectin, though not an endocrine test, has a similar diagnostic usefulness. In the future, we would expect to see CRH and even the use of selective cytokines, probably IL-6, as possible diagnostic tests. Whereas all of these agents have some diagnostic usefulness, none of them can be expected to predict every case of preterm delivery and some battery of tests, not unlike the triple or quadruple tests that are used for prenatal diagnosis of Down syndrome, may be effective and should be examined in the future. The use of these tests, salivary estriol and fetal fibronectin in particular, has already had an effect on management and decision making involved in preterm labor, and the future should give us more options and hopefully, better choices to manage this most difficult condition.