Current topic: the placental corticotrophin-releasing hormone-adrenocorticotrophin axis

In this review the factors regulating production of corticotrophin-releasing hormone (CRH) in intrauterine tissues are discussed and interactions of placental CRH with placental pro-opiomelanocortin (POMC)/adrenocorticotrophin (ACTH) and prostaglandins (PG) are examined. Discrepant results concerning localization of immunoreactive (IR-) CRH and its binding protein (CRH-BP) and their mRNAs in intrauterine tissues are described, and these issues require further resolution. It is suggested that the CRH-ACTH-PG axis in the placenta and choriodecidua may be important in relation to paracrine/autocrine regulation of uteroplacental blood flow, and in term and preterm labour. During the initial stages of preterm labour in the setting of infection, intrauterine cytokines and other factors may stimulate CRH output, implying a role for the immune-neuroendocrine axes in this process. With loss of chronic trophoblasts in advanced infection leading to preterm labour, a major intrauterine site of CRH production may be lost and the influence of this pathway becomes minimal. At this time increased intrauterine prostaglandin synthesis, together with loss of prostaglandin dehydrogenase activity in the fetal membranes, may become the primary route leading to myometrial activity and delivery.