Väisänen-Tommiska Mervi, Nuutila Mika, Ylikorkala Olavi
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Obstet Gynecol. 2004 Apr;103(4):657-62. doi: 10.1097/01.AOG.0000115509.10605.64.
Nitric oxide may be a factor in cervical ripening. We compared the nitric oxide metabolite levels in cervical fluid in women going beyond term and in women delivering spontaneously at term.
We studied a total of 208 women with singleton pregnancies: 108 women who went beyond term (294 days or longer), and 100 women who went spontaneously into labor at term. Cervical fluid samples, collected well before the initiation of labor, were assessed for nitric oxide metabolites using an assay with a detection limit of 3.8 micromol/L.
Women going beyond term had detectable levels of nitric oxide metabolites in their cervical fluid (60%) less often (P =.001) than women delivering at term (87%). The nitric oxide metabolite concentration in cervical fluid in women going beyond term (median 23.5 micromol/L; 95% confidence interval less than 3.8, 31.8) was 4.5 times lower (P <.001) than that in women delivering at term (median 106.0 micromol/L; 95% confidence interval 81.8, 135.0). Such a difference (14.0 versus 106.0 micromol/L) also existed when only the 66 women going into spontaneous postterm labor were included in the comparison. Both nulliparous (median less than 3.8 micromol/L) and parous (median 31.3 micromol/L) women going beyond term had lower (P <.01) cervical fluid nitric oxide metabolite levels than nulliparous and parous women delivering at term (medians 76.1 and 101.3 micromol/L, respectively). In the postterm group, women with cervical fluid nitric oxide metabolite concentrations at or below the median failed more often (P <.001) to progress in labor and had longer (P =.02) duration of labor than those with cervical fluid nitric oxide metabolite concentrations above the median.
Reduced cervical nitric oxide release may contribute to prolonged pregnancy.
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一氧化氮可能是宫颈成熟的一个因素。我们比较了过期妊娠妇女和足月自然分娩妇女宫颈液中一氧化氮代谢物水平。
我们共研究了208名单胎妊娠妇女：108名过期妊娠妇女（294天或更长时间），以及100名足月自然临产妇女。在临产开始前采集宫颈液样本，使用检测限为3.8微摩尔/升的检测方法评估一氧化氮代谢物。
过期妊娠妇女宫颈液中可检测到一氧化氮代谢物水平的比例（60%）低于足月分娩妇女（87%）（P = 0.001）。过期妊娠妇女宫颈液中一氧化氮代谢物浓度（中位数23.5微摩尔/升；95%置信区间小于3.8，31.8）比足月分娩妇女（中位数106.0微摩尔/升；95%置信区间81.8，135.0）低4.5倍（P < 0.001）。当仅将66名过期后自然临产妇女纳入比较时，也存在这种差异（14.0对106.0微摩尔/升）。过期妊娠的初产妇（中位数小于3.8微摩尔/升）和经产妇（中位数31.3微摩尔/升）宫颈液中一氧化氮代谢物水平均低于足月分娩的初产妇和经产妇（中位数分别为76.1和101.3微摩尔/升）（P < 0.01）。在过期妊娠组中，宫颈液一氧化氮代谢物浓度等于或低于中位数的妇女产程进展失败的频率更高（P < 0.001），产程持续时间更长（P = 0.02），而宫颈液一氧化氮代谢物浓度高于中位数的妇女则不然。
宫颈一氧化氮释放减少可能导致妊娠延长。
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