在前列腺素E2介导的引产过程中，宫颈一氧化氮浓度的变化与 Bishop 评分及宫颈长度的改变相关。

Changes in cervical nitric oxide concentration correlate with Bishop score and cervical length modifications in prostaglandin E2-mediated induction of labor.

作者信息

Chiossi Giuseppe, Verocchi Gianluca, Venturini Paolo, Facchinetti Fabio

机构信息

Mother-Infant Department, Modena Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy.

出版信息

J Soc Gynecol Investig. 2006 Apr;13(3):203-8. doi: 10.1016/j.jsgi.2006.01.001.

DOI:10.1016/j.jsgi.2006.01.001

PMID:16638591

Abstract

OBJECTIVE

Nitric oxide (NO) plays a fundamental role in cervical ripening and it is synthesized in the human cervix. We studied the effect of the dinoprostone on cervical NO release in pregnant women, and we investigated the relationship between cervical NO metabolites, cervical length, and Bishop score.

METHODS

Seventy-seven women underwent induction of labor at > or = 37 weeks of gestation, due to post-term pregnancy (23.8%), oligohydramnios (36.3) or preeclampsia (29.9%). Cervical fluid samples for NO metabolites (NOx), Bishop score, and cervical length were assessed immediately before (time 0 [T0]) and 6 hours after (T6) the local application of dinoprostone, a commercially available prostaglandin E2 (PGE2) analog.

RESULTS

The mean patients' age was 34 +/- 3.2 years, mean gestational age at enrollment was 284 +/- 9.2 days, and nulliparous represented 31.2% of the study population. At time 0, Bishop score was less than 4 in 74% (57/77) of the subjects, mean cervical length was 28.6 +/- 5.8 mm, mean NOx concentration was 208.6 +/- 103.8 microM/mL; 6 hours later, at T6, the mean cervical length decreased to 19.5 +/- 8.8 mm, and the mean NOx concentration increased up to 316.7 +/- 240.9 microM/mL. Data were unaffected by parity or by regular uterine contraction patterns. A statistically significant positive correlation was found between changes in cervical NOx levels and Bishop score modification (P < .01; r = .494), as well as between the modification of NO metabolites concentration and cervical shortening (P < .01; r = .307).

CONCLUSIONS

Prostaglandin (PG)-induced cervical ripening is associated with local NO release. NO plays an active role in cervical remodeling since it positively correlates with both cervical shortening and Bishop score increase. NO oxide and PG are the two pathways that, cross activating each other, trigger the cascade of events responsible of cervical ripening.

摘要

目的

一氧化氮（NO）在宫颈成熟过程中起重要作用，且在人体宫颈中合成。我们研究了地诺前列酮对孕妇宫颈NO释放的影响，并探讨了宫颈NO代谢产物、宫颈长度与 Bishop 评分之间的关系。

方法

77 名妊娠≥37 周的妇女因过期妊娠（23.8%）、羊水过少（36.3%）或先兆子痫（29.9%）接受引产。在局部应用地诺前列酮（一种市售的前列腺素 E2（PGE2）类似物）之前（时间 0 [T0]）和之后 6 小时（T6），立即评估宫颈液样本中的 NO 代谢产物（NOx）、Bishop 评分和宫颈长度。

结果

患者的平均年龄为 34±3.2 岁，入组时的平均孕周为 284±9.2 天，初产妇占研究人群的 31.2%。在 T0 时，74%（57/77）的受试者 Bishop 评分低于 4 分，平均宫颈长度为 28.6±5.8 毫米，平均 NOx 浓度为 208.6±103.8 微摩尔/毫升；6 小时后，在 T6 时，平均宫颈长度降至 19.5±8.8 毫米，平均 NOx 浓度升至 316.7±240.9 微摩尔/毫升。数据不受产次或规律子宫收缩模式的影响。宫颈 NOx 水平变化与 Bishop 评分改变之间存在统计学显著正相关（P <.01；r =.494），NO 代谢产物浓度改变与宫颈缩短之间也存在正相关（P <.01；r =.307）。