Blanks Andrew M, Shmygol Anatoly, Thornton Steven
Clinical Sciences Research Institute, University of Warwick, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
Best Pract Res Clin Obstet Gynaecol. 2007 Oct;21(5):807-19. doi: 10.1016/j.bpobgyn.2007.03.003. Epub 2007 Apr 18.
The primary function of the uterus during gestation is to harbour the growing conceptus in a largely quiescent environment. Upon maturation of the fetus to a point sufficient for extrauterine survival, the uterus must remodel itself sufficiently to generate forceful contractions during labour. During preterm delivery, the process of remodelling of the myometrium occurs early due to a number of different causes, although the underlying basis for myometrial contraction remains the same. This review summarises the anatomical, physiological and molecular basis for contraction. We describe the fibre structure of the human uterus and how this relates to the spread of electrical excitation during a contraction. The process of excitation within a single myometrial cell is described, as well as how this relates to contraction. We then focus on how excitation-contraction coupling is modulated by intercellular communication, pharmacomechanical-coupling and hormonal milieu. Lastly, we consider the actions of the commonly accepted uterine agonists oxytocin, prostaglandin F(2alpha), and prostaglandin E(2), and the tocolytic ritodrine.
妊娠期间子宫的主要功能是在很大程度上静止的环境中容纳不断生长的胚胎。当胎儿成熟到足以宫外存活时，子宫必须充分重塑自身，以便在分娩时产生有力的收缩。在早产时，由于多种不同原因，子宫肌层的重塑过程会提前发生，尽管子宫肌层收缩的潜在基础保持不变。本综述总结了收缩的解剖学、生理学和分子基础。我们描述了人类子宫的纤维结构以及这与收缩过程中电兴奋传播的关系。描述了单个子宫肌层细胞内的兴奋过程以及这与收缩的关系。然后我们关注细胞间通讯、药物机械偶联和激素环境如何调节兴奋 - 收缩偶联。最后，我们考虑了公认的子宫激动剂催产素、前列腺素F(2α)和前列腺素E(2)以及宫缩抑制剂利托君的作用。
