Wray Susan
Department of Physiology, University of Liverpool, Crown Street, Liverpool L69 3BX, UK.
Exp Physiol. 2007 Jul;92(4):621-31. doi: 10.1113/expphysiol.2007.038125. Epub 2007 May 4.
A better understanding of the mechanisms that generate and modulate uterine contractility is needed if progress is to be made in the prevention or treatment of problems in labour. Dysfunctional labour describes the condition when uterine contractility is too poor to dilate the cervix, and it is the leading cause of emergency Caesarean sections. Recently, insight has been gained into a possible causal mechanism for dysfunctional labour. Study of the physiological mechanisms that produce excitation in the uterus, the subsequent Ca(2)(+) signals and biochemical pathway leading to contraction has underpinned this progress. In this review, I give an account of excitation-contraction signalling in the myometrium and explore the implications of recent findings concerning lipid rafts for these processes. I also discuss how changes of pH are fundamentally enmeshed in uterine activity and biochemistry and explore the effect that pH changes will have on human myometrium. Finally, I present the evidence that acidification of the myometrium is correlated with dysfunctional labour and suggest the processes by which it is occurring. It is only by gaining a better understanding of uterine physiology and pathophysiology that progress will be made and research findings translated into clinical benefit for women and their families.
如果要在预防或治疗分娩问题方面取得进展，就需要更好地了解产生和调节子宫收缩力的机制。功能失调性分娩描述的是子宫收缩力太差而无法扩张宫颈的情况，它是紧急剖宫产的主要原因。最近，人们对功能失调性分娩的一种可能因果机制有了深入了解。对子宫中产生兴奋的生理机制、随后的Ca(2)(+)信号以及导致收缩的生化途径的研究为这一进展奠定了基础。在这篇综述中，我阐述了子宫肌层中的兴奋 - 收缩信号传导，并探讨了关于脂筏的最新发现对这些过程的影响。我还讨论了pH值变化如何从根本上与子宫活动和生物化学相互交织，并探讨了pH值变化对人子宫肌层的影响。最后，我展示了子宫肌层酸化与功能失调性分娩相关的证据，并提出了其发生的过程。只有更好地了解子宫生理学和病理生理学，才能取得进展，并将研究结果转化为对女性及其家庭的临床益处。
