Malvasi Antonio, Cavallotti Carlo, Resta Leonardo, Mynbaev Ospan A, Di Tommaso Silvia, Vergara Daniele, Gustapane Sarah, Giacci Francesco, Tinelli Andrea
Department of Gynecology and Obstetrics, Santa Maria Hospital, Bari, Italy.
Curr Protein Pept Sci. 2017;18(2):149-154. doi: 10.2174/1389203717666160322150125.
Collagen IV and Laminin are localized in cells and tissue of numerous human organs including the uterus, where these polypeptides control either age changes, or uterus growth in pregnancy, or ripening and dilatation in labor. Authors examined the polypeptides distribution of collagen IV and Laminin in the human pregnant uterus, in normal and dystocic labor, to clarify their physiologic role, by distribution and/or their changes in prolonged dystocic labor. We collected lower uterine segment (LUS) fragments during cesarean section (CS); these biopsies were treated with basic morphological staining for the observation of microscopic- anatomic details. Other samples were processed with immunohistochemical staining for collagen IV and for membrane bound Laminin. All morphological and immunochemical results were analyzed with quantitative analysis of images and statistical analysis of data. Both Collagen IV and Laminin show changes in the pregnant uterus before 4 hours of full cervical dilatation in patients after 4 hours. All the three types of the human uterine cells, mucosal, submucosal and smooth muscular cells, are more reduced in LUS after 4 hours of cervical dilatation in dystocic labor. The connective tissues (including fibroblast) show the most evident changes in the dystocic LUS, collagen IV and laminin changes during cervical dilatation in prolonged dystocic labor, with a decreased elasticity with increased roughness and dryness. The LUS anatomical modifications during labor can be the cause of pathological changes in protracted dystocic labor. In the dystocic labor that lasts more than 4 hours from the complete cervical ripening and dilatation, the laminin and collagen IV concentration reduces in the LUS tissue. In dystocic labor, delivery should be completed before the 3 hours of full dilation, to avoid a reduction of laminin and collagen IV and a worsening of LUS healing for the next pregnancy.
IV型胶原蛋白和层粘连蛋白定位于包括子宫在内的众多人体器官的细胞和组织中，在子宫中，这些多肽可控制年龄变化、孕期子宫生长或分娩时的成熟和扩张。作者研究了IV型胶原蛋白和层粘连蛋白在人类妊娠子宫、正常分娩和难产中的多肽分布，以通过其分布和/或在延长的难产中的变化来阐明它们的生理作用。我们在剖宫产（CS）过程中收集子宫下段（LUS）碎片；这些活检组织用基本形态学染色处理，以观察微观解剖细节。其他样本用IV型胶原蛋白和膜结合层粘连蛋白的免疫组织化学染色处理。所有形态学和免疫化学结果通过图像定量分析和数据统计分析进行分析。在宫颈完全扩张4小时后的患者中，IV型胶原蛋白和层粘连蛋白在妊娠子宫中均有变化。在难产中，宫颈扩张4小时后，人类子宫的三种类型细胞，即黏膜细胞、黏膜下细胞和平滑肌细胞，在LUS中均减少得更多。结缔组织（包括成纤维细胞）在难产的LUS中显示出最明显的变化，在延长的难产中宫颈扩张期间IV型胶原蛋白和层粘连蛋白发生变化，弹性降低，粗糙度和干燥度增加。分娩时LUS的解剖学改变可能是延长难产病理变化的原因。在宫颈完全成熟和扩张后持续超过4小时的难产中，LUS组织中层粘连蛋白和IV型胶原蛋白浓度降低。在难产中，应在完全扩张3小时前完成分娩，以避免层粘连蛋白和IV型胶原蛋白减少以及LUS愈合恶化，影响下一胎妊娠。
