1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy.
MOMO' FertiLIFE, IVF Clinic, 76011 Bisceglie, Italy.
Int J Mol Sci. 2024 May 22;25(11):5630. doi: 10.3390/ijms25115630.
In eutocic labor, the autonomic nervous system is dominated by the parasympathetic system, which ensures optimal blood flow to the uterus and placenta. This study is focused on the detection of the quantitative presence of catecholamine (C) neurofibers in the internal uterine orifice (IUO) and in the lower uterine segment (LUS) of the pregnant uterus, which could play a role in labor and delivery. A total of 102 women were enrolled before their submission to a scheduled cesarean section (CS); patients showed a singleton fetus in a cephalic presentation outside labor. During CS, surgeons sampled two serial consecutive full-thickness sections 5 mm in depth (including the myometrial layer) on the LUS and two randomly selected samples of 5 mm depth from the IUO of the cervix. All histological samples were studied to quantify the distribution of A nerve fibers. The authors demonstrated a significant and notably higher concentration of A fibers in the IUO (46 ± 4.8) than in the LUS (21 ± 2.6), showing that the pregnant cervix has a greater concentration of A neurofibers than the at-term LUS. Pregnant women's mechanosensitive pacemakers can operate normally when the body is in a physiological state, which permits normal uterine contractions and eutocic delivery. The increased frequency of C neurofibers in the cervix may influence the smooth muscle cell bundles' activation, which could cause an aberrant mechano-sensitive pacemaker activation-deactivation cycle. Stressful circumstances (anxiety, tension, fetal head position) cause the sympathetic nervous system to become more active, working through these nerve fibers in the gravid cervix. They might interfere with the mechano-sensitive pacemakers, slowing down the uterine contractions and cervix ripening, which could result in dystocic labor.
在正常分娩过程中,自主神经系统受副交感神经系统支配,以确保子宫和胎盘的最佳血流。本研究专注于检测妊娠子宫内口(IUO)和子宫下段(LUS)中儿茶酚胺(C)神经纤维的定量存在,这些神经纤维可能在分娩中发挥作用。共有 102 名妇女在计划剖宫产(CS)前入组;这些患者在分娩前表现为头位单胎。在 CS 过程中,外科医生在 LUS 上连续采集 2 个 5mm 全层(包括肌层)深度的连续切片,以及宫颈 IUO 上随机选择的 2 个 5mm 深度的样本。对所有组织学样本进行研究,以定量分析 A 神经纤维的分布。作者发现 IUO 中的 A 纤维(46±4.8)显著高于 LUS(21±2.6),表明妊娠宫颈的 A 神经纤维浓度高于足月 LUS。当身体处于生理状态时,孕妇的机械敏感起搏机能正常运行,从而允许正常的子宫收缩和正常分娩。宫颈中 C 神经纤维的频率增加可能会影响平滑肌细胞束的激活,从而导致异常的机械敏感起搏激活-失活周期。应激情况(焦虑、紧张、胎头位置)会使交感神经系统变得更加活跃,通过这些在妊娠宫颈中的神经纤维发挥作用。它们可能会干扰机械敏感起搏,减缓子宫收缩和宫颈成熟,从而导致难产。
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