Warkentin B
Arch Gynakol. 1977 Jan 27;222(1):15-27. doi: 10.1007/BF00670854.
The question of initiation of labour is not yet solved. A fetal fixing of the date would be ingenious. On the one hand the fet is endangered by prematurity, on the other hand by placental insufficiency in postmaturity. Fetuses with comparatively lighter placenta remain in average shorter in utero until spontaneous initiation of labour than those with comparatively heavier placenta. This fact leads to the assumption of a relative placental insufficiency as a determining factor of the onset of labour. A further inquiry demonstrates, that babies born after premature termination of pregnancy about the term - either by induction of labour or by primary sectio caesarea - are heavier and longer than those born after spontaneous labour. This leads to the assumption of a prenatal weight loss of the infant before spontaneous initiation of labour. This weight loss is caused by diminution of water content and relative placental insufficiency. This relative placental insufficiency also leads to a diminution of amniotic fluid, which is swallowed by the "hungry" fet in a greater amount. Altogether a diminution of uterine volume is resulting, which is accomplished by a diminution of uterine wall tension. The coordination of uterine activity, which precedes delivery, is combined with the ripening of the cervix. The ripening of the cervix also leads to a retraction of myometrium and thus to a further diminution of uterine wall tension. It is concluded, that a diminution of uterine volume, causes by fetal weight loss and diminution of amniotic fluid, leads to a reduction of uterine wall tension, which is supported by the ripening of the cervix. This reduction of uterine wall tension is the precondition of the increasing coordination of activity, which precedes delivery.
分娩发动的问题尚未解决。确定胎儿的预产期会是个巧妙的办法。一方面,胎儿会受到早产的威胁,另一方面,过期产时又会面临胎盘功能不全的问题。胎盘相对较轻的胎儿,在子宫内平均停留时间比胎盘相对较重的胎儿短,直至自然发动分娩。这一事实使人推测,相对胎盘功能不全是分娩发动的决定性因素。进一步的研究表明,在预产期前通过引产或剖宫产提前终止妊娠出生的婴儿,比自然分娩出生的婴儿体重更重、身长更长。这使人推测,在自然发动分娩前,胎儿在产前会有体重减轻。这种体重减轻是由于水分含量减少和相对胎盘功能不全所致。这种相对胎盘功能不全还会导致羊水减少,“饥饿”的胎儿会更多地吞咽羊水。总体而言,子宫体积会减小,这是通过子宫壁张力的降低来实现的。分娩前子宫活动的协调与宫颈成熟相结合。宫颈成熟也会导致子宫肌层收缩,从而进一步降低子宫壁张力。可以得出结论,胎儿体重减轻和羊水减少导致的子宫体积减小,会引起子宫壁张力降低,而宫颈成熟会对此起到支持作用。子宫壁张力的降低是分娩前活动协调性增强的前提条件。