Honoré L H
Am J Obstet Gynecol. 1976 Dec 15;126(8):1011-5. doi: 10.1016/0002-9378(76)90693-1.
This modification of Gustavii's hypothesis recognizes the central role of saline-induced decidual cell necrosis and secondary prostaglandin release in the initiation of myometrial activity. In the absence of significant necrosis in the decidua basalis, passive stretching of the subplacental myometrium is considered to activate this region leading to secondary intervillous stasis and the reduction in progesterone delivery to the myometrium and systemic circulation. This drop in progesterone further sensitizes the myometrium to PGF2alpha stimulation and helps the self-sustaining process of myometrial activity culminating in clinical abortion. A third hypothetical contributing factor may be the loss of some myometrial inhibitor normally present in the amniotic fluid.
古斯塔维假说的这一修正认识到，盐水诱导的蜕膜细胞坏死和继发性前列腺素释放在子宫肌层活动启动过程中发挥着核心作用。在基蜕膜不存在显著坏死的情况下，胎盘下子宫肌层的被动拉伸被认为会激活该区域，导致继发性绒毛间隙血流停滞，以及输送至子宫肌层和体循环的孕酮减少。孕酮水平的下降进一步使子宫肌层对前列腺素F2α刺激更加敏感，并有助于子宫肌层活动的自我维持过程，最终导致临床流产。第三个假设的促成因素可能是羊水内通常存在的某种子宫肌层抑制剂的丧失。
