Book Reading

Mechanism of The Initiation of Human Partition

Raissa Nurwany

Supervisor:
Dr. Hj. Putri Mirani, SpOG (K)

Program Studi Dokter Spesialis (PPDS)

Obstetri dan Ginekologi
Fakultas Kedokteran Universitas Sriwijaya
2016
1
INTRODUCTION

Post partum
Labor per se uterine
evolution

Preparation
uterus

Parturition

2
 THIS CHAPTER

Review mechanism of parturition in normal pregnancies

3
NORMAL DURATION OF PREGNANCY

280 postmenstrual Preterm: birth before

days (40 weeks) 37 weeks

Post Term: gestation

extends beyond 42
weeks

4
 AN OVERVIEW OF PARTURITION AND LABOR

Labor: acute process by which the fetus is expelled from the uterus,
usually within 24 hours
Labor: a state increased frequency and intensity of uterine
contractions -> progressive cervical effacement, dilatation & delivery
Parturition: the changes that occur in preparation for, during and after
labor

The process of parturition goes on for weeks, while labor lasts hour

5
THE INITIATION OF PARTURITION
AND THE ONSET OF LABOR

6
OVERVIEW OF PARTURITION AND LABOR

Phase 0:
myometria
l
tranquility

Phase 3: Phase 1:
Events
after
preparation
delivery of labor

Phase 2:
Process of
labor

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BIOCHEMICAL MEDIATORS INVOLVED
IN THE FOUR PHASES OF PARTURITION

8
THE COMMON PATHWAY OF
PARTURITION: COMPONENTS
ANATOMICA
ANATOMICA
L
L

CLINICAL
CLINICAL BIOCHEMICA
BIOCHEMICA
EVENTS
EVENTS L
L

PHYSIOLOGIC
PHYSIOLOGIC

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THE COMMON TERMINAL PATHWAY
OF PRETERM AND TERM PARTURITION

10
THE ROLE OF PROGESTERONE
PROGESTERON
E
Maintain myometrial quiescence

Down-regulate gap-junction
formation
Inhibit cervical ripening

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THE ROLE OF ESTROGEN
ESTROGE
N Increasing myometrial
contractility and excitability

Induction of cervical ripening

prior to the onset of labor

12
SOURCES OF STEROIDS AND MECHANISM FOR PROGESTERONE
WITHDRAWAL BEFORE PARTURITION IN SEVERAL SPECIES

13
THE ROLE OF PROSTAGLANDINE

PROSTAGLANDINS

• Administrations of prostaglandins can induce early or late

termination of pregnancy
• Treatment with indomethacin or aspirin can delay spontaneous
onset of parturition in animals
• Concentrations of prostaglandins in plasma and amniotic fluid
increase during labor
• Intra-amniotic injection of arachidonic acid, the precursor for
prostaglandins, induces abortions
• Prostaglandins concentrations in amniotic fluid increase early
during spontaneous labor at term

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POSSIBLE ROUTES FOR THE FETUS
TO SIGNAL THE ONSET OF LABOR
Endocrine pathway
• Fetal circulation delivers the molecules to
the placenta and reaches the uterus directly
or through the maternal circulation

Paracrine pathway
• Molecules produced by fetal organs reach
the amniotic cavity to exert an effect on the
fetal membranes that transduce the signal to
the myometrium and cervix

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POSSIBLE ROUTES OF TRANSMISSION OF THE SIGNAL
FOR THE INITIATION OF LABOR FROM THE
CONCEPTUS TO THE MOTHER

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 PARTURITION AS AN INFLAMMATORY
PROCESS

Inflammations can be detected in the cervix, myometrium,

chorioamniotic membranes, and the amniotic cavity in women in
labor.

Spontaneous labor at term is associated with infiltration of

inflammatory cells in these tissues and increased production of a
wide range of pro-inflammatory cytokines and chemokine.

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 THE ROLE OF PLACENTA

Onset of labor is independent of the presence of the fetus

The fetus plays an important role in the timing of delivery in primates, and
that in the absence of the fetus, gestasional length is longer than in normal
pregnancies

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 CONCLUSION

The common pathway of parturition; increased uterine contractility, cervical

ripening, degradation of the extracellular matrix -> membrane rupture

Mechanism initiation of labor; production of fetal or placental signals

activate the common pathway (surfactants protein-A and CRH/cortisol)

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