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publicado em 22/06/2011 às 03h00:00
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Cervical ripening differs in normal and premature births

The cervical remodeling is not necessarily an acceleration of the physiological process of labor within the normal

 
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The cervical ripening that causes preterm labor is different from what happens at the beginning of labor that occurs in normal time.

The findings challenge the conventional assumption that the premature ripening and remodeling are just an accelerated version of normal, and that the maturation of normal period is caused mainly by the activation of inflammatory responses.

The cervical remodeling is the process by which the cervix is ​​transformed to open sufficiently during childbirth.

"The early remodeling of the cervix can occur for more than one mechanism and is not necessarily an acceleration of the physiological process of labor-term normal. Depending on the cause of premature birth, this mechanism can vary," said Dr. Mala Mahendroo, professor of obstetrics and gynecology.

Previous studies suggest that in preterm labor or not white blood cells flow into the cervix releasing enzymes that break down the supporting tissue and remodel the cervix, allowing the baby to pass through the birth canal. That is true only in part, the researchers said.

"The immune system (inflammatory response) is sufficient to cause cervical ripening, but is not absolutely necessary for this to happen," said Brenda Timmons, research scientist in obstetrics and gynecology.

Almost 13% of all U.S. births are premature. Premature babies can suffer respiratory distress, intraventricular hemorrhage, and even cerebral palsy. The risk factors for preterm birth include smoking, alcohol consumption, maternal age, genetics, cervical insufficiency, prior preterm delivery and infection.

"In about half of premature births, the cause is unknown. It is crucial to identify the multiple causes of preterm labor that effective therapies can be developed for each type. When patients come in early labor, we have many therapies to stop it, "said Dr. Roxane Holt, a specialist in maternal-fetal medicine.

Researchers at the University of Texas Southwestern compared models of preterm labor in rats. They injected lipopolysaccharide (LPS) to promote conditions similar to those of an infection and an inflammatory response in a model. In the other, they administered mifepristone (RU486) to simulate the removal of progesterone, the hormone that supports pregnancy and it usually appears in late pregnancy.

The researchers report that the changes in cervical inflammation induced conditions are caused by an influx of white blood cells and an increased expression of pro-inflammatory markers without an increase in gene expression induced in growth that occurs within normal. The maturation induced by premature withdrawal of progesterone comes from the combined activation of processes that occur during the ripening period and shortly after normal delivery.

"These findings, if translatable to humans, suggest that a treatment can not be effective for all types of preterm birth and that early identification of the cause of prematurity is needed to determine the right treatment," said Dr. Mahendroo.

Polish

Source: Isaude.net
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premature birth    labor    cervical ripening    early remodeling of the cervix    lipopolysaccharide    mifepristone   
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