Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 2, March-April, p. 283–288

Publication type: review article

Language: English

Initiation of Preterm Labor

Inicjacja porodu przedwczesnego

Małgorzata Pawelec1,A,B,C,D,G, Bogusław Pałczyński1,B, Joanna Krzemieniewska1,A, Mikołaj Karmowski1,B, Jerzy Koryś2,C, Krzysztof Łątkowski1,B, Andrzej Karmowski1,E,F

1 1st Department and Clinic of Gynecology and Obstetrics, Wroclaw Medical University, Wrocław, Poland

2 Non-Public Health Care Center (NZOZ), Legnickie Pole, Poland

Abstract

Preterm births are still a major problem in obstetrics. It is estimated that preterm births occur in about 12% of all pregnancies. Due to advances in medical technology and better care of fetuses and premature babies, the preterm mortality rate has been falling (as recently as 1995 the survival rate in the US for premature infants born at 34 weeks amounted to only a fraction of the corresponding rate for those born after 37 weeks). In the US in 2005, preterm births cost society approximately $26 billion, and medical care for premature babies cost more than $51 billion. Only the richest countries can afford such costly medical care. That is why it is not only the individual aspects but also the social aspects that are important when studying preterm birth mechanisms and ways of preventing them. The existing research indicates that both spontaneous mature birth and preterm birth begin and proceed in a similar manner. This is confirmed by the similar involvement in both processes of corticotropin-releasing hormone, urocortin, extracellular stress protein HSP70 (amniotic fluid heat shock protein), prostaglandins, proinflammatory cytokines or glucocorticosteroids. Apparently, at the beginning of either a preterm birth or a term birth, there is a stimulus that ends the development of the fetus or initiates birth. This stimulus works via feedback through placental hormones and through substances present in the fetal membranes, ultimately leading to functional progesterone withdrawal (FPW), thus leaving the uterus sensitive to contractive factors.

Streszczenie

Porody przedwczesne stanowią ciągle istotny problem położniczy. Szacuje się, że przedwczesnymi urodzeniami kończy się około 12% wszystkich ciąż. Dzięki rozwojowi techniki medycznej i lepszej opiece nad płodami i wcześniakami śmiertelność wcześniaków zmniejsza się (w USA jeszcze w 1995 roku współczynnik przeżycia dla wcześniaków urodzonych w 34. tygodniu ciąży stanowił zaledwie ułamek analogicznego współczynnika dla urodzonych po 37. tygodniu). W USA w 2005 roku porody przedwczesne kosztowały społeczeństwo około 26 miliardów dolarów, a ponad 51 miliardów dolarów kosztowało leczenie wcześniaków. Tylko najbogatsze kraje stać na inwestowanie w tak kosztowną opiekę medyczną, dlatego poznawanie mechanizmów porodów przedwczesnych i metod ich skutecznego leczenia ma nie tylko istotny aspekt indywidualny, ale i społeczny. Dotychczasowe badania naukowe wskazują, że samoistny poród o czasie i poród przedwczesny rozpoczynają się i przebiegają w podobny sposób, a wyrazem tego może być takie samo zaangażowanie w oba procesy między innymi: kortykoliberyny, urokortyny, pozakomórkowego białka stresu HSP70 (amniotic fluid heat shock protein), prostaglandyn, prozapalnych cytokin, czy glukokortykosteroidów. Wydaje się, że na początku porodu przedwczesnego, czy porodu o czasie, pojawia się bodziec kończący dojrzewanie płodu lub inicjujący poród przedwczesny, który drogą sprzężeń zwrotnych działa przez hormony łożyska i przez substancje obecne w błonach płodowych, w ostateczności prowadząc do czynnościowego wycofania progesteronu (FPW), a więc niejako pozostawienia macicy bezbronnej wobec czynników skurczogennych.

Key words

preterm birth, initiation of labor, urocortin, aquaporin 9, heat shock protein HSP70, glucocorticosteroids.

Słowa kluczowe

poród przedwczesny, inicjacja porodu, urokortyna, akwaporyna 9, białko stresu HSP70, glikokortykosteroidy.

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