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Chapter: Medical Physiology: Pregnancy and Lactation

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Increased Uterine Excitability Near Term - Parturition

Parturition means birth of the baby. Toward the end ofpregnancy, the uterus becomes progressively more excitable, until finally it develops such strong rhythmi-cal contractions that the baby is expelled.

Parturition

Increased Uterine Excitability Near Term

Parturition means birth of the baby. Toward the end ofpregnancy, the uterus becomes progressively more excitable, until finally it develops such strong rhythmi-cal contractions that the baby is expelled. The exact cause of the increased activity of the uterus is not known, but at least two major categories of effects lead up to the intense contractions responsible for parturi-tion: (1) progressive hormonal changes that cause increased excitability of the uterine musculature, and (2) progressive mechanical changes.

Hormonal Factors That Increase Uterine Contractility

Increased Ratio of Estrogens to Progesterone. Progesteroneinhibits uterine contractility during pregnancy, thereby helping to prevent expulsion of the fetus. Conversely, estrogens have a definite tendency to increase the degree of uterine contractility, partly because estrogens increase the number of gap junctions between the adjacent uterine smooth muscle cells, but also because of other poorly understood effects. Both progesterone and estrogen are secreted in progres-sively greater quantities throughout most of preg-nancy, but from the seventh month onward, estrogen secretion continues to increase while progesterone secretion remains constant or perhaps even decreases slightly. Therefore, it has been postulated that the estrogen-to-progesterone ratioincreases sufficientlytoward the end of pregnancy to be at least partly responsible for the increased contractility of the uterus.

 

Effect of Oxytocin on the Uterus. Oxytocin is a hormonesecreted by the neurohypophysis that specifically causes uterine contraction. There are four reasons to believe that oxytocin might be impor-tant in increasing the contractility of the uterus near term: (1) The uterine muscle increases its oxytocin receptors and, therefore, increases its responsiveness to a given dose of oxytocin during the latter few months of pregnancy. (2) The rate of oxytocin secre-tion by the neurohypophysis is considerably increased at the time of labor. (3) Although hypophysectomized animals can still deliver their young at term, labor is prolonged. (4) Experiments in animals indicate that irritation or stretching of the uterine cervix, as occurs during labor, can cause a neurogenic reflex through the paraventricular and supraoptic nuclei of the hypothalamus that causes the posterior pituitary gland (the neurohypophysis) to increase its secretion of oxytocin.

Effect of Fetal Hormones on the Uterus. The fetus’s pitu-itary gland secretes increasing quantities of oxytocin, which might play a role in exciting the uterus. Also, the fetus’s adrenal glands secrete large quantities of corti-sol, another possible uterine stimulant. In addition, the fetal membranes release prostaglandins in high con-centration at the time of labor. These, too, can increase the intensity of uterine contractions.

Mechanical Factors That Increase Uterine Contractility Stretch of the Uterine Musculature. Simply stretchingsmooth muscle organs usually increases their contrac-tility. Further, intermittent stretch, as occurs repeat-edly in the uterus because of fetal movements, can also elicit smooth muscle contraction. Note especially that twins are born, on average, 19 days earlier than a single child, which emphasizes the importance of mechanical stretch in eliciting uterine contractions.

Stretch or Irritation of the Cervix. There is reason tobelieve that stretching or irritating the uterine cervix is particularly important in eliciting uterine contrac-tions. For instance, the obstetrician frequently induces labor by rupturing the membranes so that the head of the baby stretches the cervix more forcefully than usual or irritates it in other ways.

The mechanism by which cervical irritation excites the body of the uterus is not known. It has been suggested that stretching or irritation of nerves in the cervix initiates reflexes to the body of the uterus, but the effect could also result simply from myogenic transmission of signals from the cervix to the body of the uterus.

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