难产和以往的剖宫产瘢痕对子宫下段拉伸性能的影响  

The effect of dystocia and previous cesarean uterine scar on the tensile properties of the lower uterine segment

作　　者：Buhimschi C. S Buhimschi I.A Yu C 张新艳(译) 柳蕴(校) 

机构地区：[1]Yale University, Department of Obstetrics, Gynecology, and Reproductive Sciences, FMB 339, 333 Cedar St, NewHaven, CT 06520, United States [2]不详

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2006年第6期11-12,共2页Core Journal in Obstetrics/Gynecology

摘　　要：Objective: The remodeling of uterine connective tissue during labor can lead to the reorganization of the extracellular matrix that, in turn, may influence the biomechanical properties of the myometrial wall. We hypothesized that the stretching of the lower uterine segment in laboring women with dystocia changes the viscoelastic properties of the uterine wall. Study design: We tested the tensile strength of lower uterine segment myometrium in 68 pregnant women at term. The biomechanical, structural, and biochemical properties were compared among 3 groups: (1) 39 laboring women who underwent primary low- transverse cesarean delivery for labor dystocia, (2) 12 nonlaboring women who underwent primary elective low- transverse cesarean delivery and (3) 17 women who underwent an elective repeat low- transverse cesarean delivery at term. The tensile properties were quantitated with a stretching regimen that was designed to mimic the conditions of labor. Parameters such as slope, yield point, and break point were recorded, analyzed, and interpreted. Biochemical properties were determined by the measurement of the sulfated glycosaminoglycans, hydroxyproline, and pyridinoline- deoxypyridinoline. Histologic properties of the connective tissue were assessed by collagen birefringence. Lastly, the association between these properties and biomechanical responses were compared among groups. Results: Lower uterine segment myometrium specimens obtained from laboring women were stiffer compared with specimens from women who were not in labor (P = .013) or had scarred myometrium (P < .001). The force that was required to reach the yield point was similar between labor and nonlabor groups (P = .216). Likewise, a previous lower uterine segment scar did not alter the yield point. The break point was similar among all groups (P = .317). Sulfated glycosaminoglycan levels were unaffected by labor or scarring (P = .354). Scarred lower uterine segment myometrium had a higher collagen content compared with unscarred myometrium specimens thatObjective： The remodeling of uterine connective tissue during labor can lead to the reorganization of the extracellular matrix that, in turn, may influence the biomechanical properties of the myometrial wall. We hypothesized that the stretching of the lower uterine segment in laboring women with dystocia changes the viscoelastic properties of the uterine wall. Study design： We tested the tensile strength of lower uterine segment myometrium in 68 pregnant women at term. The biomechanical, structural, and biochemical properties were compared among 3 groups： （1） 39 laboring women who underwent primary low-transverse cesarean delivery for labor dystocia, （2） 12 nonlaboring women who underwent primary elective low-transverse cesarean delivery and （3） 17 women who underwent an elective repeat low-transverse cesarean delivery at term. The tensile properties were quantitated with a stretching regimen that was designed to mimic the conditions of labor. Parameters such as slope, yield point, and break point were recorded, analyzed, and interpreted. Biochemical properties were determined by the measurement of the sulfated gly- cosaminoglycans, hydroxyproline, and pyridinoline-deoxypyridinoline. Histologic properties of the connective tissue were assessed by collagen birefringence. Lastly, the association between these properties and biomechanical responses were compared among groups. Results： Lower uterine segment myometrium specimens obtained from laboring women were stiffer compared with specimens from women who were not in labor （P = . 013） or had scarred myometrium （P 〈. 001） .

关 键 词：子宫下段剖宫产 子宫下段瘢痕 横切口剖宫产 拉伸强度 难产 生物力学特性 子宫结缔组织 分娩妇女 子宫肌层 脱氧吡啶啉 

分 类 号：R719.8[医药卫生—妇产科学] R783.1[医药卫生—临床医学]