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Biochemie der Zervixreifung und Muttermundseröffnung

Biochemistry of cervical ripening and dilatation

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Zusammenfassung

Die biochemischen Mechanismen der Zervixreifung und ihre Regulationssysteme sind nach wie vor nicht vollständig aufgeklärt. Die sich über Wochen vollziehende Zervixreifungsphase (bis zu einer Muttermundweite von 2–3 cm) ist gekennzeichnet durch einen katabolen Proteoglykan- und Glykosaminoglykanstoffwechsel, insbesondere durch einen drastischen Anstieg des Hyaluronans mit Hydratation des Gewebes und einer signifkanten Verminderung der Kollagenkonzentration innerhalb der extrazellulären Matrix, die v. a. über Fibroblasten von Steroidhormonen, Prostaglandin E2, Zytokinen und das NO-System gesteuert werden. Die Rolle bereits um und in den Gefäßen der Zervix akkumulierter neutrophiler Granulozyten und Makrophagen ist in diesem Zusammenhang noch unklar.

Die Muttermundseröffnung unter der Geburt ähnelt einer entzündlichen Reaktion des Gewebes mit Migration, Infiltration und Degranulation neutrophiler Granulozyten, Freisetzung von Proteasen (v. a. Kollagenasen) und Degradation matrixbildender Proteine (v. a. Kollagen). Dabei kommt der Synthesesteigerung von Zytokinen (v. a. IL-1β, IL-8) und vaskulärer Adhäsionsmoleküle besondere Bedeutung zu.

Mögliche klinische Konsequenzen aus diesen Grundlagenuntersuchungen bestehen in der Entwicklung neuer Konzepte zur Diagnostik und Therapie sowohl der verzögerten als auch der vorzeitigen Muttermundseröffnung bei Frühgeburt.

Abstract

The biochemical mechanisms of cervical ripening and its regulation are yet not fully understood. The cervical ripening phase, which begins 4 weeks prior to the delivery (up to a cervical dilatation of 2–3 cm), is characterized by acatabolic metabolism of proteoglycans and glycosaminoglycans, mainly by a dramatic increase in the hyaluronan concentration associated with increased water uptake and by a significant reduction of collagen concentration within the extracellular matrix. These catabolic transformation processes of the cervix are regulated via cervical fibroblasts by steroid hormones, prostaglandin E2, cytokines and the NO system.

The role of neutrophils and macrophages, which are accumulated in and around cervical vessels at that time, still remains unclear. The cervical dilatation during parturition has been compared to an inflammatory reaction and is characterized by migration, infiltration and degranulation of neutrophils with subsequent release of proteases and collagenases and enzymatic degradation of fundamental matrix proteins, in particular collagen. The increased synthesis of cytokines, in particular IL-1β and IL-8, and the increased expression of vascular endothelial adhesion molecules play a crucial role in these processes.

Recent findings from biochemical research may give new insights in the mechanisms of physiological cervical ripening and “artificial” cervical ripening at induction of labor and may also contribute to the development of more promising approaches in the diagnosis and treatment of prematurity.

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  1. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen

    W. Rath & C. Bartz

  2. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen

    W. Rath

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Correspondence to W. Rath.

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Rath, W., Bartz, C. Biochemie der Zervixreifung und Muttermundseröffnung. Gynäkologe 37, 314–320 (2003). https://doi.org/10.1007/s00129-004-1508-9

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  • DOI: https://doi.org/10.1007/s00129-004-1508-9

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