MODERN CONCEPTS IN REGULATORY MECHANISMS OF INDUCTION OF LABOR

Abstract

In modern conditions of the development of obstetric science, one of the leading factors ensuring the reduction of maternal and perinatal morbidity and mortality is the solution of the problem of labor disorders by improving knowledge of the biological mechanisms of the birth process. The urgency of the problem of violations of labor is due to the frequency of distribution in the population, reaching 30%. The outcome of childbirth for the mother and fetus depends on the biological readiness of the woman’s body for childbirth. There is no doubt that the study of the mechanisms of preparation for physiological childbirth at the cellular-molecular level can provide important progress in this direction.The aim of research is to determine new mechanisms for regulating the preparation of a pregnant woman’s body for childbirth by studying the influence of hormonal and immunological factors on the maturation of the cervix.Materials and research methods. To achieve the goal, 80 primary pregnant women were examined at 38- 40 weeks of gestation, which, depending on the degree of ripe of the cervix upon admission to the hospital, were divided into the main and control groups. All pregnant women underwent anamnesis collection, a complete clinical and laboratory examination, regulated by the Order of the Ministry of Health of Ukraine No. 417 of 15.07.2011. The woman’s body readiness for childbirth was determined taking into account the assessment of the degree of “ripe” of the cervix using the scale proposed by E.H. Bishop. Immunological studies: the concentration of serum relaxin, the content of matrix metalloproteinases (MMP-1, MMP-9) in the peripheral blood serum were determined. The daily urinary excretion of information biochemical parameters, in particular, hydroxyproline and glycosaminoglycans, markers of collagen catabolism, was studied. The results were statistically processed on a personal computer using the STATISTICA-6 program.Research results and their discussion. The results of the study make it possible to identify the most significant factors characterizing the processes of preparing the body for childbirth, which include the “labor hormone” relaxin, as well as the immune mechanisms of regulation of the “ripe” of the cervix before childbirth. The data obtained allow us to regard relaxin as a positive regulator of the production of the main types of MMPs that affect type I collagen. Such a positive regulation of MMP-1 and MMP-9 due to increased levels of relaxin may be of unique importance for the development of remodeling processes of the connective tissue of the cervix, as evidenced by the change in the content of markers of metabolic processes in the cervix.Conclusions: Relaxin is an important factor in preparing the body of a pregnant woman for childbirth, due to the regulation of the production of proteolytic enzymes, matrix metalloproteinases, at the end of the gestational process. The investigated factors can be regarded as new markers of the onset of timely physiological labor, as well as the effectiveness of complex therapeutic measures for the induction of labor.