Changes in intracellular pH close to term and their possible significance to labour

Insights from physiology into myometrial function and dysfunction

NEW FINDINGS

What is the topic of this review? I focus on clinical aspects of uterine physiology, specifically, myometrial contractility. I bring together and contrast findings using physiological approaches and those using newer techniques, 'omics'. What advances does it highlight? Physiological studies have recently shed light on the myometrium in twin pregnancies, but there have been no 'omic' approaches. In contrast, studies of preterm delivery using newer approaches are generating new research avenues, whereas traditional approaches have not flourished. Finally, I describe significant advances in understanding of 'slow-to-progress' labours, achieved using physiological and clinical approaches. Advances in molecular, genetic and 'omic' technologies are fuelling the thirst for better understanding of the uterus and application of this information to problems in pregnancy and labour. Progress has, however, been limited while we still have an incomplete understanding of some of the basic physiology of uterine smooth muscle (myometrium). In this review and opinion piece, I explore some of the fascinating findings from selected recent studies and see how these may provide new avenues for physiological and clinical research. It is also the case, however, that there is still limited mechanistic understanding about physiological and pathophysiological processes in the myometrium. This lack of understanding limits the usefulness of some findings from genomic and allied studies. By focusing on some key recent findings and relating these to two important clinical problems in childbirth that involve myometrial activity, namely preterm delivery and difficult labours, the interplay between our physiological knowledge and the information provided by newer technologies is explored. My opinion is that physiology has provided much more new mechanistic insight into difficult births and that the newer technologies may lead to breakthroughs in preterm birth research, but that this has not yet happened.

The effects of pH change on Ca(++) signaling and force in pregnant human myometrium

OBJECTIVE

This study was designed to determine the effects of both intracellular and extracellular pH change on contractile activity and intracellular Ca(++) during spontaneous contractions, oxytocin, and depolarization-induced stimulation of human myometrium.

STUDY DESIGN

Human myometrial tissue was obtained at elective caesarean delivery at term (37-41 completed weeks of gestation). Longitudinal strips were dissected and loaded with the calcium sensitive indicator Indo-1. Statistical significance was tested with the Student t test.

RESULTS

Both intracellular and extracellular acidification significantly reduces or even abolishes phasic activity, whether it arises spontaneously or in the presence of oxytocin. These contractile changes can be accounted for by the changes in intracellular Ca(++). Alkalinization produced the opposite effects. However, baseline or maintained tension changes could not be accounted for by changes in intracellular Ca(++).

CONCLUSION

We suggest that the effects on phasic activity are due to the inhibition of L-type calcium entry and that, during maintained or baseline activity, pH-sensitive Ca(++) release, possibly from the sarcoplasmic reticulum occurs; but it is insufficient to overcome the inhibitory effects at the myofilaments. We conclude that alterations of pH significantly affect calcium signaling and force production in the human myometrium and may contribute to dysfunction in labor.

Differential expression of amiloride-sensitive Na+ channel subunits messenger RNA in the rat uterus

The expression of the amiloride-sensitive Na+ channel was investigated by reverse transcription-polymerase chain reaction (RT-PCR) in uteri from pregnant and non-pregnant rats. Three subunits (alpha,beta,gamma) of this epithelial Na+ channel have been characterized in the rat. All three subunit mRNAs were present in day 16 pregnant uteri while only alpha and beta subunit mRNAs were detected in uteri from non-pregnant or day 1 postpartum rats. The level of expression of the alpha subunit was similar in day 16 pregnant and non-pregnant animals while the level of expression of the beta subunit was higher in pregnant than in non-pregnant rats. These findings show that amiloride-sensitive Na+ channels are expressed in the rat uterus and that mRNA expression levels of the alpha, beta and gamma subunits are selectively and differentially regulated during pregnancy in the rat.

External alkalinization decreases intracellular Ca++ and spontaneous contractions in pregnant rat myometrium

OBJECTIVES

As plasma pH rises during pregnancy, the effect of raising external pH on spontaneous contractions in pregnant rat myometrium was investigated to test the hypothesis that elevated external pH depresses contraction.

STUDY DESIGN

Strips of longitudinal myometrium were loaded with SNARF (seminaphthorhodafluor) or Indo-1 for simultaneous intracellular pH or Ca++ and force measurements. Results were obtained from a minimum of five animals in each group, and significant differences were tested for by paired Student t tests.

RESULTS

Raising the external pH significantly reduced spontaneous force and calcium transient in the pregnant uterus. Raising the external pH led to a slow rise in intracellular pH, but this could not account for the functional effect. K+ rubidium 86-labeled efflux rates were unaffected by external pH, suggesting no hyperpolarization. The Ca++ channel agonist Bay K8644 (5 mumol/L) restored contractions abolished by raised external pH.

CONCLUSIONS

Raised external pH reduces spontaneous contractions in the pregnant rat uterus, probably by an external effect on Ca++ entry. This effect may contribute to uterine quiescence before term.