Parturition

Parturition process

1. Parturition Mediana sutopo liedapraja Ppds tahap 1a Obstetri dan ginekologi fakultas kedokteran universitas Indonesia – RSUPN CIPTOMANGUNKUSOMO

2. The timing of birth  development of placenta  gene expression of CRH ( corticotropin releasing hormone) Maternal plasma CRH increase as pregnancy advances  peak at time of delivery Human produce CRHBP for CRH  end of pregnancy  CRHBP falls  CRH rise .

3. CRH Receptors CRH secreted from placenta  into maternal blood and fetal circulation CRH bind to CRH type 1 R ( G Protein couple receptor ). Mother CRH-R  Pituitary , myometrium, adrenal glands Fetus CRH-R  Pituitary , Adrenal Glands, Lungs . MOTHER + FETUS  initiate the changes of parturition .

4. stimulate placenta release CRH Glucocorticoids stimulate CRH gene and production CRH  CRH stimulate pituitary  produce corticotropin  Adrenal cortex to release cortisol +DHEAS Estrogen synthesis . “CRH level has a relatively specific association with risk of preterm birth  Maternal CRH levels is the most accurate predictor .”

5. CRH in the fetus

6. In conclusion as gestation advances Systems in mother and fetus increase in placental CRH  change in fetal cortisol concentration, fetal lung maturations, amniotic fluid protein, phospholipids and myometrial receptor expression.

7. COX -2

8. Activation of the myometrium at term Important event  “ Contraction associated proteins”  Relax ?? Or contraction ?? 3 types: 1. Interaction between actin and myosin proteins 2. Excitability of myometrial cells 3. Intercellular connectivity

9. Action and Myosin interaction = Contraction Actin converted  Globular to Filamentous Actin partner  Myosin  activated by M-light chain kinase  activated by Calmodulin and Intracellular Calcium. Myocyte depolarizes  Influx extracellular Ca 2+  contraction . Example : Nifedipine  Tocolytic  block voltage-regulated Ca 2+ channel.

10. Fetal membrane activation

11. CRH MMP-9 Degradate Collagen Cervix Structure

12. A Better Understanding of the pathway to normal birth should provide a pathological process. The goal is to predict which pregnancies carry a risk of preterm , Reduce the incidences of cerebral palsy and cognitive impairment associated with preterm birth.

13. THANK YOU