UNDERSTANDING UTERUS FUNCTION WILL HELP US UNDERSTAND PRETERM LABOUR
The pregnant uterus and the brain are the only two remaining organs in the human body where there is scientific disagreement on how they actually work. A better understanding of uterus function is essential to enable us to answer vital questions about preterm birth and how to prevent it. Recently, Borne collaborator Dr. Roger Young proposed a new mechanism of function for the uterus that seems to accommodate the historical modern data.
A major controversy exists among clinicians and scientists about how the uterus coordinates the muscular contractions in all its parts, or regions. The pregnant uterus and the brain are the only two remaining organs in the human body where there is scientific disagreement on how they actually work.
For the uterus, this lack of understanding is fairly surprising. The uterus is primarily composed of only one type of cell – the smooth muscle cell – which is responsible for creating uterine contractions. Other than sensory nerves, there are no nerves that control the contractions like with skeletal muscle, and no special pathways for signalling like with the heart.
This lack of understanding has probably contributed to our inability to precisely control labour, and without control, unfortunate outcomes occur too often. Borne is particularly concerned about our inability to stop preterm labour, and our inability to fully understand dysfunctional labour that leads to Cesarean Section deliveries. Clearly, a better understanding of how the uterus contracts is required.
“With this new framework for uterine function, it now seems possible to understand the enigma of human labour.”
The key element of understanding of this research was that the pregnant uterus is fluid-filled and pressurised. Because of the pressure, each region of the uterus experiences a mechanical tension that is shared with all the other regions. This hydraulic-mechanical signalling allows the regions of the uterus to rapidly communicate with each other, much like the brakes on each wheel of your car can be activated at the same time by foot pressure at a remote location.
While the Dual mechanism is simple to describe, it took 5 years of dedicated research for the scientific community to begin to accept this as important for uterine functioning. Further work needs to be performed to establish important details of the Dual mechanism, specifically pointed towards stopping preterm labour and normalising dysfunctional labour. However, with this new framework for uterine function, it now seems possible to understand the enigma of human labour.
With this new understanding, Borne has high hopes that additional research will find new clinical treatments. Continuing to improve understanding is the only way to gain better control of labor, so that someday soon the word “impossible” can be removed from the practice of clinical obstetrics.