What causes labour in women?

Can we predict it?

Professor A López BernalUniversity of Bristol

Department of Clinical Sciences at South Bristol

100

80

60

40

20

023 24 25 26

%

Weeks of gestation

Survival

Disability

The horizontal bars represent the mean and the vertical bars represent 95% C.I. Morrison & Rennie, 1997 Br J Obstet Gynaecol 104, 1341-1350.Marlow et al. 2005. N Eng J Med; 352: 9-19

Preterm birth remains the major cause of neonatal mortality and morbidity

Signals for the physiological onset of labourPathophysiology of preterm labour?

Maternal compartment

Fetal blood

Amniotic fluid

Choriodecidua interface

Cervical secretions

Myometrium

A López Bernal

Control Isoproterenol

250kD

150kD

100kD

75kD

50kD

37kD

pH4 pH4pH7 pH7

Identification of labour associated proteins in the human uterus

Term Preterm

A López Bernal

Signalling pathways that regulate contractility

Calcium waves in human myometrial cells

A López Bernal

Further research into factors controlling the onset of labour is essential

We need to improve the management of preterm labour to decrease neonatal mortality and morbidity

Search for biomarkers to predict labour