About preparing pregnant women for the upcoming birth

In preparing the body of a pregnant woman for the upcoming birth, including structural reorganization of the pregnant uterus in the "birth", are essential as neurohumoral (including hormonal)and neuro-mechanical factors.
About me (jointly with C. A. Petrov) was said more than 25 years ago in the Chapter "elements of the theory, which explains the emergence of labor", published in 1940 in the monograph "New ways in the study of labor".
Speaking about the importance neurohormonal, humoral and mechanical factors during pregnancy and labor, it is necessary to understand biomechanism their actions not just as passive stretching the walls of the uterus, but as a highly complex biological process, breathtaking whole body of a woman taking place throughout pregnancy and reaching the highest limit to the start of the delivery,
The increase in the uterus by stretching her walls in connection with the development of the ovum is, on the one hand, thanks to the dynamic growth of muscle cells (processes hyperplasia and hypertrophy) and argyrophile substance, and with another - owing to vzaimoponimaniyu last (retraction), active stretching and ability to hold this status within the required time period. All these functional changes are directed and governed by neurohumoral (including hormonal) pulses that support the required level of the state of the processes related to pregnancy and childbirth. In the first pregnancy prevails the increase of the uterus, which is usually terminated by the end of the ninth month of pregnancy, although growth of the ovum continues. From this moment begins to grow intrauterine pressure, peaking towards the end of pregnancy.
These changes in the uterus of a pregnant woman are in connection with the qualitative and quantitative changes in the endocrine system under the influence of the changed pulses from the Central nervous system. It is established, that by the end of pregnancy is reduced braking effect of the hormone yellow body and gonadotropinov (fraction B). On the other hand, there is a relative increase in the influence of estrogen (due to accumulation of more active their fractions), which leads to an increase tone and excitability of the uterus, except for the part where the placenta.
Thus, the increased reflex activity of the uterus and are prerequisites for effective impact of pituitrin, acetylcholine and other humoral factors contributing to the outbreak of genera and over.
Reflex activity in the gravid uterus depends not only biophysical changes (in volume and intrauterine pressure)and biochemical processes in tissues, namely: in the smooth muscle in argyrophile substance; they appear in sufficient quantities such intermediate substance exchange, which increase the sensitivity of the uterus to factors that cause it down, and make them more powerful and long. These include, in particular, the enzyme actomyosin stimulating the muscles of the uterus.
Despite biophysical changes in the tissues of the uterus during pregnancy, due to the increase of its volume and growth intrauterine pressure, disorders of pregnancy still occurs. Appropriate neurohormonal biomechanism hold the uterus in a state's inherent plastic, otherwise known viscose tone (or in other words - tonic voltage) without any noticeable signs of a decrease, and thus allow the uterus to adapt to any kind of temporary changes in volume, and later to pressure changes inside the latter. This is especially true for the part of the uterus, where the placenta.
Maintaining an appropriate level of uterine tone is extremely important, because in direct connection with it are the state of excitability and contractile activity of the latter. So disruption in the normal ratio of the volume and pressure of the uterus during pregnancy immediately affect on the receptor apparatus of the latter, and the result is a change of reflex activity of the uterus.
The threshold of excitability of the uterus, of course, depends on the functional state of higher nervous activity and typological characteristics of the woman, its reactivity. About us already partly discussed above.
Numerous clinical and laboratory research has shown that the change reflex excitability of the uterus caused by the fluctuations of qualitative and quantitative ratios gonadotroponah hormones, and, first of all, determined by the ratio of estrogen and progesterone, the efficiency of which, in turn, is closely linked to the peculiarities of metabolism in the body of the pregnant woman (in particular with the metabolism of vitamin C).
Estrogen sencibilisiruet the uterus, increases the excitability of its neuro-muscular apparatus. Progesterone reduces the reflex excitability of cancer by inhibiting the action of estrogen hormones. Drugs yellow body together with prolinom reduce the excitability of the uterus and thereby inhibit excessively strong contractions of the muscles of the latter.
Hormone yellow body only under certain proportions with estrogen reduces anxiety of the uterus to pituitrin.
In maintaining such a "protective" state of pregnancy, adapting the neuro-muscular system of the uterus to flowing internal (biophysical and biochemical) and external stimuli, involve the whole nervous system, but the main role belongs to the cerebral cortex (p. P. Lazarev, I. I. Yakovlev, G. M. Lisovskaya and others).
The cerebral cortex is the Central point for coordinating all visceral and vegetative functions of the organism (K. M. Bykov). It is the brain organizes, directs and configures the work of the uterus. Using neuro-humoral (hormonal) regulation reduces the excitability of the uterine muscles, but the latter is supported able tone without any visible signs of contraction.
The impact of the cerebral cortex on the processes of excitation and inhibition of reflex activity of the uterus is not always the same. It is determined the functional state of peripheral (perceiving irritation) nervous apparatus last conducting vegetative and spinal nerve pathways and nerve centers (cortical and subcortical visual representation).
Therefore, not all cases reflex activity of the uterus is in inverse relationship with anxiety relevant centres in the brain, which in its time had pointed I. P. Pavlov.
The uterus has many special nervous machine - building, mechanical, thermal and chemoreceptors, perceiving various kinds of anger (K. X. Kakcheev and F. A. Syrovatko, E. Sh. life of our birds, E. F. Kryzhanovskii, V. M. LOTIS, S. K. ghambashidze, L. C. Alexandrov and others).
B. I. Lavrent'ev in his article "Sensitive innervation of internal organs" indicates that the coexistence in the neighborhood, and sometimes very close, muscle receptors and mechanoreceptors, located in the connective tissue, is explained by their different functional purpose, though both receptors are machines, indicating the degree of stretch fabric or reduction of the body. But the exceptional abundance of nerve endings located nearby muscle cells, makes you think that the excessive reduction of smooth muscles (spasm) it is annoying muscle receptors and causes pain.


The same should be said about the chemoreceptors, which has an internal organs, including the uterus. The impulses that come from them by the nervous system, reaching centers provokes reactions of the whole organism.
Therefore, you should assume that irritation coming from the growing of the ovum, the listed nervous apparatus, are transformed into nerve process, and then in the form of numerous pulses continuously come to the Central nervous system and impact through the centers of nervous activity as a function of the uterus, and the organism as a whole. The functional state of cerebral cortex determines the body's response to impulses that come from the uterus or falling on a woman's body from the outside.
The processes that occur in the brain under the influence of impulses coming from a pregnant or given birth" of the uterus, can change the character and dynamics of perception of stimuli coming from the external environment through visual, auditory, gustatory and tactile devices. Changes in the functional state of the crust, in turn, for the second time can lead to further change the function of the uterus. Secondary changes in the uterus, in turn, again affect subsequent function of natural processes and so on
However, up until irritation arising in connection with increase in volume and increased intrauterine pressure and perceived interoreceptors uterus, do not exceed a threshold, reflex excitability of the uterus (as already mentioned) did not increase, and therefore is not observed uterine contractions. But as soon as the pulse reaches the threshold value, the reflex excitability of the uterus begins to increase, which raises the periodic reduction of muscles.
On the background of the changed reactivity of the uterus continuously cumulative internal and external irritation can lead to the deployment of regular labor activity. At this Point tend to decrease the braking effect of the cerebral cortex and increasing the excitability of spinal cord (P. Lazarev, I. I. Yakovlev and B. A. Petrov and others).
What is happening in the functional state of the nervous system changes are closely linked to changes in the proportions gonadotroponah hormones and with the appearance of qualitatively new factions latter, of course, while changes in the entire endocrine system.
At the end of pregnancy, shortly before delivery (during the formation of generic dominant), reduces the number of hormones yellow body and increases the number of hormones oestrogen and appear most active factions, raising the tone and excitability of the uterus, and therefore likely to lead to its reduction. Estrogenic substances not only support the uterine tone, but independent cause of reduction of the latter with the help of formation and accumulation of acetylcholine. The impact of estrogenic substances on the uterus occurs due to the changes of metabolic processes in the muscle tissue of the latter.
In close connection with changes in the hormonal system, of course, happen functional changes in the vegetative nervous system, as well as the spinal cord, is under directing and regulating influence of the cerebral cortex. As a result of changes occurring in the cortex and spinal cord, transmitters of nervous excitement cause the uterus to the active state - adrenalin substance of the sympathetic nervous system (sympathy or adrenaline) prepare and continuously increase the tone of the uterine muscles through changing lability of the Central nervous system, and directly "starting" function (uterine) shall acetylcholine, the mediator parasympathetic nervous system.
Research p. P. Lazarev, I. I. Yakovlev and B. A. Petrov et al. have shown that the relationships that exist between the centers of the brain and spinal cord, you can guide and support in a desirable direction and thereby to control birth.
About the functional condition of the uterus can be judged not only on the basis of her characteristic of biomechanical effect, but also by changing its bioelectric activity (I. I. Yakovlev, G. M. Lisovskaya).
Electrogastrogram, as well as biomechanically, are a reflection of the changes in the functional state of the uterus.
Attaching primary importance to deploy, and then maintain on the relevant level of labor activity of the nervous system through special transmitters of nervous excitement, we cannot withdraw is purely mechanical squeezing predlagay part of the fetus (irritation of interoreceptors) nerve plexus and components, embedded in the wall of the uterus and the tissue surrounding the area of internal throat and neck (paracervical and vaginal ganglia). The result of irritation of the parasympathetic nervous system (pelvic nerve) is to increase the allocation of acetylcholine, which exerts its contractile effect on sensitised the uterus. Thus, the increase intrauterine pressure creates a certain background for the application of neurohumoral factors in the deployment of labor activity. Therefore, we consider erroneous rejection of the values of intrauterine pressure, threshold, as the impetus for the stimulation generic activities. This, in our opinion, due to the fact that supporters of such views is too simplistic, thematisieren and mechanically consider this factor.
Meanwhile, it is quite clear that it should be regarded as an integral part of complex biological and biophysical process, what is generic act. The links of these authors that women with multiple pregnancy, or large fruit, with polyhydramnios childbirth usually delayed, despite the maximum extension of the uterus unjustified.
In these cases, there Soroptimist the ultimate, and even often superultimate, the so-called excessive stretching of tissues, which, of course, a negative influence on the receptor apparatus, and in this regard, undoubtedly, is changing the threshold of sensitivity. At the same time, of course, there have been changes in the functional properties of nervous-muscular apparatus of the uterus.
Thus, in the preparation of pregnant and parturient women for the upcoming act of birth, the main role belongs to the Central nervous system (CNS). With its help are directed and supported at the appropriate level of all physiological processes occurring in the body, including the birth process itself. It should always be remembered that the Central nervous system cannot function properly without the close relationship and cooperation with endocrine, humoral systems and mesenchimal. Here care about the restructuring which occur in pregnant women in General, and in the genital area, in particular, referred to as the dominant genera.
In the offensive and deploying descent act the main role have internal stimuli - impulses coming from ovum - the foetus and the pregnant uterus.
To the uterus could regularly and intensively to decline, should be its "readiness", on the one hand, and on the other, the provision of appropriate regulation of the nervous system. The results of long-term clinical-physiological research performed in our Department, suggest certainly proved the position that the pregnant uterus have the reflex nature and the time of labour reflexes of the uterus increase. This allows the status of the pregnant and the "birth" of the uterus be regarded as associated with dominant.
In this connection, it is quite reasonable point of view of those clinicians who believe shown to determine the nature of reflex reactions in pregnant women during the formation of generic dominant. However, as noted above, one should not forget that the nature nerverending reactions gravid uterus on extero - and interoceptive stimuli in dynamics in conditions of complete-functioning organism varies and depends on many factors and, first of all, from the structure and physiological state of the smooth muscles of the uterus.
The above implies that the functional condition of the pregnant uterus cannot be considered separately from the state of the body in General, and without somatic and psychological state of the latter. Then, we should not forget about the possibility of concomitant some form of obstetric pathology and, finally, about the attitude of the woman to her pregnancy and the upcoming birth. Therefore, the definition in advance, before birth, during the formation of generic dominant, indicators of the restructuring of the whole body and functional status of the pregnant uterus (table. 22), is of paramount importance in the work of the Clinician. With relevant data, the doctor has an opportunity to outline more correct tactics of childbirth and in advance to use in necessary cases, the most effective methods and means of treatment.