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Diabetes is associated with impairment of uterine contractility and high Caesarean section rate

AIMS/HYPOTHESIS: The prevalence of births worldwide complicated by diabetes mellitus is increasing. In the UK, for example, <25% of diabetic women have a non-instrumental vaginal delivery. Strikingly, more than half the Caesarean sections (CS) in these patients are non-elective, but the reasons f...

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Autores principales: Al-Qahtani, S., Heath, A., Quenby, S., Dawood, F., Floyd, R., Burdyga, T., Wray, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer-Verlag 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245824/
https://www.ncbi.nlm.nih.gov/pubmed/22101974
http://dx.doi.org/10.1007/s00125-011-2371-6
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author Al-Qahtani, S.
Heath, A.
Quenby, S.
Dawood, F.
Floyd, R.
Burdyga, T.
Wray, S.
author_facet Al-Qahtani, S.
Heath, A.
Quenby, S.
Dawood, F.
Floyd, R.
Burdyga, T.
Wray, S.
author_sort Al-Qahtani, S.
collection PubMed
description AIMS/HYPOTHESIS: The prevalence of births worldwide complicated by diabetes mellitus is increasing. In the UK, for example, <25% of diabetic women have a non-instrumental vaginal delivery. Strikingly, more than half the Caesarean sections (CS) in these patients are non-elective, but the reasons for this are not understood. We have tested the hypothesis that poor myometrial contractility as a consequence of the disease contributes to this high CS rate. METHODS: We compared spontaneous, high K depolarisation and oxytocin-induced contractions from diabetic and matched control patients having an elective CS. To investigate the mechanism of any differences we measured intracellular Ca, and performed western blotting and compared the tissues histologically. RESULTS: There was significantly decreased contraction amplitude and duration in uteri from diabetic compared with control patients, even when possible confounders such as BMI were analysed. Reduced intracellular calcium signals and expression of calcium entry channels were found in uteruses from diabetic patients, which, along with a reduction in muscle content found on histological examination, could explain the reduced force. Myometrium from diabetic patients was responsive to oxytocin, but still did not reach the levels found in non-diabetic patients. CONCLUSIONS/INTERPRETATIONS: These are the first data investigating myometrium in diabetic patients and they support the hypothesis that there is poorer contractility even in the presence of oxytocin. The underlying mechanism is related to reduced Ca channel expression and intracellular calcium signals and a decrease in muscle mass. We conclude that these factors significantly contribute to the increased emergency CS rate in diabetic patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-011-2371-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
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spelling pubmed-32458242011-12-27 Diabetes is associated with impairment of uterine contractility and high Caesarean section rate Al-Qahtani, S. Heath, A. Quenby, S. Dawood, F. Floyd, R. Burdyga, T. Wray, S. Diabetologia Article AIMS/HYPOTHESIS: The prevalence of births worldwide complicated by diabetes mellitus is increasing. In the UK, for example, <25% of diabetic women have a non-instrumental vaginal delivery. Strikingly, more than half the Caesarean sections (CS) in these patients are non-elective, but the reasons for this are not understood. We have tested the hypothesis that poor myometrial contractility as a consequence of the disease contributes to this high CS rate. METHODS: We compared spontaneous, high K depolarisation and oxytocin-induced contractions from diabetic and matched control patients having an elective CS. To investigate the mechanism of any differences we measured intracellular Ca, and performed western blotting and compared the tissues histologically. RESULTS: There was significantly decreased contraction amplitude and duration in uteri from diabetic compared with control patients, even when possible confounders such as BMI were analysed. Reduced intracellular calcium signals and expression of calcium entry channels were found in uteruses from diabetic patients, which, along with a reduction in muscle content found on histological examination, could explain the reduced force. Myometrium from diabetic patients was responsive to oxytocin, but still did not reach the levels found in non-diabetic patients. CONCLUSIONS/INTERPRETATIONS: These are the first data investigating myometrium in diabetic patients and they support the hypothesis that there is poorer contractility even in the presence of oxytocin. The underlying mechanism is related to reduced Ca channel expression and intracellular calcium signals and a decrease in muscle mass. We conclude that these factors significantly contribute to the increased emergency CS rate in diabetic patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-011-2371-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. Springer-Verlag 2011-11-19 2012 /pmc/articles/PMC3245824/ /pubmed/22101974 http://dx.doi.org/10.1007/s00125-011-2371-6 Text en © The Author(s) 2011 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Article
Al-Qahtani, S.
Heath, A.
Quenby, S.
Dawood, F.
Floyd, R.
Burdyga, T.
Wray, S.
Diabetes is associated with impairment of uterine contractility and high Caesarean section rate
title Diabetes is associated with impairment of uterine contractility and high Caesarean section rate
title_full Diabetes is associated with impairment of uterine contractility and high Caesarean section rate
title_fullStr Diabetes is associated with impairment of uterine contractility and high Caesarean section rate
title_full_unstemmed Diabetes is associated with impairment of uterine contractility and high Caesarean section rate
title_short Diabetes is associated with impairment of uterine contractility and high Caesarean section rate
title_sort diabetes is associated with impairment of uterine contractility and high caesarean section rate
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245824/
https://www.ncbi.nlm.nih.gov/pubmed/22101974
http://dx.doi.org/10.1007/s00125-011-2371-6
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