Clinical evaluation of mechanism of precipitate labor

Aim. To study the clinical course of pregnancy, labor and features of the structural changes in the cervix in women with precipitate labor.

Methods. We observed 186 women who delivered vaginally at 37-41 weeks of gestation. Main (I) group consisted of 146 women with precipitate labor. The comparison group (II) consisted of 40 women with a standard duration of delivery. Morphological and immunohistochemical study of cervical tissue, determining the expression level of collagen genes COL1A2 and SOL3A1 in the cervix and blood of women of studied groups were performed. Material sampling was carried out in the early postpartum period.

Results. In absolute majority of cases precipitate labor is not accompanied by intense patrimonial activity. Multiple complications develop during delivery, post-natal and early neonatal periods in 60% of patients with the precipitate labor. Pregnancy in women with a complicated course of precipitate labor occurs amid the infectious disease with predominant localization in the lower genital tract. The results of histological study of cervical tissue show numerous inflammatory changes. The expression levels of collagen genes in women with precipitate labor multifold exceed those in women with physiological duration of delivery.

Conclusion. Pathologic outcomes of precipitate labor are caused not by the character of patrimonial activity, but by adverse infectious background; accelerated cervical remodeling plays a key role in the genesis of precipitate labor; high rate of collagen metabolism in these women constitutes the epigenetic realization of the genetic determinants, formed under the influence of a number of exogenous and endogenous factors.