MEDIANA SUTOPO LIEDAPRAJA
PPDS TAHAP 1A
OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN
UNIVERSITAS INDONESIA – RSUPN CIPTOMANGUNKUSOMO
• The timing of birth development of placenta
gene expression of CRH (corticotropin releasing
• Maternal plasma CRH increase as pregnancy advances
peak at time of delivery
• Human produce CRHBP for CRH end of pregnancy
CRHBP falls CRH rise.
Birth Placenta CRH
CRH secreted from placenta
into maternal blood and fetal
CRH bind to CRH type 1 R
(G Protein couple receptor).
Pituitary, Adrenal Glands, Lungs.
MOTHER + FETUS initiate
the changes of parturition.
stimulate placenta release CRH
Glucocorticoids stimulate CRH gene and
production CRH CRH stimulate pituitary
Adrenal cortex to release cortisol +DHEAS
“CRH level has a relatively specific association with risk of preterm
birth Maternal CRH levels is the most accurate predictor.”
CRH IN THE FETUS
by adrenal glands
and maturation of
Surfactant protein A
CRH stimulation of
as gestation advances Systems in mother and fetus
increase in placental CRH
change in fetal cortisol concentration, fetal lung
maturations, amniotic fluid protein, phospholipids and
myometrial receptor expression.
ACTIVATION OF THE MYOMETRIUM AT TERM
Important event “ Contraction associated proteins”
Relax ?? Or contraction ??
1. Interaction between actin and myosin proteins
2. Excitability of myometrial cells
3. Intercellular connectivity
Physical connection by
multimer connexin 43.
Connection formed by
F2α and local release of
• Action and Myosin interaction =
• Actin converted Globular to
• Actin partner Myosin activated by
M-light chain kinase activated by
Calmodulin and Intracellular Calcium.
• Myocyte depolarizes Influx
extracellular Ca2+ contraction.
Nifedipine Tocolytic block voltage-
regulated Ca2+ channel.
• Stretching of myometrium (fetal growth)mitogen
activated protein kinase
• increase intracellular CAMP
• activating protein kinase A.
• inactivate myosin light chain
FETAL MEMBRANE ACTIVATION
Production of surfactant proteins,
phospholipids and inflammatory
cytokines in amniotic fluid
Increase as COX-2 activity
and PGE2 in amnion.
inflammation in the
Chorion underlies the amnion
Produce PDGH (prostaglandin
As Potent “Inactivator”
A Better Understanding of the pathway to normal birth should
provide a pathological process.
The goal is to predict which pregnancies carry a risk of preterm,
Reduce the incidences of cerebral palsy and cognitive
impairment associated with preterm birth.