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BMC Pregnancy and Childbirth Jul 2022Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for... (Review)
Review
BACKGROUND
Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE.
CASE PRESENTATION
A twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus.
CONCLUSION
A review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.
Topics: Adult; Cesarean Section; Female; Humans; Lupus Erythematosus, Systemic; Myometrium; Placenta; Placenta Accreta; Pregnancy; Steroids
PubMed: 35780086
DOI: 10.1186/s12884-022-04864-z -
Journal de Radiologie Dec 2001Leiomyoma and adenomyosis are the most frequent myometrial disorders, followed by cystic and vascular disorders. After an update on the anatomy, physiology and histology... (Review)
Review
Leiomyoma and adenomyosis are the most frequent myometrial disorders, followed by cystic and vascular disorders. After an update on the anatomy, physiology and histology of the myometrium, the authors will describe the normal sonographic and MRI aspects of the uterus. The pathology of leiomyoma will be recalled, and the various forms of myoma encountered during Doppler US, hysterography, hysterosonography, MRI and computed tomography will be described. The therapeutic use of pelvic arteriography with arterial embolization will be discussed. Adenomyosis is the second most frequent essential myometrial disorder, and is often associated with leiomyoma. After giving a histopathologic definition, the authors will examine in some detail the diagnostic value and limitations of transabdominal, pelvic and endovaginal sonography and MRI. Intramyometrial cystic disorders (cystic adenomyosis, myoma with cystic degeneration and vestigial cysts) and vascular disorders (intramyometrial and parametrial vascular malformations) are rare, but a sound knowledge is required to optimize their management, which is based on surgery and interventional vascular techniques.
Topics: Female; Humans; Leiomyoma; Myometrium; Radiography; Ultrasonography; Uterine Diseases; Uterine Neoplasms
PubMed: 11917652
DOI: No ID Found -
Experimental Biology and Medicine... May 2021The myometrium is the smooth muscle layer of the uterus that generates the contractions that drive processes such as menstruation and childbirth. Aberrant contractions... (Review)
Review
The myometrium is the smooth muscle layer of the uterus that generates the contractions that drive processes such as menstruation and childbirth. Aberrant contractions of the myometrium can result in preterm birth, insufficient progression of labor, or other difficulties that can lead to maternal or fetal complications or even death. To investigate the underlying mechanisms of these conditions, the most common model systems have conventionally been animal models and human tissue strips, which have limitations mostly related to relevance and scalability, respectively. Myometrial smooth muscle cells have also been isolated from patient biopsies and cultured as a more controlled experimental system. However, approaches have focused primarily on measuring the effects of biochemical stimuli and neglected biomechanical stimuli, despite the extensive evidence indicating that remodeling of tissue rigidity or excessive strain is associated with uterine disorders. In this review, we first describe the existing approaches for modeling human myometrium with animal models and human tissue strips and compare their advantages and disadvantages. Next, we introduce existing techniques and assays for assessing contractility and summarize their applications in elucidating the role of biochemical or biomechanical stimuli on human myometrium. Finally, we conclude by proposing the translation of "organ on chip" approaches to myometrial smooth muscle cells as new paradigms for establishing their fundamental mechanobiology and to serve as next-generation platforms for drug development.
Topics: Animals; Biophysical Phenomena; Female; Humans; In Vitro Techniques; Models, Animal; Models, Biological; Myocytes, Smooth Muscle; Myometrium
PubMed: 33554648
DOI: 10.1177/1535370221989259 -
Annals of the New York Academy of... Apr 2007The pregnant uterus is unique because of the dramatic functional changes that occur in the peripartum period. To promote the concept that we have a relatively poor... (Review)
Review
The pregnant uterus is unique because of the dramatic functional changes that occur in the peripartum period. To promote the concept that we have a relatively poor understanding of the physiology of parturition, we will posit 10 facts that are so obvious and so clearly accepted as facts that they probably are not even facts at all. (1) The laboring uterus undergoes peristalsis to dilate the cervix, deliver the fetus, and expel the placenta. (2) The human uterus is composed of longitudinal and circular layers of smooth muscle. (3) The functional cells of the uterus are the myocytes, which are a homogeneous cell type responsible for the generation of contraction forces, passage of action potentials, and control of contractility. (4) The phasic contractions of the uterus are typical for visceral smooth muscle. (5) The primary, and perhaps only, role of gap junctions is to allow passage of action potentials through the tissue. (6) Action potential propagation as the mechanism for global communication (over many centimeters throughout the uterus) is sufficient to recruit all regions and all myocytes of the uterus. (7) Slow waves pace the contractions of human myometrium. (8) Calcium-activated potassium channels are responsible for repolarization of the membrane potential that terminates each contraction. (9) Chloride channels are not important in uterine electrophysiology. (10) With enough computing power, it would be straightforward to build a closed model of human labor, given our current understanding of the components of myometrium. This manuscript discusses each point to stimulate questions for future investigation.
Topics: Female; Humans; Models, Biological; Myocytes, Smooth Muscle; Myometrium; Uterine Contraction
PubMed: 17442780
DOI: 10.1196/annals.1389.038 -
Journal of Clinical Ultrasound : JCU 2023Uterine Arteriovenous malformations (AVM) are vascular disorders characterized by complex high-flow tangles of abnormal vessels connecting arteries and veins with... (Review)
Review
Uterine Arteriovenous malformations (AVM) are vascular disorders characterized by complex high-flow tangles of abnormal vessels connecting arteries and veins with bypassing capillaries. Recently, the terminology applied to describe uterine AVMs has been modified. Most AVMs are acquired. The term enhanced myometrial vascularity (EMV) is used to describe any condition in which any uterine pathology may lead to increased myometrial vascularity regardless of the absence or presence of residual tissue of gestation.
Topics: Female; Humans; Arteriovenous Malformations; Myometrium; Uterus; Methotrexate; Vascular Diseases
PubMed: 37285167
DOI: 10.1002/jcu.23495 -
The International Journal of... Mar 2011Endothelin-1 (ET-1), a member of endothelin peptide family is released by many different tissues including uterine smooth muscle. ET-1 acts through ETA and ETB receptors... (Review)
Review
Endothelin-1 (ET-1), a member of endothelin peptide family is released by many different tissues including uterine smooth muscle. ET-1 acts through ETA and ETB receptors and is implicated in a wide range of biological and pathological functions that explain the great attention of the pharmacological industry for ET-1 receptors as potential therapeutic targets in vascular pathologies and cancers. It is now well established that ET-1 is also able to regulate myometrial functions. In the present review, we focused on ET axis and related signaling pathways involved in the regulation of myometrial contraction, as well as cell proliferation and survival. Such ET-1-mediated cellular functions play a critical role in normal pregnancy, preterm birth and uterine leiomyoma.
Topics: Amino Acid Sequence; Disease; Endothelin-1; Female; Humans; Molecular Sequence Data; Myometrium; Signal Transduction; Uterine Contraction
PubMed: 20974279
DOI: 10.1016/j.biocel.2010.10.009 -
Biology of Reproduction Dec 2014Tissue-specific (or somatic) stem cells constitute a subset of cells residing in normal adult tissues. By undergoing asymmetric division, they retain their ability to... (Review)
Review
Tissue-specific (or somatic) stem cells constitute a subset of cells residing in normal adult tissues. By undergoing asymmetric division, they retain their ability to self-renew while producing daughter cells that go on to differentiate and play a role in tissue regeneration and repair. The human uterus consists primarily of endometrium and myometrium (the smooth muscle layer) that rapidly enlarges through its tremendous regenerative and remodeling capacity to accommodate the developing fetus. Such uterine enlargement and remodeling can take place repeatedly and cyclically over the course of a woman's reproductive life. These unique properties of the uterus suggest the existence of endometrial and myometrial stem cell systems. In addition, like somatic cells, tumor stem cells or tumor-initiating cells, a subset of cells within a tumor, retain the ability to reconstitute tumors. Uterine smooth muscle cells are thought to be the origin of leiomyomas that are the most common type of gynecologic tumor. Recent work has identified, isolated, and characterized putative stem/progenitor cells in the myometrium and in leiomyomas. Here, we review current studies of myometrial and leiomyoma stem/progenitor cells and provide a new paradigm for understanding myometrial physiology and pathology and how these cells might contribute to uterine remodeling during pregnancy and the formation of leiomyomas. The role of the WNT/CTNNB1 pathway in the pathogenesis of leiomyoma is also discussed.
Topics: Adult; Animals; Disease Models, Animal; Female; Humans; Leiomyoma; Myometrium; Neoplastic Stem Cells; Organ Specificity; Pregnancy; Stem Cells; Uterine Neoplasms
PubMed: 25376230
DOI: 10.1095/biolreprod.114.123794 -
Clinical and Translational Medicine Apr 2023The transition of the myometrium from a quiescent to a contractile state during labour is known to involve inflammation, which is characterized by the infiltration of...
BACKGROUND
The transition of the myometrium from a quiescent to a contractile state during labour is known to involve inflammation, which is characterized by the infiltration of immune cells and the secretion of cytokines. However, the specific cellular mechanisms underlying inflammation in the myometrium during human parturition are not yet fully understood.
METHODS
Through the analysis of transcriptomics, proteomics, and cytokine arrays, the inflammation in the human myometrium during labour was revealed. By performing single-cell RNA sequencing (scRNA-seq) and spatiotemporal transcriptomic (ST) analyses on human myometrium in term in labour (TIL) and term in non-labour (TNL), we established a comprehensive landscape of immune cells, their transcriptional characteristics, distribution, function and intercellular communications during labour. Histological staining, flow cytometry, and western blotting were applied to validate some results from scRNA-seq and ST.
RESULTS
Our analysis identified immune cell types, including monocytes, neutrophils, T cells, natural killer (NK) cells and B cells, present in the myometrium. TIL myometrium had a higher proportion of monocytes and neutrophils than TNL myometrium. Furthermore, the scRNA-seq analysis showed an increase in M1 macrophages in TIL myometrium. CXCL8 expression was mainly observed in neutrophils and increased in TIL myometrium. CCL3 and CCL4 were principally expressed in M2 macrophages and neutrophils-6, and decreased during labour; XCL1 and XCL2 were specifically expressed in NK cells, and decreased during labour. Analysis of cytokine receptor expression revealed an increase in IL1R2, which primarily expressed in neutrophils. Finally, we visualized the spatial proximity of representative cytokines, contraction-associated genes, and corresponding receptors in ST to demonstrate their location within the myometrium.
CONCLUSIONS
Our analysis comprehensively revealed changes in immune cells, cytokines, and cytokine receptors during labour. It provided a valuable resource to detect and characterize inflammatory changes, yielding insights into the immune mechanisms underlying labour.
Topics: Female; Humans; Myometrium; Transcriptome; Cytokines; Inflammation; Sequence Analysis, RNA
PubMed: 37095651
DOI: 10.1002/ctm2.1234 -
Pharmacology & Therapeutics 1996Nitric oxide (NO) is a potent smooth muscle relaxant in blood vessels, the gastrointestinal tract and the respiratory system. Recent evidence has shown that NO has a... (Comparative Study)
Comparative Study Review
Nitric oxide (NO) is a potent smooth muscle relaxant in blood vessels, the gastrointestinal tract and the respiratory system. Recent evidence has shown that NO has a relaxant (tocolytic) effect on myometrium. NO is produced within the female genital tract during pregnancy, and a reduction in NO synthesis may be involved in the initiation of parturition. Furthermore, the administration of NO donors may be useful in inhibiting uterine contractions in situations where such activity is unwanted, e.g., in preterm labour. NO is also produced in the myometrium in the nonpregnant state, and has potential roles in the facilitation of implantation and the prevention of dysmenorrhoea. This article aims to examine the evidence suggesting that NO has a physiological role in the maintenance of pregnancy and potential pharmacological use in the treatment of preterm labour.
Topics: Animals; Female; Humans; Myometrium; Neuromuscular Agents; Nitric Oxide; Obstetric Labor, Premature; Pregnancy; Uterine Contraction
PubMed: 8843464
DOI: 10.1016/0163-7258(96)00004-6 -
Placenta Aug 2022MRI has demonstrated its potential in the diagnosis of placenta percreta. Texture analysis is a novel technique to quantify tissue heterogeneity. The study aimed to... (Observational Study)
Observational Study
INTRODUCTION
MRI has demonstrated its potential in the diagnosis of placenta percreta. Texture analysis is a novel technique to quantify tissue heterogeneity. The study aimed to evaluate the feasibility of using texture analysis based on myometrium-derived T2WI to differentiate placenta accreta from increta.
METHODS
Participants with MRI and clinical or histopathological diagnosis of placenta increta were retrospectively enrolled. Texture analysis of T2WI was implemented on normal myometrium and placenta increta by MaZda software. With the Fisher discriminant method, parameter selection and reduction were done automatically. Multivariate analysis was used for the comparison of response variables between two groups. The contours of multivariable average vectors were compared using profile analysis. Two-step clustering was performed to assess the importance of parameters.
RESULTS
There were a total of 23 participants (median age 29 years, range 22-43 years). The pixel intensity distribution was narrow and wide in two first-order histograms taken from normal myometrium and placenta increta, respectively. Multivariate analysis showed nine second-order parameters derived from the histogram were statistically significant (P < 0.05). The results of two-step clustering indicated that three second-order parameters (Mean, Percentile 90%, and Percentile 99%) were important (predictor importance > 0.8). Multivariate analysis of three second-order parameters further showed they were different between normal myometrium and placenta increta.
DISCUSSION
Texture analysis based on myometrium-derived T2WI may be a useful add-on to MRI in diagnosing placenta increta.
TRIAL REGISTRATION
Registration number: ChiCTR2000038604 and name of registry: Evaluation of diagnostic accuracy of MRI multi-parameter imaging combined with texture analysis for placenta accreta spectrum disorders (PAD).
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Myometrium; Placenta; Placenta Accreta; Pregnancy; Retrospective Studies; Young Adult
PubMed: 35738112
DOI: 10.1016/j.placenta.2022.06.002