Article

Pregnancy Increases Excitability of Mechanosensitive Afferents Innervating the Uterine Cervix

Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
Anesthesiology (Impact Factor: 6.17). 06/2008; 108(6):1087-92. DOI: 10.1097/ALN.0b013e31817302e0
Source: PubMed

ABSTRACT Labor pain derives primarily from stimulation of afferents innervating the uterine cervix and lower uterine segment. The authors have previously shown that the excitability of these afferents is regulated by sex hormones and test in this study whether pregnancy also alters their excitability.
After animal care committee approval, Sprague-Dawley rats (nonpregnant, pregnant days 17 and 21) were anesthetized, and two metal rods were placed through the cervix for distension. The right hypogastric nerve was dissected and carefully teased until recording from a single unit was obtained. Spontaneous activity and the response to a graded distension (20-80 g) were recorded for off-line analysis.
A total of 151 fiber units were recorded. Pregnancy was associated with an increase in spontaneous nerve activity in the absence of a mechanical stimulus (median of 0.98 and 1.56 Hz from pregnant days 17 and 21, respectively, compared with 0.45 Hz in nonpregnant; P < 0.01). The proportion of fibers responding to the weakest stimulus (20 g) was significantly greater in pregnant than in nonpregnant animals. The response to graded distension differed significantly among groups, with day 21 > day 17 > nonpregnant.
Afferents that innervate the uterine cervix sprout into this tissue during late pregnancy, and estrogen increases excitability of these mechanosensitive afferents. Here, the authors show that excitability also increases during pregnancy. These data suggest that, close to the onset of labor, there is an increased input to the spinal cord from cervical distension and an increased depolarization of afferent terminals in the cervix, effects that could influence pain and the progress of labor.

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    • "In a model of mechanical stimulation of the uterine-cervix in rats to emulate labor, ovariectomy decreased the visceromotor response which was reversed by E2 replacement and the response of the innervating hypogastric nerve afferents increased in OVx+E2 rats via activation of TRPV1 (Liu et al., 2005; Yan et al., 2007). Correspondingly , uterine-cervix afferent activity increased as estrogen levels increased during pregnancy (Liu et al., 2008). NMDA receptor activity could partially account for the sex difference induced by estrogen in deep tissue pain. "
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