title: Substance P (SP) and vasoactive intestinal polypeptide (VIP) in the lower uterine segment in first and repeated cesarean sections.
abstract: The authors studied the presence of substance P (SP) and vasoactive intestinal polypeptide (VIP) and their related fibers in the lower uterine segment (LUS) in 133 women undergoing cesarean sections (CS) during active labor. These were divided into 2 groups: women undergoing repeat or first CSs. Specimens were collected from the LUS and were evaluated by light microscopy and by immunohistochemistry, for the morphometrical quantification of the SP and VIP fibers in the LUS. The SP amount was higher in the post-CS scar, while the VIP amount decreased: nerve fibers contained an SP amount of up to 13 ± 2.6C.U., while nerve fibers contained a VIP amount of up to 7 ± 1.9 C.U. The SP amount counts 10 ± 1.5% of the total Bodian fibers, and the ratio of the VIP is 10 ± 1.8% of their total amount. In normal conditions only 6.61 C.U. of the Bodian surface is occupied by SP related nerve fibers in contrast to 6.63 C.U. of the total surface by VIP; the amount of SP increased up to 13 ± 2.6C.U., while it decreased in the LUS previous scars. The SP levels are higher in repeat CS, while the VIP levels are reduced in the LUS. The increase of SP is probably linked to the attempt to achieve cervical ripening in a post-CS LUS, with the possible consequences of dystocia during vaginal birth after CS. Nevertheless, the decrease of VIP probably affects the relaxation of the internal uterine orifice, compromising the LUS formation and cervical ripening.
authors.affiliation: Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Cavallotti
authors.forename: Stefano
authors.initials: S
authors.lastname: Bettocchi
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Di Renzo
authors.forename: Michael
authors.initials: M
authors.lastname: Stark
mesh_terms: D020070:Cervical Ripening / Q000502:physiology; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D002921:Cicatrix / Q000378:metabolism; D005260:Female; D006801:Humans; D009412:Nerve Fibers / Q000737:chemistry*; D011247:Pregnancy; D013373:Substance P / Q000032:analysis*; D014599:Uterus / Q000294:innervation* / Q000378:metabolism; D014660:Vasoactive Intestinal Peptide / Q000032:analysis*
chemical_list: D013373:Substance P; D014660:Vasoactive Intestinal Peptide