M.D., Professor G.Savitsky

The Thirtieth Anniversary of the

Hemodynamic” Concept of Biomechanics of Human Uterine Contraction

Saint-Petersburg

G.Savitsky, M.D., Professor,

A.Savitsky, M.D.

This book is a brief summary of the main propositions of the “hemodynamic” concept of biomechanics of uterine contraction that was first enunciated and proposed by Professor Genady Savitsky in 1980. M.D. Alexey Savitsky later helped with the development of the concept. According to the propositions of demonstrative medicine this concept presents the biomechanics of uterine contractios as a result of two energy-producing systems called myometrial and hemodynamic functioning in the uterus. This material presents the main ideas of labor activity from the point of view of clinics and biomechanics, which are presented in the monograph “Human Labor Contraction” in a more expanded way (Published by «ЭЛБИ-СПб», Russia in 2011). The purpose of the edition is to draw attention to the issues of contractility dysfunction, as nowadays their study is an urgent need.

Contact details: http://savitsky.ucoz.ru, [e-mail]

Thirty years ago, in the autumn of 1980, Professor Genady Savitsky, holding at that time a post of Head of Operative Gynecology Section at the Otta Research Institution under the Russian Academy of Medical Sciences, submitted an application on “The Biomechanism of Uterine Contraction in the First LaborStage ” (320Т10280) for an alleged discovery at the State Committee for Inventions and Discoveries of USSR.

M.D., Professor G.Savitsky

It formulated absolutely new ideas about the biomechanics of uterine contraction. The main point of the new biomechanical concept is that the smooth muscle tissue of the human uterus during labor is not the only energy-producing system during labor from the authors’s point of view. Moreover, the energy generated during the isometric labor contraction of myometrium may be turned into effective external capacity, for instance, for the dilation of cervix only with the mediatory involvement of the other energy-producing uterus system – the hemodynamic one. From the very first labor stage not only does this system provide the mediatory function on converting the energy produced in the myometrical uterus system, but it also produces the energy itself that is changed into effective external capacity, directly involved in the cervical dilatation and delivery of the presenting part of the fetus at the active phase of the first stage of labor.

The functioning of the two uterus systems during labor is based on the principles of interrelation, interdependence and interconditionality with the use of mechanisms of positive and negative feedbacks. The basis for the unique unity is the strongly coordinated interaction of two biomechanical phenomena – the mechano-receptoric mechanism of a feedback on the dilation of the myocites of myometrium activated during labor, and the mechanism of forced blood depositing into vascular reservoirs of the body and cervix.

So, thirty years ago our native scientist Professor G. Savitsky made an officially registered by the State Committee for Inventions and Discoveries of USSR attempt characterizing human uterine contraction as a composite biomechanical phenomenon, in which against the background of phase isometric activity of myometrium a few various physical processes occur simultaneously (as well as in the hemodynamic uterus system), that in total make up the so-called labor forces.

Besides, in physiological conditions each of the interacting systems during the labor process not only does possess the ability for self-regulation, but also actively regulate and control the functioning of the other according to the principles of feedback. While developing the main propositions of the concept, previously and now, (D.M. A. Savitsky has been actively involved with the development of the concept for the last two decades), its authors used materials of their own research and those research materials made by others that did not contradict the actual probative data on the fundamentals of functional morphology and physiology of the myometral and hemodynamic systems of the human uterus during labor and conformed to the requirements of the law on compliance of structure and function of biological systems.

Thirty years later as well as at the time when the concept was first enunciated we have to emphasize the fact that the basic idea of the concept is a composite biomechanical analysis of a force macroprocess – the nature of labor forces, that activate all morphological changes necessary for the first stage of labor thus transforming the uterus from a bearing organ into an expulsing one. Officially, our concept is totally opposite to the still prevailing (in the obstetric literature) concept of “The Triple Descending Gradient”, “Contraction-Retraction-Destraction”, and “Reciprocal Relations” of various segments and layers of the myometrium.

In neither methodical, nor methodological regard does the validity system of the main propositions of our biomechanical concept of uterine contraction differ from the validity systems that have been resorted to earlier and are still used by competent advocates of the above-mentioned officially accepted biomechanical concept of uterine contraction.

Firstly, it is an analysis of actual data on functional morphology and physiology of meometrium and the vascular systems of the human uterus during labor. Secondly, it is an adequate evaluation, absolutely stripped of error limits and various speculations on the results of those research that directly deals with the discussed topic.

As it has been mentioned, thirty years have passed from the times of the first publications that, to this or that extent, covered different aspects of the new concept of biomechanics of uterine contraction. Today this issue has been discussed in four monographs and a few dozens of publications. Our monograph “Human Uterine Contraction” (published by Элби-СПб in 2010) is a peculiar contribution to this discussion. But it is more important that during those years lots of interesting research was made, whose authors shown that peculiarities of biomechanics of uterine contraction and, consequently, peculiarities of a labor act are dependent on peculiarities of the functional morphology and physiology of various sections of the blood system. Especially valuable in this regard were the publications by Professor Voskresensky S., Professor Zabozlev F., and M.D. Yannaeva N. For the past years that have been very fruitful for the new concept we have not come across any reasoned material disproving its main idea. That’s why we have considered it necessary to publish its supplemented version on our own website – www.savitsky.ucoz.ru. Beside we have done it not just out of the desire to prove our authority in dealing with this issue but more out of the urgent need to get a “new breath” to finally start the development of common issues of labor mechanics that has been in a state of deep stagnation for more than half a century due to the position taken by our obstetric elite. In the most reputable national obstetrics guide – though this book was supposed to have contained all the newest developments on the mechanics of labor action - still centers around the axiomatic (and not subject to doubt) concept of “The Triple Descending Gradient”, “Contraction-Retraction-Destraction”, and “Reciprocal Relations”, etc. The fifty-year experience of practical obstetrics has shown that theoretical concepts alone do not anyhow contribute to the improvement of the obstetrics process.

In 1996 Professor Voskresensky S. wrote, “Perhaps, classic concepts of biomechanics of labor help the obstetrician to orientate in the dynamics of such processes by offering a model characteristics for the course? Such help can not be found in any study books, guides, and periodicals. It does not exit. It does not exist for the reason that the concepts of biomechanics of labor are based upon theoretical conclusions alone without being proved by scientific data..,” The issue of labor forces should be paid significant attention to according to its importance because there will be no progress in the obstetrics with this issue remaining unsolved, “ thus emphasizing the meaningless of the classic point of view in practice if considered from the angle of possible doctor’s control over the labor process.

Domination of the “official” concepts in the native obstetrics has naturally resulted in the current obstetrics, totally stripped of “theoretical control”, basing its progress on empirical experience alone. The absence of an actual scientifically grounded prognostic knowledgebase in today’s conditions of “active labor management” and its commercialization turns obstetrics into one of the most belligerent sections of practical medicine. Today’s obstetrics has to be pro-actively involved with the labor process as a result of being promoted by pharmacological “lobbies” and numerous methodical recommendations and standards that are quickly-created in imitation of a new medicine. A surgical way of solving obstetric problems, a huge part of which has an iatrogenic nature and is a direct consequence of a pro-active behavior of obstetricians, is gaining popularity against the background of the deceptive administrative power of the doctor over the labor process. I suppose it is high time for the theory field of labor process to be radically purged. It can only be done by creating new concepts allowing the doctor to at least deliberately assess and forecast their attempts to influence the biomechanics of uterine contraction. The most important thing is that an open discussion on the issues of the biomechanics of uterine contraction should finally take place. As a result of many scientific innovations and attempts of their official promotion being ignored and ironically rejected by the top circles, the need for the ideas among practitioners, beginners and advocates of real progress in medicine becomes the main “engine of progress”. Figuratively speaking, they are the “knowledge consumers” who can give life to this kind of discussion. As for a start let’s discuss it at the macroprocess level what any discussion is normally started from in common accepted concepts in numerous study books and obstetrics guides. I suppose it is the Internet field that is the best “arena” for this discussion not only to start but also be of benefit for the native obstetrics. As “a whipping boy” for well-grounded, constructive and official criticism I propose the concept of Professor Savitsky G., largely supplemented by works of M.D. Savitsky A. I emphasize that all the materials related to the concept have alredy been published, as well as ways of their obtaining, processing and analysis have a lready been given a detailed coverage to. In this regard, the concept materials will be stated in the form which is considered most convincing.

Any concept of mechanics of uterine contraction as well as ours that bases on the data of functional morphology and physiology of humane uterus during labor is bound to take into account the requirements of the Law on compliance of structure and function as well as peculiarities of physical nature laws that take place in biological systems.

Дата добавления: 2015-10-30