Circulating excitations and re-entry in the pregnant uterus

The propagation of individual action potentials during spontaneous bursts of activity in isolated pregnant rat myometrium in the final stage of pregnancy was analyzed. Simultaneous recordings from 240 extracellular recording sites (inter-electrode distance 1 mm) made it possible to reconstruct, in spatial and temporal details, the conduction of the electrical impulse. On several occasions, the impulse was seen to be conducted in a circular fashion whereby the impulse repeatedly re-excited the myometrium. No evidence was found of circuits rotating around an area of depressed excitability or anatomical obstacle, suggesting that these circuits are similar to those proposed to occur in cardiac muscle by the 'leading circuit' model. Because of the anisotropic conduction properties of the myometrium, several circuits revolved in an ellipse with the long axis parallel to the longitudinal fiber direction, similar to functional re-entry in the anisotropic ventricle. Of a total of 46 bursts analyzed, myometrial re-entry occurred in 10 of the bursts. Furthermore, re-entries were found at day 17, day 19 and day 21 ( = term) stages of pregnancy suggesting that re-entry may occur throughout the final stage of gestation. In conclusion, functional re-entry, previously shown in the myocardium, may also occur in the pregnant myometrium. The presence of re-entry in the uterus could underlie the mechanism for uterine tachysystole, leading to dysfunctional labor.