Abstract
BackgroundIt has been suggested that cervical insufficiency (CI) is characterized by a "muscular cervix" with low collagen and high smooth muscle concentrations also in the non-pregnant state. Therefore, the aim of this study was to investigate the biomechanical properties, collagen concentration, smooth muscle cell density, and collagen fiber orientation in cervical biopsies from non-pregnant women with a history of CI.MethodsCervical punch biopsies (2 × 15 mm) were obtained from 57 normal non-pregnant women and 22 women with a history of CI. Biomechanical tensile testing was performed, and collagen content was determined by hydroxyproline quantification. Histomorphometry was used to determine the volume densities of extracellular matrix and smooth muscle cells from the distal to the proximal part of each sample. Smooth muscle cells were identified using immunohistoche-mistry. Finally, collagen fiber orientation was investigated. Data are given as mean +/- SD.ResultsCollagen concentration was lower in the CI group (58.6 +/- 8.8%) compared with the control group (62.2 +/- 6.6%) (p = 0.033). However, when data were adjusted for age and parity, no difference in collagen concentration was found between the two groups. Maximum load of the specimens did not differ between the groups (p = 0.78). The tensile strength of cervical collagen, i.e. maximum load normalized per unit collagen (mg of collagen per mm of specimen length), was increased in the CI group compared with controls (p = 0.033). No differences in the volume density of extracellular matrix or smooth muscle cells were found between the two groups. Fibers not oriented in the plane of sectioning were increased in CI patients compared with controls.ConclusionsCervical insufficiency does not appear to be associated with a constitutionally low collagen concentration or collagen of inferior mechanical quality. Furthermore, the hypothesis that a "muscular cervix" with an abundance of smooth muscle cells contributes to the development of cervical insufficiency is not supported by the present study.
Highlights
It has been suggested that cervical insufficiency (CI) is characterized by a “muscular cervix” with low collagen and high smooth muscle concentrations in the non-pregnant state
The hypothesis that a “muscular cervix” with an abundance of smooth muscle cells contributes to the development of cervical insufficiency is not supported by the present study
CI might be seen as an extended biological continuum with degrees of cervical competence [3], replacing the traditional dichotomous view of cervical competence as being present or absent
Summary
It has been suggested that cervical insufficiency (CI) is characterized by a “muscular cervix” with low collagen and high smooth muscle concentrations in the non-pregnant state. The aim of this study was to investigate the biomechanical properties, collagen concentration, smooth muscle cell density, and collagen fiber orientation in cervical biopsies from non-pregnant women with a history of CI. The most prominent include the following: 1) an inability of the uterine cervix to retain a pregnancy in the absence of uterine contractions [1]; and 2) a painless, progressive dilatation and effacement of the cervix that may lead to second trimester abortions or preterm delivery [2]. CI remains a Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark. Full list of author information is available at the end of the article diagnosis of exclusion because the pathophysiology of CI remains unknown. It is well established that changes in connective tissue are important in the process of cervical ripening and remodeling [4] as the normal cervix is dominated by connective tissue rich in collagen, with only 15% muscle cells [5]
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