Cervical Remodeling Research Articles

Quantitative Assessment of Collagen Remodeling during a Murine Pregnancy.

Uterine cervical remodeling is a fundamental feature of pregnancy, facilitating the delivery of the fetus through the cervical canal. Yet, we still know very little about this process due to the lack of methodologies that can quantitatively and unequivocally pinpoint the changes the cervix undergoes during pregnancy. We utilize polarization-resolved second harmonic generation to visualize the alterations the cervix extracellular matrix, specifically collagen, undergoes during pregnancy with exquisite resolution. This technique provides images of the collagen orientation at the pixel level (0.4 μm) over the entire murine cervical section. They show tight and ordered packing of collagen fibers around the os at the early stage of pregnancy and their disruption at the later stages. Furthermore, we utilize a straightforward statistical analysis to demonstrate the loss of order in the tissue, consistent with the loss of mechanical properties associated with this process. This work provides a deeper understanding of the parturition process and could support research into the cause of pathological or premature birth.

Whole cervix imaging of collagen, muscle, and cellularity in term and preterm pregnancy

Cervical softening and dilation are critical for the successful term delivery of a fetus, with premature changes associated with preterm birth. Traditional clinical measures like transvaginal ultrasound and Bishop scores fall short in predicting preterm births and elucidating the cervix’s complex microstructural changes. Here, we introduce a magnetic resonance diffusion basis spectrum imaging (DBSI) technique for non-invasive, comprehensive imaging of cervical cellularity, collagen, and muscle fibers. This method is validated through ex vivo DBSI and histological analyses of specimens from total hysterectomies. Subsequently, retrospective in vivo DBSI analysis at 32 weeks of gestation in ten term deliveries and seven preterm deliveries with inflammation-related conditions shows distinct microstructural differences between the groups, alongside significant correlations with delivery timing. These results highlight DBSI’s potential to improve understanding of premature cervical remodeling and aid in the evaluation of therapeutic interventions for at-risk pregnancies. Future studies will further assess DBSI’s clinical applicability.

Gestational age-specific reference intervals for androgens in pregnancy.

Androgen could impact cervical remodelling during pregnancy, and a higher level is associated with adverse pregnancy outcomes. A population-based gestation age-specific reference interval (RI) of total testosterone (TT), androstenedione (A4), and 17-hydroxyprogesterone (17-OHP) can help to diagnose maternal hyperandrogenism. We enrolled 600 healthy Chinese women to obtain longitudinal serum samples across gestation. The serum androgen profile was measured by liquid chromatography-tandem mass spectrometry. The equations for medians of TT, A4, and 17-OHP were generated by MedCal, and the variances adjusted for 2-level modeling were generated by MLwiN, a system for the specification and analysis of a range of multilevel models. A4 and TT levels increased across the gestation, and they closely correlated with each other (R = 0.90, P=<0.001), whereas 17-OHP level decreased from 5th gestational week to 16th gestational week and then increased afterward towards the end of pregnancy. Women diagnosed with preeclampsia (PE) were found to have a significantly higher level of A4, TT, and 17-OHP when compared with non-PE cases with p ≤0.01, whereas mothers carrying male versus female fetuses have comparable levels of A4, TT, and 17-OHP. The study highlights a methodology for constructing gestational age-specific TT, A4, and 17-OHP levels to provide a better interpretation of results in a cohort of healthy Chinese women. The observation in PE supports previous findings, and the higher levels of TT, A4, and 17-OHP were observed before the onset of PE.

CELASTO (Cervical ELASTOgraphy) pilot study — the use of cervical elastography during pregnancy

BACKGROUND: Ultrasound assessment of cervical length is an integral part of a comprehensive examination during pregnancy, but it does not provide a complete picture of structural changes in the cervix. The use of E-Cervix elastography is a promising method to assess cervical remodeling throughout the gestation period. AIM: The aim of this study was to evaluate the possibility of using automated cervical elastography in clinical practice to analyze the main parameters of cervical elasticity and hardness in pregnancy. MATERIALS AND METHODS: This prospective pilot study included 136 patients with singleton pregnancies at gestational ages ranging from 7+0 to 41+0 weeks. Cervical elastography was performed using E-Cervix software of the W10 diagnostic ultrasound system (Samsung Medison Co., Ltd., South Korea) with evaluation of quantitative parameters such as hardness ratio, elasticity contrast index, internal os, external os. RESULTS: Correlation analysis showed that hardness ratio decreased with increasing gestational age (ρ = −0.439) and decreasing cervical length (ρ = 0.408; p 0.001). In the group of patients with cervical length less than 25 mm, there was a decrease in hardness ratio compared to the control group (48.0 vs. 63.8%, respectively; p 0.001). The elasticity contrast index score, which reflects cervical tissue heterogeneity, increased with gestational age and cervical shortening (ρ = 0.368 and −0.450, respectively), the parameter being higher in patients with cervical length less than 25 mm [4.73 (IQR 4.21–5.90); p 0.001]. The increase in internal os and external os with gestational age (ρ = 0.433 and ρ = 0.365, respectively; p 0.001) indicates softening of the cervix and is accompanied by its shortening. CONCLUSIONS: Results indicate decreased hardness and increased elasticity of the cervix with increasing gestational age and decreased cervical length. E-Cervix technology allows for assessing structural changes in the cervix throughout pregnancy, starting from early gestation.

Association Between Mode of Delivery and Postpartum Assessment of High-Grade Cervical Dysplasia Diagnosed in Pregnancy [ID 2683564

INTRODUCTION: Approximately 5% of pregnancies are complicated by cervical dysplasia. It is hypothesized that cervical remodeling during vaginal delivery may confer higher rates of postpartum regression when compared to cesarean. We sought to evaluate the relationship between mode of delivery and postpartum dysplasia outcomes. METHODS: This is a retrospective cohort study of patients with biopsy-proven high-grade dysplasia diagnosed during pregnancy from January 2013 to December 2022. Demographics, obstetric outcomes, and antepartum and postpartum cervical pathology were collected and IRB approval obtained. Only immunocompetent patients with postpartum pathology obtained within 1 year of delivery were included. Definitions based on postpartum pathology were as follows: regression as low-grade or resolved dysplasia, persistence as high-grade dysplasia, and progression as cervical cancer. Rates were stratified by mode of delivery and data analyzed using the chi-squared test. RESULTS: Among our cohort (N=286), 101 (35%) were diagnosed with CIN2, 181 (63%) with CIN3/CIS, and 4 (1%) with HSIL (not otherwise specified) on antepartum cervical biopsy. 228 (80%) delivered via vaginal delivery and 58 (20%) delivered via cesarean. Rate of postpartum regression was similar in both delivery groups (37% versus 38%; P=.927), as was persistence (62% versus 60%; P=.786). Rate of apparent progression to invasive cancer was low in both groups (&lt;1% versus 2%; P=.365). CONCLUSION: High rates of persistence and low rates of apparent progression were observed subsequent to both vaginal and cesarean deliveries. Our data indicate that the natural history of high-grade dysplasia diagnosed during pregnancy is not affected by route of delivery in a way that should influence postpartum management.

Assessing the multifaceted cervix: examining cervical gland area at cervical length screening to predict spontaneous preterm birth

BACKGROUNDBiologically active cervical glands provide a mucous barrier while influencing the composition and biomechanical strength of the cervical extracellular matrix. Cervical remodeling during ripening may be reflected as loss of the sonographic cervical gland area. As sonographic cervical length remains suboptimal for universal screening, adjunctive evaluation of other facets of the mid-trimester cervix may impart additional screening benefit. OBJECTIVETo sonographically assess the cervical gland area at universal cervical length screening for preterm birth. STUDY DESIGNWe performed a retrospective cohort study of singletons with transvaginal cervical length screening universally performed during anatomic survey between 18 0/7 and 23 6/7 weeks and subsequent live delivery at a single institution in 2018. Uterine anomalies, cerclage, suboptimal imaging, or medically indicated preterm birth were excluded. Ultrasound images were assessed for cervical length and cervical gland area (with quantitative measurements when present). The primary outcome was spontaneous preterm birth <37 weeks. Absent and present gland groups were compared using χ2, Fisher's exact, T-test, and multivariate logistic regression (adjusting for parity and progesterone use, as well as the gestational age, cervical length, and gland absence at screening ultrasound). Gland measurements were evaluated using the Mann-Whitney-U Test and Spearman's correlation. RESULTSAmong the cohort of 772 patients, absent and present CGA groups were overall similar. Patients were on average 33 years old, ∼20 weeks gestation at screening ultrasound, and overall, 2.5% had history of prior spontaneous preterm birth. The absent gland group was more likely to have been taking progesterone (17% vs 4%, P=.04). Overall rate of preterm birth was 2.6%. However, the 2.3% of patients with absent cervical gland area were significantly more likely to deliver <37 weeks (aOR 23.9, 95% CI 6.4–89, P<.001). Multivariate logistic regression demonstrated better performance of a cervical length screening model for preterm birth prediction with the addition of qualitative gland evaluation (P<.001). Qualitative gland assessment was reproducible (PABAK 0.89), but quantitative gland measurements did not correlate with preterm birth. CONCLUSIONQualitative gland absence at mid-gestation cervical length screening was associated with subsequent spontaneous preterm birth, whereas quantitative gland measurements were not. Multifaceted ultrasound screening may be needed to adequately evaluate the multiple biologic functions of the cervix.

Endocannabinoid regulation in the cervix during pregnancy: insights into molecular mechanisms of premature labor.

The cervix plays a crucial role not only in the maintenance of pregnancy but also during delivery, when it undergoes extensive changes. This study highlights the involvement of the endocannabinoidome in cervical remodeling, emphasizing its relevance in the shift from a nonpregnant to pregnant state and its potential contribution to preterm delivery in inflammatory contexts. During pregnancy, the main role of the cervix is to isolate the fetus from outside pathogens and maintain the relatively closed system of uterine gestation. Conversely, toward the end of pregnancy, the cervix must be remodeled to increase flexibility and allow the delivery. This process is called cervical remodeling and dysregulation of the process plays a role in premature delivery. The endocannabinoidome plays an important role in several reproductive events; however, its function on cervical tissue throughout pregnancy is poorly understood. The goal of this study was to evaluate the presence and participation of the endocannabinoidome in lipopolysaccharide (LPS)-induced cervical changes. Therefore, we evaluated key components of the endocannabinoidome in cervical tissue from nonpregnant mice and pregnant mice with and without LPS treatment. Using mass spectrometric analysis, we found an increase in anandamide and 2-arachidonoylglycerol in the cervix of pregnant mice when compared to nonpregnant mice. We have also found a reduction in FAAH protein expression in these tissues. Furthermore, when treated with LPS, we observed a reduction in the cervical immunostaining with anti-CB1 and anti-CB2 antibodies. Likewise, using cervix explants from pregnant mice, we found that LPS significantly increased cervical metalloprotease activity and cyclooxygenase 2, which were subsequently modulated by cannabinoid receptor antagonists. Collectively, our findings suggest that an LPS-induced imbalance of cervix endocannabinoidome likely contributes to premature cervical remodeling, which is part of the key components that contribute to premature delivery.

Cervical Collagen Network Porosity Assessed by SHG Endomicroscopy Distinguishes Preterm and Normal Pregnancy - a Pilot Study.

Preterm birth (PTB) remains a pressing global health concern associated with premature cervical ripening and weakened cervical mechanical strength. Second harmonic generation (SHG) microscopy has proved instrumental in tracking progressive changes in cervical collagen morphology during pregnancy. To translate this imaging modality into clinical practice, we have developed a flexible SHG endomicroscope for label-free visualization of cervical collagen architecture. This study aims to assess the feasibility of our SHG endomicroscope for non-invasive differentiation of normal and PTB mouse models, with the ultimate goal of enabling early diagnosis and risk assessment of PTB in vivo. in this pilot investigation, we conducted endomicroscopic SHG imaging on frozen cervical tissue sections and intact cervices resected from both normal pregnant mice and mifepristone-induced PTB mouse models, and then analyzed the acquired images to identify collagen morphology characteristics associated with abnormal cervical collagen remodeling. quantitative image analysis revealed significantly altered collage spatial distribution, larger collagen fiber diameter and pore size, along with reduced pore numbers in SHG endomicroscopy images from PTB mouse models compared to normal pregnant mice. Similar trends were consistent across SHG endomicroscopy images of subepithelial collagen fibers acquired directly from intact cervices. overall, the experiment results underscore the potential of SHG endomicroscopy, coupled with quantitative image analysis, for clinically evaluating cervical collagen remodeling and PTB risk.

The Fluid Mechanics of Female Reproduction: A Review of the Biofluid Mechanics of Pregnancy and Delivery

Reproductive biomechanics, a broad and developing field, contains fluid mechanics problems at every stage. In particular, the human female reproductive system is a complex and dynamic fluid-structure system. Until recently, the majority of this research focused on the early moments of reproduction—namely, the transport phenomena that dominate fertilization and implantation. However, in the past two decades, fluid mechanics has begun to be used in investigations of all aspects surrounding pregnancy, labor, and delivery. In this review, we discuss human reproduction starting with the nonpregnant uterus through implantation, delivery, and lactation and breastfeeding. We cover physiologic changes from the transformation of the uterus and the cervical remodeling process to the development of the placenta and the beginning of lactation. We examine the role of reproductive fluids such as amniotic fluid and vernix caseosa, and how force is transferred during labor.

Xenobiotic metabolites modify immune responses of the cervicovaginal epithelium: potential mechanisms underlying barrier disruption.

Xenobiotic metabolites are exogenous biochemicals that can adversely impact reproductive health. We previously identified xenobiotics in cervicovaginal fluid during pregnancy in association with short cervix. In other organ systems, xenobiotics can modify epithelial barrier function. We hypothesise that xenobiotics dysregulate epithelial cell and macrophage immune responses as a mechanism to disrupt the cervicovaginal barrier. In vitro cell culture system. Laboratory within academic institution. Vaginal, ectocervical and endocervical epithelial cell lines and primary macrophages. Cells were treated with diethanolamine (2.5 mM), ethyl glucoside (5 mM) or tartrate (2.5 mM) for 24 h. Cytokines and matrix metalloproteinases were measured in cell supernatants (n = 3 per condition). One-way analysis of variance (ANOVA) with Dunnett's test for multiple comparisons was performed. Diethanolamine induces inflammatory cytokines, whereas ethyl glucoside and tartrate generally exert anti-inflammatory effects across all cells. Diethanolamine increases interleukin 6 (IL-6), IL-8, interferon γ-induced protein 10 kDa (IP-10), growth-regulated oncogene (GRO), fractalkine, matrix metalloproteinase 1 (MMP-1), MMP-9 and MMP-10 (p < 0.05 for all), factors involved in acute inflammation and recruitment of monocytes, neutrophils and lymphocytes. Ethyl glucoside and tartrate decrease multiple cytokines, including RANTES and MCP-1 (p < 0.05 for all), which serve as chemotactic factors. Vaginal cells exhibit heightened inflammatory tone compared with cervical cells and macrophages, with a greater number of differentially expressed analytes after xenobiotic exposure. Xenobiotic metabolites present in the cervicovaginal space during pregnancy modify immune responses, unveiling potential pathways through which environmental exposures may contribute to the pathogenesis of cervical remodelling preceding preterm birth. Future work identifying xenobiotic sources and routes of exposure offers the potential to modify environmental risks to improve pregnancy outcomes.

Efficacy of Intravaginal Administration of Isosorbide Dinitrate Together with Misoprostol versus Misoprostol Alone in Induction of Labor

Background Cervical ripening is a complex process involving extensive remodeling and dynamic anatomic and physiologic alternations governed by hormonal changes, inflammatory responses, vasodilatory changes, and other biological processes. Prostaglandins, produced both locally in the cervix and uterus as well as originating from the fetal membranes, play a critical role in cervical ripening and uterine contractility by increasing inflammatory mediators in the cervix and inducing cervical remodeling. Objective To assess the adjunctive Role of intravaginal administration of Isosorbide dinitrate in induction of labor. Patients and Methods This randomized controlled clinical trial was conducted at tertiary care hospital at Ain Shams University Maternity hospital (labor ward) and was randomly selected from full term patients attending the labor ward and scheduled for induction of labor. Results Our results revealed that the need to cesarean section was statistically significantly less frequent among Isosorbide dinitrate group. Our results revealed that the duration of induction to active phase interval and the duration of active stage of labor were significantly shorter among Isosorbide dinitrate group than among Control group. Conclusion As evident from the current study, both intravaginal misoprostol and combination of vaginal Isosorbide dinitrate and misoprostol are safe and effective modes of labor induction. Vaginal isosorbide dinitrate and misoprostol is more effective than misoprostol alone in terms of post induction Bishop Score, shorter induction to active phase interval and induction to delivery interval. Thus, the combined use of vaginal isosorbide dinitrate with misoprostol for preinduction cervical ripening at term may prove to be a major therapeutic advance.

A finite porous-viscoelastic model capturing mechanical behavior of human cervix under multi-step spherical indentation

The cervix is a soft tissue exhibiting time-dependent behavior under mechanical loads. The cervix is a vital mechanical barrier to protect the growing fetus. The remodeling of the cervical tissue, characterized by an increase in time-dependent material properties, is necessary for a safe parturition. The failure of its mechanical function and accelerated tissue remodeling is hypothesized to lead to preterm birth, which is birth before 37 weeks of gestation. To understand the mechanism of the time-dependent behavior of the cervix under compressive states, we employ a porous-viscoelastic material model to describe a set of spherical indentation tests performed on nonpregnant and term pregnant tissue. A genetic algorithm-based inverse finite element analysis is used to fit the force-relaxation data by optimizing the material parameters, and the statistical analysis of the optimized material parameters is conducted on different sample groups. The force response is captured well using the porous-viscoelastic model. The indentation force-relaxation of the cervix is explained by the porous effects and the intrinsic viscoelastic properties of the extracellular matrix (ECM) microstructure. The hydraulic permeability obtained from the inverse finite element analysis agrees with the trend of the value directly measured previously by our group. The nonpregnant samples are found significantly more permeable than the pregnant samples. Within nonpregnant samples, the posterior internal os is found significantly less permeable than the anterior and posterior external os. The proposed model exhibits the superior capability to capture the force-relaxation response of the cervix under indentation, as compared to the conventional quasi-linear viscoelastic framework (range of r2 of the porous-viscoelastic model 0.88–0.98 vs. quasi-linear model: 0.67–0.89). As a constitutive model with a relatively simple form, the porous-viscoelastic framework has the potential to be used to understand disease mechanisms of premature cervical remodeling, model contact of the cervix with biomedical devices, and interpret force readings from novel in-vivo measurement tools such as an aspiration device.

A novel aspiration technique to assess cervical remodelling in patients with or without cervical shortening: Sequence of first changes, definition of cut-off values and impact of cervical pessary, stratified for cervical length.

The therapeutic significance of the cervical pessary has been confirmed by several studies. However, the underlying mechanism by which pessaries reduce the risk of a preterm birth remains elusive. The aim of this study is to investigate the hypothesis whether the application of a cervical pessary may stabilize the ectocervical stiffness in order to achieve a cervical arrest. This is a prospective, controlled, non-interventional, post-market, monocentric, longitudinal, cohort study in a tertiary maternity hospital to determine ectocervical stiffness and its changes measured before and after placement of a pessary in singleton pregnancies with cervical shortening in the mid trimester. In order to assess reference values for cervical stiffness, we measured also singleton pregnancies with normal cervical length in the same gestational week spectrum. The cervical stiffness measured with the Pregnolia System as the Cervical Stiffness Index (CSI, in mbar) shall be the primary endpoint, whilst patient delivery data (gestational age, mode of delivery and complications) will be the secondary endpoint. In this pilot study, up to 142 subjects will be enrolled to have a total of 120 subjects (estimated dropout rate of 15%) to complete the study; pessary cohort: 60 (up to 71 recruited), control group: 60 (up to 71 recruited). Our hypothesis is that patients with cervical shortening will present with lower CSI values and that pessary placement will be able to stabilize the CSI values through further prevention of cervical remodelling. The measurement of controls with normal cervical length shall serve as a reference.

Biomechanisms of cervical remodeling and current approaches to maturity assessment

The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, and repair to the original state, which is a dense long tubular structure. In this review, the problem of impaired cervical remodeling is discussed in both preterm birth and delayed transformation, which leads to the unpreparedness of the cervix for childbirth and prolongation of pregnancy. Histological, immunological and structural dynamic changes in the cervix begin long before delivery and are noted as early as the first trimester of gestation. There are a few ways to assess the maturity of the cervix. In the second and third trimester, in order to predict preterm birth, these are ultrasound cervicometry and a cervical phosphorylated insulin-like growth factor binding protein-1 test. At full term, in order to determine its readiness for delivery, this is a palpation assessment. Inadequate assessment of the cervical characteristics is one of the factors of untimely prevention of preterm birth, and at full term leads to inappropriate choice of method of preparation for labor. It is necessary to develop new approaches to the comprehensive assessment of the cervix, using existing methods, and to discover new ways to assess its maturity.&#x0D; In this review, the problem of cervical maturation diagnosis is considered based on literature data from such databases as PubMed, ResearchGate, and Google Scholar, as well as from electronic resources of the M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes data on molecular, biochemical and histophysiological processes occurring during cervical maturation at all stages of gestation.&#x0D; It is generally accepted that the main role in cervical changes at all stages of gestation is played by: collagen fiber restructuring / desorganization, decreased concentrations of collagen and elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level and tissue hydrophilicity, increased cervical vascularization, as well as changes in glycosaminoglycan and matrix metalloproteinase content. Palpatory technique and ultrasound cervicometry are the most common methods of determining the cervical length, which have insufficient sensitivity, probably because they do not cover all pathogenetic pathways of remodeling and cannot assess all cervical characteristics. Improvement of efficiency is possible through the introduction of combined techniques and the use of promising methods such as elastography, ultrasound diagnosis of the cervix with Doppler assessment of its vessels, determination of a disintegrin and metalloprotease with thrombospondin-like repeats-1 and placental 1-microglobulin in cervical secretion, and relaxin in maternal blood.&#x0D; Understanding the molecular, biochemical and histophysiological processes that occur during cervical remodeling is crucial for predicting preterm birth, diagnosing isthmic-cervical insufficiency, understanding the lack of timely cervical readiness, and choosing tactics the method of preinduction and induction of labor if necessary. The lack of clinical methods and their lack of objectivity require a combined approach and the search for new prognostic markers of cervical maturation.

S3-2 - Cervical remodeling in preterm labor

S3-2 - Cervical remodeling in preterm labor

Evaluating postpartum cervical remodeling with quantitative ultrasound technology

Having a history of a previous spontaneous preterm birth (sPTB) is the strongest risk factor for recurrent sPTB. It is unknown if there are differences in postpartum cervical remodeling between women who have delivered spontaneous preterm (sPT) and full-term. No studies have evaluated the role of postpartum remodeling between the two groups. Quantitative ultrasound (QUS) is a noninvasive ultrasound technology used to quantify tissue microstructure and function. QUS biomarkers were used to evaluate postpartum cervical microstructure in women who delivered sPT and full-term. Data were collected from 54 women:14 who delivered sPT and 40 who delivered full-term. Transvaginal QUS scans were performed at 6 weeks (±2 weeks) after delivery. Attenuation coefficient (AC), backscatter coefficient (BSC), and shear wave speed (SWS) QUS biomarkers were collected. BSC was significantly higher at six weeks postpartum in women who delivered sPT versus full-term (p = 0.01), while the AC approached statistical significance (p = 0.09). QUS biomarker BSC was able to identify cervical microstructure differences at six weeks postpartum between women who delivered sPT and full-term. QUS technology may improve our understanding of postpartum cervical remodeling and has the potential to noninvasively direct precision-health approaches for recurrent sPTB. [Work supported by NIH 5F31NR019716.]

Three-dimensional remodeling of collagen fibers within cervical tissues in pregnancy

The cervix is a collagen-rich connective tissue that must remain closed during pregnancy while undergoing progressive remodeling in preparation for delivery, which begins before the onset of the preterm labor process. Therefore, it is important to resolve the changes of collagen fibers during cervical remodeling for the prevention of preterm labor. Herein, we assessed the spatial organization of collagen fibers in a three-dimensional (3D) context within cervical tissues of mice on day 3, 9, 12, 15 and 18 of gestation. We found that the 3D directional variance, a novel metric of alignment, was higher on day 9 than that on day 3 and then gradually decreased from day 9 to day 18. Compared with two-dimensional (2D) approach, a higher sensitivity was achieved from 3D analysis, highlighting the importance of truly 3D quantification. Moreover, the depth-dependent variation of 3D directional variance was investigated. By combining multiple 3D directional variance-derived metrics, a high level of classification accuracy was acquired in distinguishing different periods of pregnancy. These results demonstrate that 3D directional variance is sensitive to remodeling of collagen fibers within cervical tissues, shedding new light on highly-sensitive, early detection of preterm birth (PTB).

Fully quantitative cervical elastography demonstrates detectable differences in cervical remodeling patterns by parity

To utilize a novel, fully quantitative cervical elastography system (FQ-CES) to numerically measure cervical stiffness and examine how physiologic cervical remodeling differs in nulliparous versus multiparous patients.

Microbes common in a Lactobacillus-deplete microbiota are negatively correlated with lipid metabolite abundance in pregnancy

A lipid-deplete cervicovaginal (CV) microenvironment is associated with short cervix, a sonographic marker of premature cervical remodeling and risk factor for spontaneous preterm birth (sPTB). Select CV microbiota have been implicated in cervical remodeling preceding sPTB. Whether lipid metabolites are associated with specific CV microbes remains unknown. We sought to examine correlations between cervicovaginal microbes and lipid metabolites in pregnancy.

Novel fully quantitative cervical elastography detects early cervical remodeling patterns in term and preterm birth

Novel fully quantitative cervical elastography detects early cervical remodeling patterns in term and preterm birth