Overview of the methods available for biomechanical testing of the uterine cervix in vivo

Hee, Lene

doi:10.1111/aogs.12483

Cited by 14 publications

(10 citation statements)

References 71 publications

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“…Toward that end, we propose to retire the term “cervical insufficiency” and adopt the broader yet better-defined term “premature cervical remodeling”. There has been a recent proposal to restore the term “precocious cervical ripening”, used in the 1980s to describe a combination of features including cervical shortening, softening, funneling, and internal os dilation [46]. Although we agree with that reasoning, we prefer the more encompassing term “premature cervical remodeling” because “ripening” invokes only the late stage of cervical remodeling and it is likely that the activating events are initiated long before the ripening phase.…”

Section: The Term “Cervical Insufficiency” Is Anachronisticmentioning

confidence: 87%

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Cervical etiology of spontaneous preterm birth

Vink

Feltovich

2016

Seminars in Fetal and Neonatal Medicine

107

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SUMMARY The cervix functions as a barrier between the uterus and vagina and keeps the uterus closed until term so that the fetus can develop. For delivery the cervix must soften and dilate, and finally reconstitute to close the uterus. This complex process involves precisely timed activation of molecular and microstructural events. Spontaneous preterm birth (sPTB) can result from aberrant timing of these events in the cervix. Unfortunately, the pathophysiology of sPTB due to cervical causes remains unclear and thus our treatment options remain limited – even if all appropriate candidates were identified and correctly treated with currently available interventions, the rate of sPTB would only be reduced by 5%. Very recent molecular and microstructural investigation is challenging prevailing concepts about cervical remodeling in pregnancy. We believe that progress toward novel, targeted solutions for the diverse pathways to sPTB entails a paradigm shift in which the overlapping and complex interactions between the cervix, uterus, membranes, fetus, placenta, and surrounding (structural and molecular) environment are suitably honored.

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Section: The Term “Cervical Insufficiency” Is Anachronisticmentioning

confidence: 87%

“…Although several studies have suggested that higher cervical strain values are associated with sPTB, the current lack of a reliable means to standardize the force applied to the tissue significantly limits the clinical usefulness of this technique [45,46]. …”

Section: Objective Detection Of “Premature Cervical Remodeling”mentioning

confidence: 99%

Cervical etiology of spontaneous preterm birth

Vink

Feltovich

2016

Seminars in Fetal and Neonatal Medicine

107

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“…These methods include magnetic resonance, acoustic, mechanical, electrical, and optical techniques. 24–26 Light-based approaches can enable the study of tissue morphology and biochemistry depending on the light-tissue interaction process used. Two optical methods have been used in vivo to specifically monitor collagen.…”

Section: Introductionmentioning

confidence: 99%

In vivo Raman spectroscopy for biochemical monitoring of the human cervix throughout pregnancy

O’Brien

Vargis

Rudin

et al. 2018

American Journal of Obstetrics and Gynecology

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BACKGROUND The cervix must undergo significant biochemical remodeling to allow for successful parturition. This process is not fully understood, especially in instances of spontaneous preterm birth. In vivo Raman spectroscopy is an optical technique that can be used to investigate the biochemical composition of tissue longitudinally and non-invasively in human beings, and has been utilized to measure physiology and disease states in a variety of medical applications. OBJECTIVE The purpose of this study is to measure in vivo Raman spectra of the cervix throughout pregnancy in women, and to identify biochemical markers that change with the preparation for delivery and postpartum repair. STUDY DESIGN In all, 68 healthy pregnant women were recruited. Raman spectra were measured from the cervix of each patient monthly in the first and second trimesters, weekly in the third trimester, and at the 6-week postpartum visit. Raman spectra were measured using an in vivo Raman system with an optical fiber probe to excite the tissue with 785 nm light. A spectral model was developed to highlight spectral regions that undergo the most changes throughout pregnancy, which were subsequently used for identifying Raman peaks for further analysis. These peaks were analyzed longitudinally to determine if they underwent significant changes over the course of pregnancy (P < .05). Finally, 6 individual components that comprise key biochemical constituents of the human cervix were measured to extract their contributions in spectral changes throughout pregnancy using a linear combination method. Patient factors including body mass index and parity were included as variables in these analyses. RESULTS Raman peaks indicative of extracellular matrix proteins (1248 and 1254 cm−1) significantly decreased (P < .05), while peaks corresponding to blood (1233 and 1563 cm−1) significantly increased (P <.0005) in a linear manner throughout pregnancy. In the postpartum cervix, significant increases in peaks corresponding to actin (1003, 1339, and 1657 cm−1) and cholesterol (1447 cm−1) were observed when compared to late gestation, while signatures from blood significantly decreased. Postpartum actin signals were significantly higher than early pregnancy, whereas extracellular matrix proteins and water signals were significantly lower than early weeks of gestation. Parity had a significant effect on blood and extracellular matrix protein signals, with nulliparous patients having significant increases in blood signals throughout pregnancy, and higher extracellular matrix protein signals in early pregnancy compared to patients with prior pregnancies. Body mass index significantly affected actin signal contribution, with low body mass index patients showing decreasing actin contribution throughout pregnancy and high body mass index patients demonstrating increasing actin signals. CONCLUSION Raman spectroscopy was successfully used to biochemically monitor cervical remodeling in pregnant women during pre-natal visits. This foundational study has d...

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“…Mechanical properties of hollow visceral organs are important for the function of the organs, i.e., for the cardiovascular system, urogenital system, respiratory system and the GI tract . The biomechanical properties show aging‐related changes in the heart, arteries, urinary tract, bladder, lung, and trachea .…”

Section: Discussionmentioning

confidence: 99%