1
|
Villegas-Downs M, Mohammadi M, Han A, O'Brien WD, Simpson DG, Peters TA, Schlaeger JM, McFarlin BL. Trajectory of Postpartum Cervical Remodeling in Women Delivering Full-Term and Spontaneous Preterm: Sensitivity to Quantitative Ultrasound Biomarkers. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00261-8. [PMID: 39237426 DOI: 10.1016/j.ultrasmedbio.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE Women with a history of spontaneous preterm birth (sPTB) face an increased risk of recurrence. Yet, the factors contributing to the increased risk are unknown, hampering the development of targeted interventions. Noninvasive quantitative ultrasound (QUS) has been validated in the characterization of cervical tissue and has the potential to provide information about postpartum cervical remodeling. The objective of this study was to determine the postpartum cervical remodeling trajectories of women over 12 mo post-delivery and to determine whether there were differences between women who delivered full-term and spontaneous preterm that were sensitive to QUS biomarkers. METHODS Data were collected prospectively from 55 women: 41 who delivered full-term and 14 who delivered spontaneously preterm at 6 wk, 3, 6, 9 and 12 mo (±2 wk) postpartum. Data from QUS biomarkers: Attenuation Coefficient; Backscatter Coefficient; Shear Wave Speed; and Lizzi-Feleppa Slope, Intercept and Midband were analyzed from the acquired radiofrequency data using a Siemens S2000 ultrasound system with a transvaginal MC 9-4 MHz probe. The biomarkers were analyzed using descriptive statistics and linear mixed-effects models. RESULTS QUS biomarkers, Backscatter Coefficient and Lizzi-Feleppa Intercept showed significant differences during the year after delivery between women who had a full-term birth and sPTB (p < 0.05), suggesting that there are differences in the cervical remodeling trajectories between the two groups. All QUS biomarkers demonstrated significant variations between the full-term birth and sPTB groups over time (p < 0.05), indicating ongoing cervical remodeling for both groups during the 12-mo postpartum period. CONCLUSION QUS biomarkers identified cervical microstructure differences and trajectories in the year after delivery between women who delivered full-term and spontaneous preterm.
Collapse
Affiliation(s)
- Michelle Villegas-Downs
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA.
| | - Mehrdad Mohammadi
- Department of Statistics, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Aiguo Han
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - William D O'Brien
- Department of Electrical and Computer Engineering, Bioacoustics Research Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Douglas G Simpson
- Department of Statistics, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Tara A Peters
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Barbara L McFarlin
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Wu W, Sun Z, Gao H, Nan Y, Pizzella S, Xu H, Lau J, Lin Y, Wang H, Woodard PK, Krigman HR, Wang Q, Wang Y. Whole cervix imaging of collagen, muscle, and cellularity in term and preterm pregnancy. Nat Commun 2024; 15:5942. [PMID: 39030173 PMCID: PMC11271604 DOI: 10.1038/s41467-024-48680-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/08/2024] [Indexed: 07/21/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Wenjie Wu
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Zhexian Sun
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hansong Gao
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Electrical & Systems Engineering, Washington University, St. Louis, MO, USA
| | - Yuan Nan
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Electrical & Systems Engineering, Washington University, St. Louis, MO, USA
| | - Stephanie Pizzella
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Haonan Xu
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Josephine Lau
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yiqi Lin
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Electrical & Systems Engineering, Washington University, St. Louis, MO, USA
| | - Hui Wang
- Department of Physics, Washington University, St. Louis, MO, USA
| | - Pamela K Woodard
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hannah R Krigman
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Qing Wang
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA.
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA.
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Yong Wang
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
3
|
Flis W, Socha MW. The Role of the NLRP3 Inflammasome in the Molecular and Biochemical Mechanisms of Cervical Ripening: A Comprehensive Review. Cells 2024; 13:600. [PMID: 38607039 PMCID: PMC11012148 DOI: 10.3390/cells13070600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
The uterine cervix is one of the key factors involved in ensuring a proper track of gestation and labor. At the end of the gestational period, the cervix undergoes extensive changes, which can be summarized as a transformation from a non-favorable cervix to one that is soft and prone to dilation. During a process called cervical ripening, fundamental remodeling of the cervical extracellular matrix (ECM) occurs. The cervical ripening process is a derivative of many interlocking and mutually driving biochemical and molecular pathways under the strict control of mediators such as inflammatory cytokines, nitric oxide, prostaglandins, and reactive oxygen species. A thorough understanding of all these pathways and learning about possible triggering factors will allow us to develop new, better treatment algorithms and therapeutic goals that could protect women from both dysfunctional childbirth and premature birth. This review aims to present the possible role of the NLRP3 inflammasome in the cervical ripening process, emphasizing possible mechanisms of action and regulatory factors.
Collapse
Affiliation(s)
- Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland;
- Department of Obstetrics and Gynecology, St. Adalbert’s Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Maciej W. Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland;
- Department of Obstetrics and Gynecology, St. Adalbert’s Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| |
Collapse
|
4
|
Mohammadkhah M, Klinge S. Review paper: The importance of consideration of collagen cross-links in computational models of collagen-based tissues. J Mech Behav Biomed Mater 2023; 148:106203. [PMID: 37879165 DOI: 10.1016/j.jmbbm.2023.106203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
Collagen as the main protein in Extra Cellular Matrix (ECM) is the main load-bearing component of fibrous tissues. Nanostructure and architecture of collagen fibrils play an important role in mechanical behavior of these tissues. Extensive experimental and theoretical studies have so far been performed to capture these properties, but none of the current models realistically represent the complexity of network mechanics because still less is known about the collagen's inner structure and its effect on the mechanical properties of tissues. The goal of this review article is to emphasize the significance of cross-links in computational modeling of different collagen-based tissues, and to reveal the need for continuum models to consider cross-links properties to better reflect the mechanical behavior observed in experiments. In addition, this study outlines the limitations of current investigations and provides potential suggestions for the future work.
Collapse
Affiliation(s)
- Melika Mohammadkhah
- Technische Universität Berlin, Institute of Mechanics, Chair of Structural Mechanics and Analysis, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany.
| | - Sandra Klinge
- Technische Universität Berlin, Institute of Mechanics, Chair of Structural Mechanics and Analysis, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
| |
Collapse
|
5
|
Yoshida K. Bioengineering and the cervix: The past, current, and future for addressing preterm birth. Curr Res Physiol 2023; 6:100107. [PMID: 38107784 PMCID: PMC10724223 DOI: 10.1016/j.crphys.2023.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023] Open
Abstract
The uterine cervix plays two important but opposing roles during pregnancy - as a mechanical barrier that maintains the fetus for nine months and as a compliant structure that dilates to allow for the delivery of a baby. In some pregnancies, however, the cervix softens and dilates prematurely, leading to preterm birth. Bioengineers have addressed and continue to address the lack of reduction in preterm birth rates by developing novel technologies to diagnose, prevent, and understand premature cervical remodeling. This article highlights these existing and emerging technologies and concludes with open areas of research related to the cervix and preterm birth that bioengineers are currently well-positioned to address.
Collapse
Affiliation(s)
- Kyoko Yoshida
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN, 55455, USA
| |
Collapse
|
6
|
Das S, Bhattacharjee MJ, Mukherjee AK, Khan MR. Recent advances in understanding of multifaceted changes in the vaginal microenvironment: implications in vaginal health and therapeutics. Crit Rev Microbiol 2023; 49:256-282. [PMID: 35312419 DOI: 10.1080/1040841x.2022.2049696] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The vagina endures multifaceted changes from neonatal to menopausal phases due to hormonal flux, metabolite deposition, and microbial colonization. These features have important implications in women's health. Several pre-factors show dynamic characteristics according to the phases that shift the vaginal microbiota from anaerobes to aerobes which is a hallmark of healthy vaginal environment. These factors include oestrogen levels, glycogen deposition, and vaginal microstructure. In the adult phase, Lactobacillus is highly dominant and regulates pH, adherence, aggregation, immune modulation, synthesis of bacteriocins, and biosurfactants (BSs) which are antagonistic to pathogens. Maternal factors are protective by favouring the colonization of lactobacilli in the vagina in the neonatal phase, which diminishes with age. The dominance of lactobacilli and dysbiosis in the adult phase depends on intrinsic and extrinsic factors in women, which vary between ethnicities. Recent developments in probiotics used against vaginal microbiome dysbiosis have shown great promise in restoring the normal microbiota including preventing the loss of beneficial bacteria. However, further in-depth studies are warranted to ensure long-term protection by probiotics. This review highlights various aspects of the vaginal microenvironment in different phases of growth and diverse ethnicities. Furthermore, it discusses future trends for formulating more effective population-specific probiotics and implications of paraprobiotics and postbiotics as effective therapeutics.
Collapse
Affiliation(s)
- Sushmita Das
- Division of Life Science, Institute of Advanced Study in Science and Technology, Guwahati, India
| | | | - Ashis K Mukherjee
- Division of Life Science, Institute of Advanced Study in Science and Technology, Guwahati, India.,Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, India
| | - Mojibur Rohman Khan
- Division of Life Science, Institute of Advanced Study in Science and Technology, Guwahati, India
| |
Collapse
|
7
|
Shi L, Hu L, Lee N, Fang S, Myers K. Three-dimensional anisotropic hyperelastic constitutive model describing the mechanical response of human and mouse cervix. Acta Biomater 2022; 150:277-294. [PMID: 35931278 DOI: 10.1016/j.actbio.2022.07.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022]
Abstract
The mechanical function of the uterine cervix is critical for a healthy pregnancy. During pregnancy, the cervix undergoes significant softening to allow for a successful delivery. Abnormal cervical remodeling is suspected to contribute to preterm birth. Material constitutive models describing known biological shifts in pregnancy are essential to predict the mechanical integrity of the cervix. In this work, the material response of human cervical tissue under spherical indentation and uniaxial tensile tests loaded along different anatomical directions is experimentally measured. A deep-learning segmentation tool is applied to capture the tissue deformation during the uniaxial tensile tests. A 3-dimensional, equilibrium anisotropic continuous fiber constitutive model is formulated, considering collagen fiber directionality, fiber bundle dispersion, and the entropic nature of wavy cross-linked collagen molecules. Additionally, the universality of the material model is demonstrated by characterizing previously published mouse cervix mechanical data. Overall, the proposed material model captures the tension-compression asymmetric material responses and the remodeling characteristics of both human and mouse cervical tissue. The pregnant (PG) human cervix (mean locking stretch ζ=2.4, mean initial stiffness ξ=12 kPa, mean bulk modulus κ=0.26 kPa, mean dispersion b=1.0) is more compliant compared with the nonpregnant (NP) cervix (mean ζ=1.3, mean ξ=32 kPa, mean κ=1.4 kPa, mean b=1.4). Creating a validated material model, which describes the role of collagen fiber directionality, dispersion, and crosslinking, enables tissue-level biomechanical simulations to determine which material and anatomical factors drive the cervix to open prematurely. STATEMENT OF SIGNIFICANCE: In this study, we report a 3D anisotropic hyperelastic constitutive model based on Langevin statistical mechanics and successfully describe the material behavior of both human and mouse cervical tissue using this model. This model bridges the connection between the extracellular matrix (ECM) microstructure remodeling and the macro mechanical properties change of the cervix during pregnancy via microstructure-associated material parameters. This is the first model, to our knowledge, to connect the the entropic nature of wavy cross-linked collagen molecules with the mechanical behavior of the cervix. Inspired by microstructure, this model provides a foundation to understand further the relationship between abnormal cervical ECM remodeling and preterm birth. Furthermore, with a relatively simple form, the proposed model can be applied to other fibrous tissues in the future.
Collapse
Affiliation(s)
- Lei Shi
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Lingfeng Hu
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Nicole Lee
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Shuyang Fang
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Kristin Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA.
| |
Collapse
|
8
|
Feng Q, Chaemsaithong P, Duan H, Ju X, Appiah K, Shen L, Wang X, Tai Y, Leung TY, Poon LC. Screening for spontaneous preterm birth by cervical length and shear-wave elastography in the first trimester of pregnancy. Am J Obstet Gynecol 2022; 227:500.e1-500.e14. [PMID: 35460624 DOI: 10.1016/j.ajog.2022.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND First-trimester cervical length for the prediction of spontaneous preterm delivery remains controversial. A better method for the measurement of the first-trimester cervical length and additional cervical ultrasound parameters for the identification of women at high risk for spontaneous preterm delivery are needed. OBJECTIVE This study aimed to compare the predictive value of cervical length measured by 2 different methods in the first trimester of pregnancy to predict spontaneous preterm delivery and to explore the potential value of first-trimester cervical shear-wave elastography for the prediction of spontaneous preterm delivery. STUDY DESIGN This was a prospective study in unselected singleton pregnancies at 11+0 to 13+6 weeks' gestation. Cervical length was measured by the following 2 methods in the base-cohort population: (1) a linear distance between the 2 ends of the glandular area around the endocervical canal (single-line method: cervical length-s) and (2) a sum of the linear distance from the internal os to the greatest cervical curvature and the linear distance from this point to the external os (2-line method: cervical length-t). In a substudy, cervical shear-wave elastography scores for 9 regions of interest (inner, middle, and external parts of anterior lip, endocervical canal, and posterior lip) in midsagittal plane were also obtained by transvaginal ultrasonography. The screening performance of the first-trimester cervical length measured by the 2 different methods for the prediction of spontaneous preterm delivery was assessed by receiver operating characteristics curve analysis. The areas under the curves were compared using a DeLong test. The predictive performance of a soft cervix (mean elastography scores with multiple of median <5th, 10th, 15th, 20th, and 25th percentile) for spontaneous preterm delivery was also determined. RESULTS Among a total of 2316 included pregnancies, spontaneous delivery at <37 and <34 weeks' gestation occurred in 111 cases (4.8%) and 20 cases (0.9%), respectively. In the total study population, when compared with the term delivery group, the median cervical length-t was shorter in women with spontaneous delivery at <34 weeks' gestation (36.9 mm vs 35.1 mm; P=.015), but there was no clear correlation for cervical length-s. Receiver operating characteristics curves demonstrated that cervical length-t achieved better performance in predicting spontaneous delivery at <34 weeks' gestation (area under the curve, 0.658 vs 0.573; P<.01) than cervical length-s. The best combined model to predict spontaneous delivery at <34 weeks' gestation was provided by cervical length-t and history of preterm delivery (area under the curve, 0.692). In the substudy, a soft cervix with a mean elastography scores multiple of median <10th percentile had a relative risk of 7.8 (95% confidence interval, 2.1-28.6) for spontaneous delivery at <34 weeks' gestation; the detection rate was 44.4% at a false-positive rate of 9.0%. CONCLUSION The 2-line approach provides a better estimate of the actual first-trimester cervical length and achieves better performance as a screening tool for spontaneous preterm delivery at <34 weeks' gestation than the conventional measurement. A soft cervix as determined by shear-wave elastograpthy in the first trimester is associated with an increased risk for subsequent spontaneous preterm delivery.
Collapse
|
9
|
Woo J, Ge W, Mancheri J, Hyett J, Mogra R. Shear wave elastography: the relationship of the cervical stiffness with gestational age and cervical length- a feasibility study. J Matern Fetal Neonatal Med 2022; 35:9684-9693. [PMID: 35337244 DOI: 10.1080/14767058.2022.2050896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To standardize the measurement of shear wave elastography for assessment of cervical stiffness and its relationship with gestational age and cervical length. METHODS A prospective cross-sectional study was conducted from September 2017 to March 2019. Data from 125 unselected women (at 11-13 + 6, 18-22 and 24-28 weeks' gestation) and 55 high-risk women were analyzed for the study. Six regions of interest were evaluated for cervical elastography in the mid-sagittal position by transvaginal ultrasound. Statistical analyses were performed using R statistical language in R-studio. Delivery outcomes were recorded for each patient. RESULTS The shear wave elastography was feasible with good intraoperator and interoperator reproducibility. The endocervical canal and anterior lip internal position had the highest reproducibility (ICC-0.82, 0.75). Shear wave speed was significantly higher in all internal os regions than the external os. There was a statistically significant negative linear relationship of shear wave speed with the gestational age. There was a weak positive relationship between shear wave speed and cervical length. There was no difference between pregnancies with and without spontaneous preterm delivery in shear wave speed measurements and cervical length, although numbers were small for statistical analysis. The internal os of the large loop excision of the transformation zone group was stiffer than the normal population. CONCLUSION Cervical elastography is feasible and effectively evaluates the tensile properties of the cervix during pregnancy. The most reproducible measurements were obtained at the anterior lip of the internal cervical os. Combining evaluation of cervical elasticity and length might further improve the identification of women at risk of preterm delivery. Currently, technical issues hinder the practical application of shear wave elastography in the clinical setting and require further research and development of the imaging modality.
Collapse
Affiliation(s)
- Joyce Woo
- Sydney Institute for Women, Children and their Families, Sydney, Australia
| | - Weirong Ge
- Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Institute for Women, Children and their Families, Sydney, Australia
| | - Jyothi Mancheri
- Sydney Institute for Women, Children and their Families, Sydney, Australia
| | - Jon Hyett
- Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Institute for Women, Children and their Families, Sydney, Australia
| | - Ritu Mogra
- Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Institute for Women, Children and their Families, Sydney, Australia
| |
Collapse
|
10
|
Moghaddam AO, Lin Z, Sivaguru M, Phillips H, McFarlin BL, Toussaint KC, Johnson AJW. Heterogeneous microstructural changes of the cervix influence cervical funneling. Acta Biomater 2022; 140:434-445. [PMID: 34958969 PMCID: PMC8828692 DOI: 10.1016/j.actbio.2021.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022]
Abstract
The cervix acts as a dynamic barrier between the uterus and vagina, retaining the fetus during pregnancy and allowing birth at term. Critical to this function, the physical properties of the cervix change, or remodel, but abnormal remodeling can lead to preterm birth (PTB). Although cervical remodeling has been studied, the complex 3D cervical microstructure has not been well-characterized. In this complex, dynamic, and heterogeneous tissue microenvironment, the microstructural changes are likely also heterogeneous. Using quantitative, 3D, second-harmonic generation microscopy, we demonstrate that rat cervical remodeling during pregnancy is not uniform across the cervix; the collagen fibers orient progressively more perpendicular to the cervical canals in the inner cervical zone, but do not reorient in other regions. Furthermore, regions that are microstructurally distinct early in pregnancy become more similar as pregnancy progresses. We use a finite element simulation to show that heterogeneous regional changes influence cervical funneling, an important marker of increased risk for PTB; the internal cervical os shows ∼6.5x larger radial displacement when fibers in the inner cervical zone are parallel to the cervical canals compared to when fibers are perpendicular to the canals. Our results provide new insights into the microstructural and tissue-level cervical changes that have been correlated with PTB and motivate further clinical studies exploring the origins of cervical funneling. STATEMENT OF SIGNIFICANCE: Cervical funneling, or dilation of the internal cervical os, is highly associated with increased risk of preterm birth. This study explores the 3D microstructural changes of the rat cervix during pregnancy and illustrates how these changes influence cervical funneling, assuming similar evolution in rats and humans. Quantitative imaging showed that microstructural remodeling during pregnancy is nonuniform across cervical regions and that initially distinct regions become more similar. We report, for the first time, that remodeling of the inner cervical zone can influence the dilation of the internal cervical os and allow the cervix to stay closed despite increased intrauterine pressure. Our results suggest a possible relationship between the microstructural changes of this zone and cervical funneling, motivating further clinical investigations.
Collapse
Affiliation(s)
- A. Ostadi Moghaddam
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Z. Lin
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - M. Sivaguru
- Flow Cytometry and Microscopy to Omics, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - H. Phillips
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - B. L. McFarlin
- Department of Women, Children and Family Health Science, University of Illinois College of Nursing, Chicago, IL 60612, USA
| | - K. C. Toussaint
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - A. J. Wagoner Johnson
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA,Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA,Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA,Corresponding author at: 2101A Mechanical Engineering Laboratory MC-244, University of Illinois at Urbana-Champaign, 1206 West Green Street, Urbana, IL 61801, United States.
| |
Collapse
|
11
|
Qi W, Zhao P, Sun Z, Ma X, Wang H, Wu W, Wen Z, Kisrieva-Ware Z, Woodard PK, Wang Q, McKinstry RC, Cahill AG, Wang Y. Magnetic resonance diffusion tensor imaging of cervical microstructure in normal early and late pregnancy in vivo. Am J Obstet Gynecol 2021; 224:101.e1-101.e11. [PMID: 32668204 DOI: 10.1016/j.ajog.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/06/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cervical remodeling is an important aspect of birth timing. Before cervical ripening, the collagen fibers are arranged in a closely interweaved network, but during ripening, the fibers become disorganized and the cervix becomes more hydrated. To quantitatively measure cervical remodeling, we need a noninvasive method to monitor changes in cervical collagen fiber organization and hydration in vivo. OBJECTIVE To use diffusion tensor imaging to image and quantify the spatial and temporal differences in cervical microstructure between normal early and late pregnancies. STUDY DESIGN After institutional review board approval and consent, a group of healthy women in early pregnancy (22 patients at 12-14 weeks' gestation) and a group in late pregnancy (27 patients at 36-38 weeks' gestation) underwent magnetic resonance imaging on a Siemens MAGNETOM Vida 3 Tesla unit. Diffusion tensor imaging of the cervix in the axial plane was performed with a two-dimensional single-shot echo planar imaging diffusion-weighted sequence. In early and late pregnancy groups, the differences of the diffusion tensor imaging measures were compared between the subglandular zone and the outer stroma regions of the cervix. In addition, the diffusion tensor imaging measures were compared between the early and late pregnancy groups. Finally, for the late pregnancy group, the diffusion tensor imaging measures were compared between the primipara and multipara groups. RESULTS Diffusion tensor imaging measures of microstructure significantly differed between the subglandular zone and outer stroma regions of the cervix in both early and late pregnancies. In the subglandular zone, fractional anisotropy was lower in the late pregnancy group than in the early pregnancy group (0.37 [0.34-0.42] vs 0.50 [0.43-0.58]; P<.0005), suggesting increased collagen fiber disorganization in this zone. In addition, mean diffusivity was higher in the late pregnancy group than in the early pregnancy group (1.84 [1.73-2.02] mm2/sec×10-3 vs 1.56 [1.42-1.69] mm2/sec×10-3; P=.001), suggesting increased hydration in the subglandular zone. In the outer stroma, neither fractional anisotropy (0.44 [0.40-0.50] vs 0.41 [0.37-0.43]; P=.095) nor mean diffusivity (2.09 [1.92-2.25] mm2/sec×10-3 vs 2.12 [2.04-2.24] mm2/sec×10-3; P=.269) significantly differed between early pregnancy and late pregnancy, suggesting insignificant temporal microstructural changes in this cervical zone. Diffusion tensor imaging measures did not significantly differ between cervixes from primiparous and multiparous women in late pregnancy. CONCLUSION This in vivo study demonstrates that diffusion tensor imaging can noninvasively quantify the microstructural differences in collagen fiber organization and hydration in cervical subregions between early pregnancy and late pregnancy.
Collapse
|
12
|
McLean JP, Fang S, Gallos G, Myers KM, Hendon CP. Three-dimensional collagen fiber mapping and tractography of human uterine tissue using OCT. BIOMEDICAL OPTICS EXPRESS 2020; 11:5518-5541. [PMID: 33149968 PMCID: PMC7587264 DOI: 10.1364/boe.397041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 05/10/2023]
Abstract
Automatic quantification and visualization of 3-D collagen fiber architecture using Optical Coherence Tomography (OCT) has previously relied on polarization information and/or prior knowledge of tissue-specific fiber architecture. This study explores image processing, enhancement, segmentation, and detection algorithms to map 3-D collagen fiber architecture from OCT images alone. 3-D fiber mapping, histogram analysis, and 3-D tractography revealed fiber groupings and macro-organization previously unseen in uterine tissue samples. We applied our method on centimeter-scale mosaic OCT volumes of uterine tissue blocks from pregnant and non-pregnant specimens revealing a complex, patient-specific network of fibrous collagen and myocyte bundles.
Collapse
Affiliation(s)
- James P. McLean
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Shuyang Fang
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - George Gallos
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kristin M. Myers
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| |
Collapse
|
13
|
Kniss DA, Summerfield TL. Progesterone Receptor Signaling Selectively Modulates Cytokine-Induced Global Gene Expression in Human Cervical Stromal Cells. Front Genet 2020; 11:883. [PMID: 33061933 PMCID: PMC7517718 DOI: 10.3389/fgene.2020.00883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/17/2020] [Indexed: 01/09/2023] Open
Abstract
Preterm birth (PTB) is the leading cause of morbidity and mortality in infants <1 year of age. Intrauterine inflammation is a hallmark of preterm and term parturition; however, this alone cannot fully explain the pathobiology of PTB. For example, the cervix undergoes a prolonged series of biochemical and biomechanical events, including extracellular matrix (ECM) remodeling and mechanochemical changes, culminating in ripening. Vaginal progesterone (P4) prophylaxis demonstrates great promise in preventing PTB in women with a short cervix (<25 mm). We used a primary culture model of human cervical stromal fibroblasts to investigate gene expression signatures in cells treated with interleukin-1β (IL-1β) in the presence or absence of P4 following 17β-estradiol (17β-E2) priming for 7–10 days. Microarrays were used to measure global gene expression in cells treated with cytokine or P4 alone or in combination, followed by validation of select transcripts by semiquantitative polymerase chain reactions (qRT-PCR). Primary/precursor (MIR) and mature microRNAs (miR) were quantified by microarray and NanoString® platforms, respectively, and validated by qRT-PCR. Differential gene expression was computed after data normalization followed by pathway analysis using Kyoto Encyclopedia Genes and Genomes (KEGG), Panther, Gene Ontology (GO), and Ingenuity Pathway Analysis (IPA) upstream regulator algorithm tools. Treatment of fibroblasts with IL-1β alone resulted in the differential expression of 1432 transcripts (protein coding and non-coding), while P4 alone led to the expression of only 43 transcripts compared to untreated controls. Cytokines, chemokines, and their cognate receptors and prostaglandin endoperoxide synthase-2 (PTGS-2) were among the most highly upregulated transcripts following either IL-1β or IL-1β + P4. Other prominent differentially expressed transcripts were those encoding ECM proteins, ECM-degrading enzymes, and enzymes involved in glycosaminoglycan (GAG) biosynthesis. We also detected differential expression of bradykinin receptor-1 and -2 transcripts, suggesting (prominent in tissue injury/remodeling) a role for the kallikrein–kinin system in cervical responses to cytokine and/or P4 challenge. Collectively, this global gene expression study provides a rich database to interrogate stromal fibroblasts in the setting of a proinflammatory and endocrine milieu that is relevant to cervical remodeling/ripening during preparation for parturition.
Collapse
Affiliation(s)
- Douglas A Kniss
- Division of Maternal-Fetal Medicine and Laboratory of Perinatal Research, Department of Obstetrics and Gynecology, The Ohio State University, College of Medicine and Wexner Medical Center, Columbus, OH, United States.,Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Taryn L Summerfield
- Division of Maternal-Fetal Medicine and Laboratory of Perinatal Research, Department of Obstetrics and Gynecology, The Ohio State University, College of Medicine and Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
14
|
Badir S, Bernardi L, Feijó Delgado F, Quack Loetscher K, Hebisch G, Hoesli I. Aspiration technique-based device is more reliable in cervical stiffness assessment than digital palpation. BMC Pregnancy Childbirth 2020; 20:391. [PMID: 32631265 PMCID: PMC7339509 DOI: 10.1186/s12884-020-03080-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to compare the reliability and reproducibility of the traditional qualitative method of assessing uterine cervical stiffness with those of a quantitative method using a novel device based on the aspiration technique. Methods Five silicone models of the uterine cervix were created and used to simulate different cervical stiffnesses throughout gestation. The stiffness of the five cervix models was assessed both by digital palpation (firm, medium and soft) and with the Pregnolia System. Five self-trained participants conducted the device-based assessment, whereas 63 obstetricians and midwives, trained in digital palpation, conducted the cervical palpation. Results The results of the two methods were analyzed in terms of inter-and intra-observer variability. For digital palpation, there was no common agreement on the assessment of the stiffness, except for the softest cervix. When assessing the same cervix model for a second time, 76% of the obstetricians and midwives disagreed with their previous assessment. In contrast, the maximum standard deviation for the device-based stiffness assessment for intra- and inter-observer variability was 3% and 3.4%, respectively. Conclusions This study has shown that a device based on the aspiration technique provides obstetricians and midwives with a method for objectively and repeatably assess uterine cervical stiffness, which can eliminate the need to rely solely on a subjective interpretation, as is the case with digital palpation.
Collapse
Affiliation(s)
- Sabrina Badir
- Pregnolia AG, Schlieren, Wiesenstrasse 33, 8952, Schlieren, Switzerland.
| | - Laura Bernardi
- Pregnolia AG, Schlieren, Wiesenstrasse 33, 8952, Schlieren, Switzerland
| | | | | | - Gundula Hebisch
- Gynecology and Obstetrics, Thurgau Hospital, Frauenfeld, Switzerland
| | - Irene Hoesli
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
15
|
Duan H, Chaemsaithong P, Ju X, Ho SYS, Sun Q, Tai Y, Leung TY, Poon LC. Shear‐wave sonoelastographic assessment of cervix in pregnancy. Acta Obstet Gynecol Scand 2020; 99:1458-1468. [DOI: 10.1111/aogs.13874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Honglei Duan
- Department of Obstetrics and Gynecology Affiliated Drum Tower HospitalMedical School of Nanjing University Nanjing China
| | - Piya Chaemsaithong
- Department of Obstetrics and gynecology The Chinese University of Hong Kong Hong Kong SAR
| | - Xiaoqing Ju
- Department of Obstetrics and gynecology The Chinese University of Hong Kong Hong Kong SAR
| | - Sin Yee Stella Ho
- Department of Imaging and Interventional Radiology The Chinese University of Hong Kong Hong Kong Hong Kong SAR
| | - Qian Sun
- Department of Obstetrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Yi‐yun Tai
- Department of Obstetrics and Gynecology National Taiwan University Hospital Taipei Taiwan
| | - Tak Yeung Leung
- Department of Obstetrics and gynecology The Chinese University of Hong Kong Hong Kong SAR
| | - Liona C. Poon
- Department of Obstetrics and gynecology The Chinese University of Hong Kong Hong Kong SAR
| |
Collapse
|
16
|
Abstract
The cervix is the essential gatekeeper for birth. Incomplete cervix remodeling contributes to problems with delivery at or post-term while preterm birth is a major factor in perinatal morbidity and mortality in newborns. Lack of cervix biopsies from women during the period preceding term or preterm birth have led to use of rodent models to advanced understanding of the mechanism for prepartum cervix remodeling. The critical transition from a soft cervix to a compliant prepartum lower uterine segment has only recently been recognized to occur in various mammalian species when progesterone in circulation is at or near the peak of pregnancy in preparation for birth. In rodents, characterization of ripening resembles an inflammatory process with a temporal coincidence of decreased density of cell nuclei, decline in cross-linked extracellular collagen, and increased presence of macrophages in the cervix. Although a role for inflammation in parturition and cervix remodeling is not a new concept, a comprehensive examination of literature in this review reveals that many conclusions are drawn from comparisons before and after ripening has occurred, not during the process. The present review focuses on essential phenotypes and functions of resident myeloid and possibly other immune cells to bridge the gap with evidence that specific biomarkers may assess the progress of ripening both at term and with preterm birth. Moreover, use of endpoints to determine the effectiveness of various therapeutic approaches to forestall remodeling and reduce risks for preterm birth, or facilitate ripening to promote parturition will improve the postpartum well-being of mothers and newborns.
Collapse
Affiliation(s)
- Steven M Yellon
- Department of Basic Sciences, Longo Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| |
Collapse
|
17
|
Effectiveness of the cervical pessary for the prevention of preterm birth in singleton pregnancies with a short cervix: a meta-analysis of randomized trials. Arch Gynecol Obstet 2019; 299:1215-1231. [DOI: 10.1007/s00404-019-05096-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 02/07/2019] [Indexed: 02/05/2023]
|