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Infectious Diseases in Obstetrics and... 2011The uterine cervix plays a vital role in maintaining pregnancy and an equally important role in allowing parturition to occur. Progesterone, either endogenously produced... (Review)
Review
The uterine cervix plays a vital role in maintaining pregnancy and an equally important role in allowing parturition to occur. Progesterone, either endogenously produced or supplied exogenously, supports the function of the cervix in sustaining intrauterine pregnancy, and the withdrawal of progesterone, either through natural processes or pharmacologic intervention, leads to delivery which underscores the importance of the progesterone's biological activities manifest in normal gestation and pregnancy that ends prematurely. Research crossing many scientific disciplines has demonstrated that progesterone is a pleotropic compound that affects the cervix through cytoplasmic and membrane receptors with profound effects on cellular and molecular functions that influence inflammatory cascades and extracellular matrix, both of which have consequences for parturition. Beyond the local cell and molecular biology of progesterone, it has systemic effects of relevance to pregnancy as well. This paper examines the biology of the cervix from its gross to cellular structure and biological activities of its cell and molecular processes that may be affected by progesterone. The implications of these processes for preterm birth are explored, and direction of current research is in relation to translational medicine implications for diagnostic, prognostic, and therapeutic approaches to threatened preterm birth.
Topics: Animals; Cervical Ripening; Cervix Uteri; Cytokines; Epithelium; Female; Humans; Inflammation; Pregnancy; Premature Birth; Progesterone; Translational Research, Biomedical
PubMed: 22114461
DOI: 10.1155/2011/353297 -
PloS One 2021Tissue mechanics is central to pregnancy, during which maternal anatomic structures undergo continuous remodeling to serve a dual function to first protect the fetus in... (Clinical Trial)
Clinical Trial
Tissue mechanics is central to pregnancy, during which maternal anatomic structures undergo continuous remodeling to serve a dual function to first protect the fetus in utero while it develops and then facilitate its passage out. In this study of normal pregnancy using biomechanical solid modeling, we used standard clinical ultrasound images to obtain measurements of structural dimensions of the gravid uterus and cervix throughout gestation. 2-dimensional ultrasound images were acquired from the uterus and cervix in 30 pregnant subjects in supine and standing positions at four time points during pregnancy (8-14, 14-16, 22-24, and 32-34 weeks). Offline, three observers independently measured from the images of multiple anatomic regions. Statistical analysis was performed to evaluate inter-observer variance, as well as effect of gestational age, gravity, and parity on maternal geometry. A parametric solid model developed in the Solidworks computer aided design (CAD) software was used to convert ultrasonic measurements to a 3-dimensional solid computer model, from which estimates of uterine and cervical volumes were made. This parametric model was compared against previous 3-dimensional solid models derived from magnetic resonance frequency images in pregnancy. In brief, we found several anatomic measurements easily derived from standard clinical imaging are reproducible and reliable, and provide sufficient information to allow biomechanical solid modeling. This structural dataset is the first, to our knowledge, to provide key variables to enable future computational calculations of tissue stress and stretch in pregnancy, making it possible to characterize the biomechanical milieu of normal pregnancy. This vital dataset will be the foundation to understand how the uterus and cervix malfunction in pregnancy leading to adverse perinatal outcomes.
Topics: Adult; Cervix Uteri; Female; Gestational Age; Humans; Imaging, Three-Dimensional; Longitudinal Studies; Models, Biological; Pregnancy; Ultrasonography, Prenatal
PubMed: 33507927
DOI: 10.1371/journal.pone.0242118 -
Scientific Reports Dec 2021Strain elastography of the uterine cervix may be useful in the diagnosis and prediction of obstetric complications. The inability to obtain quantitative results, with...
Strain elastography of the uterine cervix may be useful in the diagnosis and prediction of obstetric complications. The inability to obtain quantitative results, with only the possibility of visual semiquantitative evaluation of the obtained elastograms, has been the limitation of the method thus far. E-Cervix is a software program that uses intrinsic compression to excite tissue and allows the evaluation of quantitative parameters on the basis of pixel distribution in an elastogram. The aim of this study was to assess the repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) of the uterine cervix and to assess the correlation of the obtained parameters with selected clinical features of patients in the third trimester of pregnancy. In total, 222 patients participated in the study. We assessed 5 ultrasound parameters: elasticity index (ECI), hardness ratio (HR), internal os strain (IOS), external os strain (EOS) and IOS/EOS ratio. Each study was performed according to a predetermined standardized protocol. For all assessed elastographic parameters, we obtained good intra- and interobserver reproducibility. The interclass correlation coefficient (ICC) ranged from 0.77 to 0.838 for intraobserver variability and from 0.771 to 0.826 for interobserver variability. We demonstrated a significant correlation of some obtained elastographic parameters with the basic clinical features of patients, such as age, the number of previous caesarean sections, pregnancy weight and BMI. In each case, the correlation was very low. Quantitative elastographic assessment with the use of E-Cervix is characterized by good repeatability. Some clinical features may affect the value of the parameters obtained. The clinical relevance of this interference requires further investigation.
Topics: Adult; Cervix Uteri; Elasticity; Elasticity Imaging Techniques; Female; Humans; Observer Variation; Pregnancy; Pregnancy Trimester, Third; Reproducibility of Results; Ultrasonography, Prenatal
PubMed: 34880263
DOI: 10.1038/s41598-021-02498-3 -
The British Journal of Radiology May 2021Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to...
Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to overlook the uterine cervix while conducting a pelvic US. Uterine cervical lesions may range from benign to malignant in nature. Therefore, meticulous examination with US may play a key role in assessing uterine cervical lesions. Although there is substantial overlap in the US findings across various uterine cervical lesions, some US features, in tandem with clinical characteristics, may suggest a specific diagnosis. Familiarity with the clinical settings and US characteristics of different uterine cervical lesions can support prompt and accurate diagnosis of suspicious lesions. This review article aims to describe the features of US and possible values for distinction of these lesions in the uterine cervix.
Topics: Abortion, Spontaneous; Adolescent; Adult; Carcinoma; Cervix Uteri; Child; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Polyps; Pregnancy; Pregnancy, Ectopic; Ultrasonography; Uterine Artery; Uterine Cervical Diseases; Uterine Cervical Incompetence; Uterine Neoplasms
PubMed: 33560888
DOI: 10.1259/bjr.20201242 -
Medicina (Kaunas, Lithuania) Jan 2022: Abnormal expressions of CD74 and human leukocyte antigen-DR alpha (HLA-DRA) have been reported in various cancers, though their roles in cervical cancer remain...
: Abnormal expressions of CD74 and human leukocyte antigen-DR alpha (HLA-DRA) have been reported in various cancers, though their roles in cervical cancer remain unclear. This study aimed to evaluate the gene and protein expressions of CD74 and HLA-DRA in the progression from normal cervix to precancerous cervical intraepithelial neoplasia (CIN) and finally to squamous cell carcinoma (SCC). : The gene expression profiles of CD74 and HLA-DRA were determined in formalin-fixed paraffin-embedded tissues, with three samples each from normal cervixes, human papillomavirus type 16/18-positive, low-grade CIN (LGCIN), high-grade CIN (HGCIN), and squamous cell carcinoma (SCC) using Human Transcriptome Array 2.0. Immunohistochemical expression of the proteins was semi-quantitatively assessed in another cohort of tissue microarray samples comprising 7 normal cervix cases, 10 LGCIN, 10 HGCIN, and 95 SCC. : The transcriptomics profile and proteins' expression demonstrated similar trends of upregulation of CD74 and HLA-DRA from normal cervix to CIN and highest in SCC. There was a significant difference in both proteins' expression between the histological groups ( = 0.0001). CD74 and HLA-DRA expressions were significantly associated with CIN grade ( = 0.001 and = 0.030, respectively) but not with the subjects' age or SCC stage. Further analysis revealed a positive correlation between CD74 and HLA-DRA proteins. : CD74 appears to promote cervical carcinogenesis via oncogenic signalling mechanisms and may serve as a potential antitumour target. Additionally, the upregulation of HLA-DRA, often associated with stronger immunogenicity, could be a promising biomarker for developing immunotherapies.
Topics: Carcinogenesis; Cervix Uteri; Female; HLA-DR alpha-Chains; Humans; Uterine Cervical Neoplasms; Uterine Cervical Dysplasia
PubMed: 35208514
DOI: 10.3390/medicina58020190 -
Fetal Diagnosis and Therapy 2010Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of... (Review)
Review
Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of pregnancies. Pre-induction cervical length, measured by transvaginal sonography, has been shown to have a significant association with the induction-to-delivery interval and the risk for cesarean section. In the management of labor there is extensive evidence that digital pelvic examination does not provide accurate assessment of the position and descend of the fetal head both during the first but also in the second stage of labor. Several recent studies using both two- and three-dimensional ultrasound have now described objective measures of progression of the fetal head during labor. In instrumental deliveries an important determinant of a successful and safe use of vacuum and forceps is the correct determination of the fetal head position and appropriate application of the instrument. However, ultrasound studies have shown that digital examination before instrumental delivery fails to identify the correct fetal position in a high proportion of cases. The use of ultrasound is of crucial importance in performing a safe operative delivery and can help in the prediction of whether a vaginal delivery would be successful.
Topics: Cervix Uteri; Delivery, Obstetric; Female; Humans; Labor Presentation; Labor, Induced; Labor, Obstetric; Obstetrical Forceps; Pregnancy; Pregnancy, Prolonged; Ultrasonography; Vacuum Extraction, Obstetrical
PubMed: 20173318
DOI: 10.1159/000287588 -
Trends in Endocrinology and Metabolism:... Jun 2010Appropriate and timely cervical remodeling is key for successful birth. Premature cervical opening can result in preterm birth which occurs in 12.5% of pregnancies.... (Review)
Review
Appropriate and timely cervical remodeling is key for successful birth. Premature cervical opening can result in preterm birth which occurs in 12.5% of pregnancies. Research focused on the mechanisms of term and preterm cervical remodeling is essential to prevent prematurity. This review highlights recent findings that better define molecular processes driving progressive disorganization of the cervical extracellular matrix. This includes studies that redefine the role of immune cells and identify diverse functions of the cervical epithelia and hyaluronan in remodeling. New investigations proposing that infection-induced premature cervical remodeling is distinct from the normal process are presented. Recent advances in our understanding of term and preterm cervical remodeling provide new directions for investigation and compel investigators to reevaluate currently accepted models.
Topics: Animals; Cervical Ripening; Cervix Uteri; Female; Humans; Labor Stage, First; Parturition; Pregnancy
PubMed: 20172738
DOI: 10.1016/j.tem.2010.01.011 -
Fertility and Sterility Jan 2011To describe a rare anomaly of the female reproductive tract and review the embryology associated with the defect. (Review)
Review
OBJECTIVE
To describe a rare anomaly of the female reproductive tract and review the embryology associated with the defect.
DESIGN
Case report and review of the literature.
SETTING
Major academic medical center.
PATIENT(S)
A 14-year-old girl with two hemiuteri lacking any communication with a single normal midline cervix and vagina.
INTERVENTION(S)
Diagnostic laparoscopy with chromopertubation to identify the anomaly and subsequent bilateral supracervical hemihysterectomies.
MAIN OUTCOME MEASURE(S)
Incidence, pathogenesis, fertility implications, and treatment options for patients with congenital defects in the upper vagina, cervix, and uterus.
RESULT(S)
Based on classic embryology, the lower vagina forms from the urogenital sinus while the upper vagina, cervix, and uterus form from the müllerian ducts. If a cervix is present, then the upper vagina and uterus are also usually present and should communicate.
CONCLUSION(S)
This anomaly cannot be fully explained by traditional embryologic developmental theory. It is likely that an insult occurred between 9 weeks, when the uterovaginal canal is formed, and 12 weeks, when the müllerian ducts fuse.
Topics: Adolescent; Cervix Uteri; Female; Humans; Infertility, Female; Laparoscopy; Mullerian Ducts; Vagina
PubMed: 20643405
DOI: 10.1016/j.fertnstert.2010.05.051 -
Archives of Disease in Childhood Oct 1996The pattern of growth of the uterus was examined by ultrasound examinations of 358 girls who attended a paediatric endocrine outpatient department but were shown not to...
BACKGROUND
The pattern of growth of the uterus was examined by ultrasound examinations of 358 girls who attended a paediatric endocrine outpatient department but were shown not to have any endocrine defect.
METHOD
The uterus was measured in length and width at the cervix and at the fundus (cm). Endometrial thickness was measured (mm). Scans were divided by Tanner breast stage and the dimensions compared by one way analysis of variance (ANOVA, with the Student Newman Keuls post hoc test).
RESULTS
There was an increase in uterine length, diameter of the fundus, and endometrial thickness at each breast stage from 1 to 5 (ANOVA, p < 0.05), and in the diameter of the cervix with each breast stage from 1 to 4 (ANOVA, p < 0.05). The ratio of the fundus to the cervix increased from 0.95 to 1.29 between breast stages 1 and 4.
CONCLUSION
The onset of puberty is marked by an increase in the dimensions of the uterus and in endometrial thickness, but also by a change in the shape of the uterus from a tubular to a pear shaped organ.
Topics: Adolescent; Breast; Cervix Uteri; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Puberty; Ultrasonography; Uterus
PubMed: 8984921
DOI: 10.1136/adc.75.4.330 -
Reproduction (Cambridge, England) Jul 2018The cervix shortens and softens as its collagen microstructure remodels in preparation for birth. Altered cervical tissue collagen microstructure can contribute to a...
The cervix shortens and softens as its collagen microstructure remodels in preparation for birth. Altered cervical tissue collagen microstructure can contribute to a mechanically weak cervix and premature cervical dilation and delivery. To investigate the local microstructural changes associated with anatomic location and pregnancy, we used second-harmonic generation microscopy to quantify the orientation and spatial distribution of collagen throughout cervical tissue from 4 pregnant and 14 non-pregnant women. Across patients, the alignment and concentration of collagen within the cervix was more variable near the internal os and less variable near the external os. Across anatomic locations, the spatial distribution of collagen within a radial zone adjacent to the inner canal of the cervix was more homogeneous than that of a region comprising the middle and outer radial zones. Two regions with different collagen distribution characteristics were found. The anterior and posterior sections in the outer radial zone were characterized by greater spatial heterogeneity of collagen than that of the rest of the sections. Our findings suggest that the microstructural alignment and distribution of collagen varies with anatomic location within the human cervix. These observed differences in collagen microstructural alignment may reflect local anatomic differences in cervical mechanical loading and function. Our study deepens the understanding of specific microstructural cervical changes in pregnancy and informs investigations of potential mechanisms for normal and premature cervical remodeling.
Topics: Adult; Cervix Uteri; Collagen; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Premature Birth; Tomography, Optical Coherence; Young Adult
PubMed: 29712877
DOI: 10.1530/REP-17-0763