The influence of steroid hormones on the uterine cervix during pregnancy

This paper reviews the evidence concerning the actions of steroid hormones on the connective tissues of the pelvis. Most available data concern the effects of steroids on the cervix. The time course of cervical softening in rats, sheep and humans suggests the possibility that the changes in connective tissue biochemistry that underlie the physiological phenomenon of cervical softening are under hormonal control. Both oestrogens and progestogens have been implicated in the control of cervical softening. However, recent experiments using inhibitors of 3 beta-hydroxysteroid dehydrogenase suggest that cervical softening can be produced in both sheep and humans by progesterone withdrawal in the absence of high circulating concentrations of oestradiol-17 beta.     

Investigating the mechanical function of the cervix during pregnancy using finite element models derived from high-resolution 3D MRI

Preterm birth is a strong contributor to perinatal mortality, and preterm infants that survive are at risk for long-term morbidities. During most of pregnancy, appropriate mechanical function of the cervix is required to maintain the developing fetus in utero. Premature cervical softening and subsequent cervical shortening are hypothesized to cause preterm birth. Presently, there is a lack of understanding of the structural and material factors that influence the mechanical function of the cervix during pregnancy. In this study we build finite element models of the pregnant uterus, cervix, and fetal membrane based on magnetic resonance imagining data in order to examine the mechanical function of the cervix under the physiologic loading conditions of pregnancy. We calculate the mechanical loading state of the cervix for two pregnant patients: 22 weeks gestational age with a normal cervical length and 28 weeks with a short cervix. We investigate the influence of (1) anatomical geometry, (2) cervical material properties, and (3) fetal membrane material properties, including its adhesion properties, on the mechanical loading state of the cervix under physiologically relevant intrauterine pressures. Our study demonstrates that membrane–uterus interaction, cervical material modeling, and membrane mechanical properties are factors that must be deliberately and carefully handled in order to construct a high quality mechanical simulation of pregnancy.     

Intrinsic innervation of the ewe cervix and its variations during pregnancy

Summary The course of the cholinergic and adrenergic nerve fibers in the cervix of the ewe was investigated in nonpregnant and pregnant animals using an acetylcholinesterase method and fluorescence histochemistry. Both technics in nonpregnant animals revealed a rich network of acetylcholinesterase and norepinephrin positive nerves around the blood vessels while the muscular innervation was moderately positive. Acetylcholinesterase fibers were also concentrated beneath the surface epithelium forming a plexuslike arrangement where isolated ganglion cells could be seen. At mid pregnancy cholinergic and adrenergic fibers decreased in density. The intensity of fluorescence was weaker and nerve fiber morphology was modified. We endeavoured to relate our findings to the problem of the neural control of contractions and the opening of the cervix of the ewe which is poorly supplied in nerve fibers, particularly at mid pregnancy.     

Long-term changes in medication during pregnancy

The Finnish Register of Congenital Malformations, established in 1963, rendered possible the study of changes in medication during pregnancy. The study consisted of 659 control mothers who had delivered a healthy child during the years 1964-1984. The data of this long-term follow-up study were collected by interviews at Maternal Health Care Centers after delivery and were completed by filed antenatal data. The results show a continuous decreasing trend in the usage of analgesics and tranquilizers but not in the usage of antiemetics, antibiotics, and vitamins. We believe that in Finland the publicity aimed at unnecessary medication during pregnancy has affected both the mothers and the health personnel.     

Intrinsic innervation of the ewe cervix and its variations during pregnancy

The course of the cholinergic and adrenergic nerve fibers in the cervix of the ewe was investigated in nonpregnant and pregnant animals using an acetylcholinesterase method and fluorescence histochemistry. Both technics in nonpregnant animals revealed a rich network of acetylcholinesterase and norepinephrine positive nerves around the blood vessels while the muscular innervation was moderately positive. Acetylcholinesterase fibers were also concentrated beneath the surface epithelium forming a plexus-like arrangement where isolated ganglion cells could be seen. At mid pregnancy cholinergic and adrenergic fibers decreased in density. The intensity of fluorescence was weaker and nerve fiber morphology was modified. We endeavoured to relate our findings to the problem of the neural control of contractions and the opening of the cervix of the ewe which is poorly supplied in nerve fibers, particularly at mid pregnancy.     

microRNA expression in the cervix during pregnancy is associated with length of gestation

Preterm birth is a leading cause of infant mortality and can lead to poor life-long health and adverse neurodevelopmental outcomes. The pathophysiologic mechanisms that precede preterm labor remain elusive, and the role that epigenetic phenomena play is largely unstudied. The objective of this study was to assess the association between microRNA (miRNA) expression levels in cervical cells obtained from swabs collected during pregnancy and the length of gestation. We analyzed cervical samples obtained between 16 and 19 weeks of gestation from 53 women in a prospective cohort from Mexico City, and followed them until delivery. Cervical miRNA was extracted and expression was quantified using the NanoString nCounter Analysis System. Linear regression models were used to examine the association between miRNA expression levels and gestational age at delivery, adjusted for maternal age, education, parity, body mass index, smoke exposure, and inflammation assessed on a Papanicolaou smear. We identified 6 miRNAs that were significantly associated with gestational age at the time of delivery, including miR-21, 30e, 142, 148b, 29b, and 223. Notably, per each doubling in miR-21 expression, gestations were 0.9 (95% CI: 0.2–1.5) days shorter on average (P = 0.009). Per each doubling in miR-30e, 142, 148b, 29b, and 223 expression, gestations were shorter by 1.0 to 1.6 days. The predicted targets of the miRNAs were enriched for molecules involved in DNA replication and inflammatory processes. The levels of specific miRNAs in the human cervix during pregnancy are predictive of gestational age at delivery, and should be validated in future studies as potential biomarkers of preterm birth risk.Key words: Cervix, delivery, gestational age, labor, microRNA, Pap smear, preterm     

Changes to the mechanical properties of the glenohumeral capsule during anterior dislocation

The glenohumeral joint is the most frequently dislocated major joint in the body, and instability due to permanent deformation of the glenohumeral capsule is a common pathology. The corresponding change in mechanical properties may have implications for the ideal location and extent of plication, which is a common clinical procedure used to repair the capsule. Therefore, the objective of this study was to quantify the mechanical properties of four regions of the glenohumeral capsule after anterior dislocation and compare the properties to the normal glenohumeral capsule. Six fresh-frozen cadaveric shoulders were dislocated in the anterior direction with the joint in the apprehension position using a robotic testing system. After dislocation, mechanical testing was performed on the injured glenohumeral capsule by loading the tissue samples in tension and shear. An inverse finite element optimization routine was used to simulate the experiments and obtain material coefficients for each tissue sample. Cauchy stress–stretch curves were then generated to represent the mechanical response of each tissue sample to theoretical loading conditions. Based on several comparisons (average of the material coefficients, average stress–stretch curve for each region, and coefficients representing the average curves) between the normal and injured tissue samples, the mechanical properties of the injured tissue samples from multiple regions were found to be lower than those of the normal tissue in tension but not in shear. This finding indicates that anterior dislocation primarily affects the tensile behavior of the glenohumeral capsule rather than the shear behavior, and this phenomenon could be caused by plastic deformation of the matrix, permanent collagen fiber rotation, and/or collagen fiber failure. These results suggest that plication and suturing may not be sufficient to return stability to the shoulder after dislocation in all individuals. Thus, surgeons may need to perform a procedure that reinforces or stiffens the tissue itself, such as reconstruction or augmentation, to improve repair procedures.     

Rheological properties and mechanical stability of new gel-entrapment systems applied in bioreactors

The mechanical stability of gels applied for entrapment and retention of biocatalysts in bioreactors is of crucial importance for successful scale-up applications. Gel abrasion in agitated reactors will depend on liquid shear, bubble shear, and wall shear, as well as collisions between the gel particles. As a simplified standardized model system, abrasion of gel beads was studied in 1-m-high bubble columns with controlled aeration, and quantified by measuring the loss of gel material into solution. Gel beads were also taken out to measure stress-strain response during controlled compression. More general rheological properties of different gels were studied by applying a variety of regimes of controlled compression of standardized gel cylinders: Gel strength was measured by recording the fracture properties and the Young's modulus. Viscoelastic properties were revealed by recording creep during compression as well as recovery after compression. Oscillation tests up to 1000 cyclic compressions were applied to compare the fatigue of different gels. Results obtained for Ca-alginate gels, gels of chemically modified polyvinyl alcohol with stilbazolium groups (PVA-SbQ) as well as mixed gels of Ca-alginate and PVA-SbQ are compared with previously published data for kappa-carrageenan, agar, and polyethylene glycol (PEG) gels. It is concluded that material fatigue rather than mechanical properties such as stiffness or fracture stress should be considered when selecting a suitable gel material on the basis of abrasion resistance. The very soft and superelastic PVA-SbQ gel showed no significant fatigue in mechanical tests and no abrasion was detected in the standardized model system used. Ca-alginate gels, however, showed severe irreversible changes due to fatigue at oscillating loads and creep at constant load. Due to their similarities with kappa-carrageenan gels in mechanical tests, it is likely that Ca-alginate would also be sensitive to abrasion. Mixed gels of Ca-alginate and PVA-SbQ represent a complex system with intermediate properties, showing significant fatigue and creep, but elastic properties from the PVA-SbQ gel make it less sensitive than the pure Ca-alginate gel.     

Contribution of electrodiffusion to the dynamics of electrically stimulated changes in mechanical properties of collagen membranes

We have studied the kinetics of oscillatory tensile forces in collagen membranes. These forces were generated by sinusoidal electric fields applied across the membrane. Both the magnitude and phase of the measured force changed with frequency over a three-decade range. The membrane-separated electrolyte baths had different ionic strength but identical non-isoelectric pH. Changes in intramembrane ionic strength due to the electric field were calculated over the same frequency range via an electrodiffusion model that was generalized to include convection and electrokinetic coupling. A comparison of the experimental and theoretical phases and amplitudes versus frequency suggests that electrodiffusion is the dominant rate-limiting process in this electromechanochemical transduction. These results are relevant to electrostatic interactions in connective tissues and to membrane-based filtration devices in which membrane permeability may be actively varied and controlled by an applied electric field.     

Increase of structural glycoprotein during dilatation of human cervix in pregnancy at term.

From the human cervix uteri under various conditions, structural glycoprotein was isolated which had a remarkable resemblance in its amino acid composition to other connective-tissue glycoproteins found in mammalian tissue. It was corroborated that the amount of such a structural glycoprotein increased in pregnancy, whereas collagen content was higher in the nonpregnant control. These facts suggest that the lost collagen was replaced by those structural glycoproteins in pregnantc ervix uteri. The possible significance of those structural glycoproteins on cervical dilatation is discussed.     

Haematoporphyrin changes the mechanical properties of lipid bilayer membranes.

The interactions between haematoporphyrin (HP) and bilayer lipid membranes (BLM) were studied. A weak effect of HP on BLM conductivity was observed at HP concentrations ranging between 10(-6) and 3 x 10(-5) mol/l. Modulus of elasticity in the direction normal to the membrane plane (E perpendicular) and dynamic viscosity coefficient (eta) were measured, both exhibiting HP-induced decrease by 22-31% in the dark. In this case, membrane potential Vm became negative and reached a value close to -50 mV. Under illumination by low-intensity (1 mW) He-Ne laser (lambda = 632 nm) the values of parameters E perpendicular and eta of the HP-modified membranes increased by 41-66%, and Vm decreased to -20 mV. Upon removing HP from the solution by perfusion, irreversible changes in mechanical properties of the HP-modified membranes induced by the laser light were observed. The reason could be the formation of stable complexes of HP with the lipid molecules. HP binds to membrane noncooperatively, with a binding constant K approximately 10(5) l/mol.     

Cancellous and cortical bone mechanical properties and tissue dynamics during pregnancy, lactation, and postlactation in the rat

There are substantial changes in maternal skeletal dynamics during pregnancy, lactation, and after lactation. The purpose of this study was to correlate changes in cortical and cancellous bone mass, structure, and dynamics with mechanical properties during and after the first reproductive cycle in rats. Rats were mated and groups were taken at parturition, end of lactation and 8 wk after weaning, and were compared with age-matched, nulliparous controls. Measurements were taken on femoral cortical bone and lumbar vertebral body cancellous bone. At the end of pregnancy, there was an increase in cortical periosteal bone formation and an increase in cortical volume, but a suppression of turnover in cancellous bone with no change in cancellous or cortical mechanical properties. Lactation was associated with a decrease in cortical and cancellous bone strength with a decrease in bone volume, but an increase in turnover on cancellous and endocortical surfaces. After lactation, there was a partial or full restoration of mechanical properties. This study demonstrates substantial changes in bone mechanics that correlate with changes in bone structure and dynamics during the first reproductive cycle in rats. The greatest changes were observed during the lactation period with partial or full recovery in the postlactational period.