title: The mechanical role of the cervix in pregnancy.
abstract: Appropriate mechanical function of the uterine cervix is critical for maintaining a pregnancy to term so that the fetus can develop fully. At the end of pregnancy, however, the cervix must allow delivery, which requires it to markedly soften, shorten and dilate. There are multiple pathways to spontaneous preterm birth, the leading global cause of death in children less than 5 years old, but all culminate in premature cervical change, because that is the last step in the final common pathway to delivery. The mechanisms underlying premature cervical change in pregnancy are poorly understood, and therefore current clinical protocols to assess preterm birth risk are limited to surrogate markers of mechanical function, such as sonographically measured cervical length. This is what motivates us to study the cervix, for which we propose investigating clinical cervical function in parallel with a quantitative engineering evaluation of its structural function. We aspire to develop a common translational language, as well as generate a rigorous integrated clinical-engineering framework for assessing cervical mechanical function at the cellular to organ level. In this review, we embark on that challenge by describing the current landscape of clinical, biochemical, and engineering concepts associated with the mechanical function of the cervix during pregnancy. Our goal is to use this common platform to inspire novel approaches to delineate normal and abnormal cervical function in pregnancy.
authors.affiliation: Department of Mechanical Engineering, Columbia University, New York, NY, USA. Electronic address: kmm2233@columbia.edu.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Myers
authors.affiliation: Department of Obstetrics and Gynecology, Intermountain Healthcare, Provo, UT, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Feltovich
authors.affiliation: Department of Mechanical and Process Engineering, ETH Zurich, & EMPA Dübendorf, Switzerland.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mazza
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Vink
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Bajka
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.affiliation: Department of Medical Physics, University of Wisconsin, Madison, WI, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Hall
authors.affiliation: Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: House
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D002584:Cervix Uteri / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D003094:Collagen / Q000378:metabolism; D005260:Female; D006801:Humans; D008954:Models, Biological; D011247:Pregnancy; D047928:Premature Birth / Q000503:physiopathology*
chemical_list: D003094:Collagen
keywords: Cervix; Pregnancy; Preterm birth
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