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Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)

Major clinical challenges for obstetricians and neonatologists result from early cervix remodeling and preterm birth. Complications related to cervix remodeling or delivery account for significant morbidity in newborns and peripartum mothers. Understanding morphology and structure of the cervix in p...

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Detalles Bibliográficos
Autor principal: Yellon, Steven M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803764/
https://www.ncbi.nlm.nih.gov/pubmed/28395330
http://dx.doi.org/10.1095/biolreprod.116.142844
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author Yellon, Steven M.
author_facet Yellon, Steven M.
author_sort Yellon, Steven M.
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description Major clinical challenges for obstetricians and neonatologists result from early cervix remodeling and preterm birth. Complications related to cervix remodeling or delivery account for significant morbidity in newborns and peripartum mothers. Understanding morphology and structure of the cervix in pregnant women is limited mostly to the period soon before and after birth. However, evidence in rodent models supports a working hypothesis that a convergence of factors promotes a physiological inflammatory process that degrades the extracellular collagen matrix and enhances biomechanical distensibility of the cervix well before the uterus develops the contractile capabilities for labor. Contributing factors to this remodeling process include innervation, mechanical stretch, hypoxia, and proinflammatory mediators. Importantly, the softening and shift to ripening occurs while progesterone is near peak concentrations in circulation across species. Since progesterone is required to maintain pregnancy, the premise of this review is that loss of responsiveness to progesterone constitutes a common final mechanism for remodeling the mammalian cervix in preparation for birth at term. Various inputs are suggested to promote signaling between stromal cells and resident macrophages to drive proinflammatory processes that advance the soft cervix into ripening. With infection, pathophysiological processes may prematurely drive components of this remodeling mechanism and lead to preterm birth. Identification of critical molecules and pathways from studies in various rodent models hold promise for novel endpoints to assess risk and provide innovative approaches to treat preterm birth or promote the progress of ripening at term.
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spelling pubmed-58037642018-02-23 Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†) Yellon, Steven M. Biol Reprod Review Major clinical challenges for obstetricians and neonatologists result from early cervix remodeling and preterm birth. Complications related to cervix remodeling or delivery account for significant morbidity in newborns and peripartum mothers. Understanding morphology and structure of the cervix in pregnant women is limited mostly to the period soon before and after birth. However, evidence in rodent models supports a working hypothesis that a convergence of factors promotes a physiological inflammatory process that degrades the extracellular collagen matrix and enhances biomechanical distensibility of the cervix well before the uterus develops the contractile capabilities for labor. Contributing factors to this remodeling process include innervation, mechanical stretch, hypoxia, and proinflammatory mediators. Importantly, the softening and shift to ripening occurs while progesterone is near peak concentrations in circulation across species. Since progesterone is required to maintain pregnancy, the premise of this review is that loss of responsiveness to progesterone constitutes a common final mechanism for remodeling the mammalian cervix in preparation for birth at term. Various inputs are suggested to promote signaling between stromal cells and resident macrophages to drive proinflammatory processes that advance the soft cervix into ripening. With infection, pathophysiological processes may prematurely drive components of this remodeling mechanism and lead to preterm birth. Identification of critical molecules and pathways from studies in various rodent models hold promise for novel endpoints to assess risk and provide innovative approaches to treat preterm birth or promote the progress of ripening at term. Oxford University Press 2017-01 2016-12-22 /pmc/articles/PMC5803764/ /pubmed/28395330 http://dx.doi.org/10.1095/biolreprod.116.142844 Text en © The Author 2016. Published by Oxford University Press on behalf of Society for the Study of Reproduction. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Yellon, Steven M.
Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
title Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
title_full Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
title_fullStr Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
title_full_unstemmed Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
title_short Contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
title_sort contributions to the dynamics of cervix remodeling prior to term and preterm birth(†)
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803764/
https://www.ncbi.nlm.nih.gov/pubmed/28395330
http://dx.doi.org/10.1095/biolreprod.116.142844
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