Precocious Cervical Ripening and Preterm Labor

Papiernik, E; Bouyer, Jean; Collin, D; Winisdoerffer, G; Dreyfus, Jean‐Claude

doi:10.1097/00006250-198602000-00014

Cited by 89 publications

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“…This study underlines the significance of clinical reports of a dilated internal os and the impact of public health measures to reduce physical stress on the rate of SPB within a given population 40,41 . Since the mechanical properties of the cervical tissue in SPB resemble the changes at term, TVS in both positions may be indicated in patients around term to predict the course of induction and of delivery.…”

Section: Discussionmentioning

confidence: 65%

Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies

Arabin

Roos

Kollen

et al. 2006

Ultrasound in Obstet & Gyne

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Section: Discussionmentioning

confidence: 65%

Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies

Arabin

Roos

Kollen

et al. 2006

Ultrasound in Obstet & Gyne

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“…Investigations to define the causes of preterm birth remain a challenge in the obstetrical field as phenotypes of preterm labor and delivery vary extensively. As an example, precocious remodeling of the cervix in the absence of uterine contractions, clinically known as cervical incompetence or insufficiency in humans, is associated with preterm birth (Papiernik et al 1986). …”

Section: Introductionmentioning

confidence: 99%

Cervical remodeling during pregnancy and parturition: molecular characterization of the softening phase in mice

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Ruscheinsky³

et al. 2007

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Cervical remodeling during pregnancy and parturition is a single progressive process that can be loosely divided into four overlapping phases termed softening, ripening, dilation/labor, and post partum repair. Elucidating the molecular mechanisms that facilitate all phases of cervical remodeling is critical for an understanding of parturition and for identifying processes that are misregulated in preterm labor, a significant cause of perinatal morbidity. In the present study, biomechanical measurements indicate that softening was initiated between gestation days 10 and 12 of mouse pregnancy, and in contrast to cervical ripening on day 18, the softened cervix maintains tissue strength. Although preceded by increased collagen solubility, cervical softening is not characterized by significant increases in cell proliferation, tissue hydration or changes in the distribution of inflammatory cells. Gene expression studies reveal a potentially important role of cervical epithelia during softening and ripening in maintenance of an immunomucosal barrier that protects the stromal compartment during matrix remodeling. Expression of two genes involved in repair and protection of the epithelial permeability barrier in the gut (trefoil factor 1) and skin (serine protease inhibitor Kazal type 5) were increased during softening and/or ripening. Another gene whose function remains to be elucidated, purkinje cell protein 4, declines in expression as remodeling progressed. Collectively, these results indicate that cervical softening during pregnancy is a unique phase of the tissue remodeling process characterized by increased collagen solubility, maintenance of tissue strength, and upregulation of genes involved in mucosal protection.

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“…Digital examination of the cervix Papiernik and others [27] have noted that dilatation of the cervix > 1 cm is correlated with an increased risk of preterm delivery. Leveno et al [20] reported that cervical dilatation > 2 cm predicted preterm delivery with a sensitivity of 57%, a specificity of 94%, and positive and negative predictive values of 27% and 94% respectively.…”

Section: Biochemical Markersmentioning

confidence: 99%

Preterm labour and delivery

et al. 1996

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Preterm birth is a major cause of perinatal morbidity and mortality. It accounts for 5-10% of all births, and any treatment to prevent it could have a profound effect on neonatal outcome in both human and economic terms. The pathogenesis of both term and preterm birth remain poorly understood. Our ability to predict those at risk of preterm labour is also inaccurate, despite the creation of scoring systems, uterine activity monitoring, cervical ultrasound and several biochemical markers. Current drug therapies for preterm labour have not been shown in randomised controlled trials to significantly affect perinatal morbidity and mortality. Furthermore, most are associated with significant maternal or fetal side effects. Nitric oxide (NO) is a potent smooth muscle relaxant, produced when NO synthase acts on the amino acid L-arginine. Its presence has been demonstrated in human myometrium. We have conducted an observational study which has suggested that glyceryl trinitrate (GTN), and NO donor, may be effective in prolonging gestation. A randomised trial comparing GTN to intravenous ritodrine is currently recruiting patients; results will be available in the Spring of 1997. Few side effects have so far been encountered. Evidence suggests that GTN, an NO donor, should be a safe and effective tocolytic and early observations are encouraging; randomised trials currently underway should determine the significance of this breakthrough in the management of preterm labour.

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Precocious Cervical Ripening and Preterm Labor

Cited by 89 publications

References 0 publications

Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies

Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies

Cervical remodeling during pregnancy and parturition: molecular characterization of the softening phase in mice

Preterm labour and delivery

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