Collagen remodeling is a key event in cervical ripening for a successful vaginal delivery

MUÑOZ DE TORO M; VARAYOUD J; RAMOS JG; RODRÍGUEZ HA; LUQUE EH

BRAZILIAN JOURNAL OF MORPHOLOGICAL SCIENCES

Año: 2003 vol. 20 p. 75 - 84

0102-9010

Parturition involves a complex interplay of maternal and fetal factors. An understanding of the physiological mechanismsinvolved in maternal adaptations would be of great benefit in the diagnosis, management, and outcome of dystocicparturition, an important problem in human health care and animal production. In this review, we consider thehistofunctional changes in the uterine cervix that are essential for successful vaginal delivery and focus on work fromour laboratory. The functions of the uterine cervix change considerably during pregnancy. As the uterus enlarges toaccommodate the growing fetus, the cervix behaves essentially as a barrier. At term, however, the cervix softens anddilates through a process known as cervical ripening. This process is extremely complex and involves interactionsbetween different cellular compartments and the extracellular matrix, as well as properly timed biochemical cascades,and stromal infiltration by inflammatory cells. Since the main component of the uterine cervix is connective tissue,collagen remodeling is a key event for ripening and delivery. Moreover, because of their intrinsic mechanical properties,elastic fibers may be involved in the recovery of shape immediately after parturition. Despite the advances in ourknowledge of cervical ripening, the signals responsible for initiating these changes remain to be elucidated. By understandingthe mechanisms involved in these changes, it should be possible to address complex issues such as cervicalincompetence, pre- and post-term delivery, and proper “ripening” of the cervix in order to avoid surgical delivery.