Nallasamy Shanmugasundaram, Mahendroo Mala
Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
Semin Reprod Med. 2017 Mar;35(2):190-200. doi: 10.1055/s-0037-1599091. Epub 2017 Mar 9.
Through pregnancy the cervix must simultaneously remain competent for pregnancy maintenance and yet become progressively compliant to ensure on time parturition. Cervical changes precede not only term but also preterm birth. Thus, an understanding of the molecular mechanisms by which the cervix maintains the delicate balance between competence and compliance is required to prevent the potential for lifelong health complications that can result from a premature birth. Recent advances and accumulating evidence support distinct roles for the cervical epithelia and stroma in sustaining competence. Concurrently, structural reorganization of the stromal extracellular matrix allows for the gradual decline in tissue compliance. In recent years, advances in our understanding of the cervical remodeling process has resulted from the collective insights derived from biological, genomics, engineering, and mathematical modeling studies on clinical samples and animal models. This review will highlight recent literature that advances understanding of (1) the importance of barrier function in the lower female reproductive tract in protection against ascending infection, (2) cellular and extracellular matrix changes in the cervical stroma that influence the mechanical function of the cervix, (3) the potential translation of biological insights into clinical tools that impact preterm birth, and (4) the distinction between term and specific pathways of preterm birth. Finally, we present a discussion of future areas of investigation that are likely to advance understanding and lead to the development of clinical tools for accurate detection and prevention of premature birth.
在整个孕期，宫颈必须同时保持足以维持妊娠的功能，且逐渐变得顺应性良好，以确保按时分娩。宫颈的变化不仅先于足月分娩，也先于早产。因此，需要了解宫颈在维持功能与顺应性之间微妙平衡的分子机制，以预防早产可能导致的终身健康并发症。最近的进展和越来越多的证据支持宫颈上皮和基质在维持功能方面发挥不同作用。与此同时，基质细胞外基质的结构重组使组织顺应性逐渐下降。近年来，我们对宫颈重塑过程的理解取得进展，这得益于对临床样本和动物模型进行的生物学、基因组学、工程学和数学建模研究的综合见解。本综述将重点介绍近期文献，这些文献推动了对以下方面的理解：（1）女性下生殖道屏障功能在预防上行感染中的重要性；（2）宫颈基质中影响宫颈机械功能的细胞和细胞外基质变化；（3）将生物学见解转化为影响早产的临床工具的潜力；（4）足月分娩与早产特定途径之间的区别。最后，我们讨论了未来可能推动理解并导致开发准确检测和预防早产临床工具的研究领域。
