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PubMed2001

Ultrasonographic evaluation of the cervix: transperineal versus endovaginal imaging.

OBJECTIVE: This study compares transperineal and endovaginal ultrasonography of the gravid cervix to evaluate image quality and assess for a systematic difference in cervical lengths measured by the 2 techniques. METHODS: Transperineal and endovaginal ultrasonography of the cervix was performed on 64 pregnant women. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the cervix and for evaluating for placenta previa. Cervical length was measured prospectively in both techniques. Data were analyzed to determine if there is a systematic difference in length using the 2 approaches and if length differences are dependent on gestational age. RESULTS: There was a strong reviewer preference for endovaginal ultrasonographic images over transperineal images for both assessing the cervix (P< .001) and evaluating for placenta previa (P< .001). Despite this, transperineal and endovaginal ultrasonographic images were frequently rated as similar in diagnostic quality by both reviewers for depicting the cervix (35.9% of patients) and evaluating for placenta previa (57.8% of patients). The mean length of the cervix was slightly shorter at transperineal ultrasonography (28.4 mm) than at endovaginal ultrasonography (30.1 mm). When cervical lengths were subdivided by gestational age, however, a significant length discrepancy was found only in the 14- to 20-week gestational age range. In this age range, mean cervical length at transperineal ultrasonography (28.6 mm) averaged 5.5 mm less than at endovaginal ultrasonography (34.1 mm). CONCLUSIONS: Both transperineal and endovaginal ultrasonography can provide satisfactory images of the cervix, but endovaginal images are frequently superior to transperineal images. Endovaginal ultrasonography should be considered the optimal method for imaging the cervix in most situations. Transabdominal or transperineal ultrasonography can also be used, but if the cervix is not adequately depicted from these perspectives, endovaginal ultrasonography is indicated. Transperineal measurements of cervical length can be significantly shorter than endovaginal measurements, particularly before 20 weeks; therefore, short cervical lengths documented at transperineal ultrasonography before 20 weeks should be confirmed by endovaginal ultrasonography.

Cervix Uteri↗
PubMed1993

Intraspinal modulation of neuronal responses to uterine and cervix stimulation in rat L1 and L6 dorsal horn.

This two-part study examined intraspinal processing of input from the uterus, cervix and skin within the caudal spinal cord of virgin rats in estrus. The first part examined the effects of removing either pelvic or hypogastric nerve input (by appropriate dorsal rhizotomies) on neuronal responses to stimulation of uterus, cervix and skin in either the L1 or L6 dorsal horn of decerebrate, spinalized unanesthetized rats. Bilateral section of the T13-L2 roots (through which most hypogastric afferents travel) eliminated almost all responses to uterine distension in L1 and L6. Such rhizotomies also decreased the inhibitory effects of cervix input on neurons in L6. Bilateral section of the L6-S2 roots (through which most pelvic afferents travel) had no effect on responses to uterus, but decreased the inhibitory effects of cervix input on neurons in L1. Sections of both sets of roots eliminated responses to cervix stimulation in L6. The second part examined neuronal responses in T13/L1 of urethane-anesthetized rats before and after a T10 spinal transection. Transection increased the probability of observing neurons excited by uterine stimulation. Transection also increased excitatory responses and decreased inhibitory responses to cervix stimulation. These results confirm previous findings that input from the uterus to the spinal cord is mainly by way of the hypogastric nerve, while that from the cervix is by way of both the pelvic and hypogastric nerves. The results also demonstrate that descending influences in the estrous rat mainly increase the ability of cervix stimulation to inhibit spinal neuronal activity and reduce the effectiveness of uterine stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network.

BACKGROUND: The role of the cervix in the pathogenesis of premature delivery is controversial. In a prospective, multicenter study of pregnant women, we used vaginal ultrasonography to measure the length of the cervix; we also documented the incidence of spontaneous delivery before 35 weeks' gestation. METHODS: At 10 university-affiliated prenatal clinics, we performed vaginal ultrasonography at approximately 24 and 28 weeks of gestation in women with singleton pregnancies. We then assessed the relation between the length of the cervix and the risk of spontaneous preterm delivery. RESULTS: We examined 2915 women at approximately 24 weeks of gestation and 2531 of these women again at approximately 28 weeks. Spontaneous preterm delivery (at less than 35 weeks) occurred in 126 of the women (4.3 percent) examined at 24 weeks. The length of the cervix was normally distributed at 24 and 28 weeks (mean [+/- SD], 35.2 +/- 8.3 mm and 33.7 +/- 8.5 mm, respectively). The relative risk of preterm delivery increased as the length of the cervix decreased. When women with shorter cervixes at 24 weeks were compared with women with values above the 75th percentile, the relative risks of preterm delivery among the women with shorter cervixes were as follows: 1.98 for cervical lengths at or below the 75th percentile (40 mm), 2.35 for lengths at or below the 50th percentile (35 mm), 3.79 for lengths at or below the 25th percentile (30 mm), 6.19 for lengths at or below the 10th percentile (26 mm), 9.49 for lengths at or below the 5th percentile (22 mm), and 13.99 for lengths at or below the 1st percentile (13 mm) (P < 0.001 for values at or below the 50th percentile; P = 0.008 for values at or below the 75th percentile). For the lengths measured at 28 weeks, the corresponding relative risks were 2.80, 3.52, 5.39, 9.57, 13.88, and 24.94 (P < 0.001 for values at or below the 50th percentile; P = 0.003 for values at the 75th percentile). CONCLUSIONS: The risk of spontaneous preterm delivery is increased in women who are found to have a short cervix by vaginal ultrasonography during pregnancy.

Cervix Uteri↗
PubMed1993

Neuronal responses to stimulation of the cervix, uterus, colon, and skin in the rat spinal cord.

1. Previous studies in the rat have shown that the hypogastric nerve conveys input from the cervix and uterus mainly to the T13-L3 segments of the spinal cord, whereas the pelvic nerve conveys input from the cervix and vaginal canal mainly to the L6-S2 segments. 2. To study the effects of this input, the dorsal horns of the T13-L1, L6-S2, and L4-L5 segments in 13 decerebrate, T10-spinalized, unanesthetized, and paralyzed adult female rats in estrus were searched for neurons responsive to gentle mechanical stimulation of the cervix. The 87 neurons found were then further tested for their responses to gentle mechanical stimulation of the skin and to distension of both uterine horns, distension of the colon, and shearing stimulation of the colon and vaginal canal. 3. Neurons responsive to cervix stimulation, primarily by excitation, were readily found in the ventral part of the dorsal horn in T13-L1 and throughout the dorsal horn in L6-S2. Cervix-responsive neurons were less readily found throughout the dorsal horn in L4-L5, where 25% were inhibited by the stimulation. All but one neuron had cutaneous receptive fields. 4. The 30 cervix-responsive neurons in T13-L1 had large bilateral cutaneous receptive fields covering the perineum and hind-limbs. Most (76%) also responded, primarily by excitation, to uterine distension, as well as to colonic stimulation (59%). More than half were activated by both types of stimulation. 5. The 33 cervix-responsive neurons in L6-S2 had cutaneous receptive fields in the same regions as those in T13-L1, but generally smaller, particularly for neurons in the dorsal part of the dorsal horn, many of whose receptive fields were confined to the perineum. The L6-S2 neurons also exhibited less convergent input from other visceral structures, particularly the uterus. Fewer neurons (42%) responded to uterine distension, mostly by being inhibited, whereas about the same proportion (51%) responded with excitation to colonic stimulation. Only 24% responded to both uterus and colon. 6. All 24 cervix-responsive neurons in medial L4-L5 had small cutaneous receptive fields on the toes, and the neurons received less convergent input from other visceral structures (25% from the uterus, 33% from the colon, 13% from both). 7. These results indicate the presence of an extensive system of neurons throughout the caudal spinal cord of the rat, concentrated in separated thoracolumbar and lumbosacral segments, that is concerned with input from the reproductive tract.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2004

Localization and expression of gastrin-releasing peptide (GRP) in the bovine cervix.

Gastrin-releasing peptide (GRP) has been suggested as a novel regulatory peptide in the female reproductive tract but the presence of GRP and GRP mRNA in the non-neurogenic tissue of the cervix has not yet been clarified. In the present study, immunohistochemistry and in situ hybridization were used to reveal the distribution of GRP immunoreactivity and expression of GRP mRNA in the bovine cervix. The cervixes from 21 non-pregnant and 20 pregnant cows, and 6 fetuses were used in the study. In the fetus, adult non-pregnant and pregnant specimens, GRP and GRP mRNA were predominantly detected in the luminal epithelial cells of basal areas of peripheral regions of the cervix. Positive staining of GRP in the epithelial cells of the cervix was first detected in the CRL 37 cm of the fetus. During the estrous cycles, the staining intensity of GRP in the epithelial cells was stronger in the follicular phase than in the luteal phase. During the early gestational period, GRP immunoreactivity was detected at relatively similar intensity to the follicular phase. In situ hybridization results ascertained the expression of GRP mRNA in the superficial epithelial cells of the cervix of non-pregnant and pregnant cows. The results suggest that GRP may be important both in the development of the fetal cervix and secretory activity of the epithelial cells of the cervix.

Animals↗
PubMed2000

LH/hCG receptors in the porcine uterus--a new evidence of their presence in the cervix.

High-affinity LH/hCG binding sites have been characterized in bovine, lepine, murine, human uteri and porcine myometrium and endometrium. In the present studies we analyzed these receptors in the porcine cervix. Radioreceptor ligand assays were performed with cell membrane preparations of the cervix which were analyzed for binding sites specificity, capacity and affinity. Corpus luteum and myometrium were used as positive control tissues. In the cervix there was little competition for receptor occupancy between hCG and porcine FSH (1.2%) or bovineTSH, porcine GH and porcine PRL (0.1%, 0.1% and < 0.001%; respectively) but porcine LH could completely inhibit the binding of [125I] hCG. There was not binding for LH/hCG in crude membrane preparations of kidney or skeletal muscle. The concentration (fmol/mg protein) of cervical LH/hCG receptor did not vary significantly during particular phases of the estrous cycle, except the early luteal phase (Days 6-7) when the level of LH receptors was very low (p < 0.05). The affinity of uterine LH/hCG binding sites in the cervix and the myometrium was not different from the affinity of LH/hCG binding sites in luteal cells. The porcine cervix as well as the myometrium contains a 75- and 48-kDa immunoreactive LH/cCG receptor proteins similar to corpus luteum. Southern blot of RT-PCR products performed to enhance the specificity and sensitivity of LH receptor transcripts determination in uterine tissues revealed that expected fragments of 740 and 470 bp were present in myometrium and corpus luteum. The cervix showed only 740 bp fragment. In situ hydridization showed the expression of mRNA for LH receptor in the epithelium of the cervix. Immunoreactive staining for LH/hCG receptors was also observed only in epithelial cells of the cervical tissue. Our studies are probably the first evidence demonstrating the specific LH/hCG binding sites in female cervix.

Animals↗
PubMed2000

[Influence of elective abortion, up to the 12th week of pregnancy, on the dimensions of the cervix].

The conflicting data in the literature about the influence of the voluntary abortion on the cervix uteri and its effects has lead us to the idea to examine by ultrasound the changes in the cervix uteri as a result of elective abortion. 137 healthy women at the average age of 26.7 years have been examined, out of which 31 were pregnant for the first time. 15 with no child-births but with one previous voluntary abortion, 30 with no child-births but with more than one voluntary abortion, 35 with one child-birth and 26 with more than one child-birth. Out of the total 76 women, 64 come back for ultrasound examination of the parameters of the cervix uteri between the first and the second week after the abortion (10 + 3 days). The abortion has been done up to 12 guest. week under intravenous anesthesia, I Hegar dilatation of the cervical canal and vacuum aspiration. Each ease has been examined with an ultrasound (Kontron--France), supplied with a 7.5 MHz vaginal transducer. The results show that the measured length and width of the cervix uteri among the groups with differing number of elective abortions but with no child-births do not reveal a great statistical difference. With the increase of the number of abortions the width of the cervical canal shows a tendency to expand minimally. With women pregnant for first time and having elective abortion, of all parameters of the cervix only OECC remains a little wider than before the abortion. Child-births change dramatically the dimensions of the cervix uteri--the cervical canal expands, the cervix shortens and at the same time becomes wider. We can safely assume that the elective abortion under intravenous anesthesia within 8-9 g.w. with Hegar dilatation about 10 mm and vacuum aspiration has not shown traumatic effect on the cervix uteri according to its dimensions.

Abortion, Habitual↗
PubMed1995

[An objective measurement of softening of uterine cervix using tactile sensor for hardness].

The authors studied an objective measurement for cervical softening by means of a tactile sensor equipped with a piezoelectric swing element made from ceramic. The hardness of objects was indicated by changes in frequency (delta f) measured by this sensor. The authors measured the hardness of cervixes in 66 (non pregnant, pregnant, delivering and postpartum) Sprague-Dawley rats with the sensor. After the measurement of delta f, the rats' cervixes were removed, and the ratios of their dry weight to wet weight (weight-ratio) and hydroxyproline contents were measured. The delta f of rats' cervixes increased during pregnancy and became maximum at delivery. The weight-ratio also increased and correlated with delta f (r = 0.812). The hydroxyproline content decreased during pregnancy and correlated with delta f (r = 0.674). The hardness of the cervixes of 26 non pregnant and 192 pregnant women and their Bishop scores were also measured. The delta f of pregnant women's cervixes increased significantly in comparison with those of non pregnant women. The delta f of cervixes in primiparas correlated with the progress of pregnancy (r = 0.408). A moderate correlation between the delta f of cervixes and Bishop scores was also observed in the pregnant women. These results show that the tactile sensor may be able to be used in the objective measurement of hardness of the uterine cervix.

Animals↗
PubMedDate not supplied

Gene-gene and gene-environmental interactions of p53, p21, and IRF-1 polymorphisms in Korean women with cervix cancer.

BACKGROUND: The aim of this study was to identify gene-gene and gene-environmental factors affecting cervix carcinogenesis in Korean women. METHODS: We evaluated 530 subjects composed of 185 female cervix cancer patients and 345 normal healthy women. The single nucleotide polymorphisms (SNPs) of p53 codon 72, p21 codon 31, and interferon regulatory factor-1 (IRF-1) intron 6 were evaluated from extracted DNA of peripheral blood with an automatic DNA sequencer. The differences of each SNP, gene-gene and gene-environmental interactions between normal controls and patients were evaluated in the adjusted environmental background. RESULTS: In the environmental aspect, the rate of cervix cancer increased in the women with a lower level of education, a younger age at first sexual intercourse and more childbearing. The women who had p53 (Arg/Arg), IRF-1 (T/T), and <6 years of education showed a 14.7-fold increased risk of cervix cancer compared to the women who had p53 ( approximately Pro), IRF-1 ( approximately C), and >15 years of education. The women who had p53 (Arg/Arg), p21 (Ser/Ser), and >3 children showed a 6.4-fold increased risk of cervix cancer compared to the women who had p53 ( approximately Pro), p21 ( approximately Arg), and no children. The women who had p53 (Arg/Arg), IRF-1 (T/T), and first sexual intercourse before 22 years old showed a 5.5-fold increased risk of cervix cancer compared to the women who had p53 ( approximately Pro), IRF-1 ( approximately C), and first sexual intercourse after 26 years old. CONCLUSIONS: We found that the level of education, the age at first intercourse, and the number of children were independent risk factors in cervix carcinogenesis. The specific combinations of p53, p21, and IRF-1 gene-gene and gene-environmental interactions were significantly noted in the cervix carcinogenesis of Korean women.

Adult↗
PubMed2000

Glycodelin-A expression in the uterine cervix.

OBJECTIVE: Local immunosuppressive factors in the uterine cervix infected by human papillomavirus are felt to facilitate the malignant transformation process. Glycodelin-A is an immunosuppressive peptide found in several tissues of müllerian origin, most notably the pregnant and decidualized endometrium. Its expression in the uterine cervix has not been defined but could theoretically contribute to the immunopermissive environment of the cervix. To determine whether glycodelin-A is found in the cervix we examined the squamous and endocervical epithelia from both normal and neoplastic cervical specimens from 14 women. METHODS: Immunohistochemisty identification of glycodelin-A was performed on archival paraffin-embedded sections from 10 hysterectomies and 4 cone biopsies. Sections were evaluated and staining was scored as negative, positive, or strongly positive with a separate score for the squamous and glandular components of the cervix. RESULTS: Eleven of 14 cases, 79%, demonstrated positive staining of the squamous epithelium. Glycodelin-positive cases included hisologically normal (n = 4; 3 strongly positive, 1 positive) as well as dysplastic (n = 5; 1 strongly positive, 2 positive, and 2 negative) and malignant squamous cells (n = 5; 1 strongly positive, 3 positive, and 1 negative). Normal glandular epithelia were negative in all cases but 1, which demonstrated significant squamous and tubal metaplasia of the endocervical glands involved. CONCLUSION: Glycodelin-A is found in the squamous epithelium of both the histologically normal and the neoplastic cervix. Further characterization of these results will focus on the possible immunosuppressive effect glycodelin-A may have in the cervix.

Cervix Uteri↗
PubMed1992

Immunohistochemical localization of the eosinophil major basic protein in the uterus horn and cervix of the rat at term and after parturition.

Distribution of the eosinophil major basic protein (MBP) was studied in the rat uterus horn and cervix by means of immunohistochemistry using an antiserum raised against rat MBP. Various hormonal contexts were investigated: pre- and post-parturition, the estrous cycle, and ovariectomy followed by hormonal treatment or without treatment. MBP was detectable in the cervix as early as 12 h post-partum, appearing in the stroma close to the myometrium. The MBP had spread throughout the stroma toward the luminal epithelium after a few days. In contrast, no MBP was seen in sections of the corresponding pre- and post-partum uteri and in the pre-partum cervix. In cycling rats, MBP was distributed equally in the cervix and uterus and was more abundant during proestrus and estrus. In ovariectomized rats subsequently treated with progesterone, no MBP was detected in the cervix or uterus. In the cervix of ovariectomized rats treated with estradiol, MBP first appeared in the muscle layer situated between the two cervical lumina and then reached the stroma; within a few days only the stroma was stained. Inversely, in the uterus MBP-staining first appeared in the stroma. In conclusion, analysis of the distribution of MBP in rat uterus revealed a marked difference in the response of the cervix and horn to a hormonal environment.

Animals↗
PubMed2005

Increased innervation and ripening of the prepartum murine cervix.

OBJECTIVE: Ripening of the cervix before birth is coincident with reduced collagen content and leukocyte immigration, characteristics that are analogous to a neurogenic inflammatory-like process. We sought to assess the morphologic relationship between innervation and remodeling of the peripartum cervix. METHODS: Cervix was obtained from C3H/HeN mice on days 15 and 18 of pregnancy, 1 day postpartum, and from non-pregnant controls. Tissues were immersion-fixed, paraffin-embedded, and some sections stained with Picrosirius red to assess collagen content and complexity of organization. By image analysis of optical density, collagen content and structure were significantly decreased by the day before birth. Other sections were processed to visualize nerve fibers by immunohistochemistry with antibodies against neuron-specific epitopes, PGP9.5, peripherin, as well as brain nitric oxide synthase (bNOS), calcitonin gene-related peptide (CGRP), and other neuropeptides. Fiber density was assessed stereologically and normalized to cell density in non-pregnant cervix to correct for tissue hypertrophy due to reproductive status. RESULTS: In groups of non-pregnant, day 15 pregnant, and postpartum mice, cervix contained nerve fibers that were immunoreactive for the pan-neural markers PGP9.5 and peripherin. Punctate and beaded varicosities were sparsely distributed in stroma, subepithelium, and in proximity to vascular structures. By day 18 of pregnancy, 1 day before birth, fiber density was increased fourfold or more compared to other groups. bNOS fibers and, to a lesser extent, CGRP accounted for most of the increased innervation of the murine cervix by the day before birth, a period when macrophage numbers are enhanced. CONCLUSIONS: The findings suggest that increased bNOS and CGRP innervation contribute to early inflammatory-like processes that ripen the cervix before birth.

Animals↗
PubMed2005

Expression of pituitary adenylate cyclase activating peptide in the uterine cervix, lumbosacral dorsal root ganglia and spinal cord of rats during pregnancy.

The uterine cervix is highly innervated by the sensory nerves containing neuropeptides which change during pregnancy and are regulated, in part, by estrogen. These neuropeptides act as transmitters both in the spinal cord and cervix. The present study was undertaken to determine the expression pattern of the neuropeptide pituitary adenylate cyclase activating peptide (PACAP) in the cervix and its nerves during pregnancy and the influence of estrogen on this expression using immunohistochemistry, radioimmunoassay and RT-PCR. PACAP immunoreactivity was detected in nerves in the cervix, lumbosacral (L6-S1) dorsal root ganglia (DRG) and spinal cord. PACAP immunoreactivity was highest at day 15 of pregnancy in the cervix and dorsal spinal cord, but then decreased over the last trimester of pregnancy. However, levels of PACAP mRNA increased in the L6-S1 DRG at late pregnancy relative to early pregnancy. DRG of ovariectomized rats treated with estrogen showed increased PACAP mRNA synthesis in a dose-related manner, an effect partially blocked by the estrogen receptor (ER) antagonist ICI 182,780. We postulate that synthesis of PACAP in L6-S1 DRG and utilization in the cervix and spinal cord increase over pregnancy and this synthesis is the under influence of the estrogen-ER system. Since PACAP is expressed by sensory nerves and may have roles in nociception and vascular function, collectively, these data are consistent with the hypothesis that sensory nerve-derived neuronal factors innervate the cervix and play a role in cervical ripening.

Animals↗
PubMed1996

The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage.

OBJECTIVE: Our purpose was to determine whether perioperative transvaginal ultrasonographic evaluation of the incompetent cervix treated with emergency cerclage is predictive of pregnancy outcome. STUDY DESIGN: Twenty-nine women who underwent emergency cerclage at 16 to 26 weeks of gestation had transvaginal ultrasonographic evaluation of the cervix within 48 hours before and after surgery and at least three times thereafter until 28 weeks of gestation. The following measurements were obtained: (1) funnel width, (2) funnel length, (3) endocervical canal length, (4) the distance between the internal and external os, (5) upper cervix (length of closed endocervical canal above the cervical cerclage), (6) lower cervix (endocervical canal length below suture), and (7) cervical index (1+ Funnel length/Endocervical canal length). Values are reported as the median in millimeters, and statistical analysis was performed by use of the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman rank correlation, 2 x 2 contingency tables, and multiple regression analysis with significance set at p < 0.05. RESULTS: Cerclage procedures resulted in significant improvement in postoperative median measurements of funnel width (15 vs 4.0 mm, p < 0.0001), funnel length (29 vs 3 mm, p < 0.0001), and endocervical canal length (2 vs 27 mm, p < 0.0001). There was a significant relationship between gestational age at delivery and the following measurements: preoperative funnel width (r = -0.51, p = 0.007), postoperative endocervical canal length (r = 0.39, p = 0.04), length of the lower cervix (r = 0.39, p = 0.038), and the cervical index (r = -0.39, p = 0.038). An upper cervical length < 10 mm was a good predictor of delivery before 36 weeks of gestation, sensitivity 85.7% (12/14), specificity 66.7% (10/15), positive predictive value 70.6% (12/17), negative predictive value 83% (10/12), and Fisher's exact p = 0.008. Postoperatively all patients had upper cervical lengths < 10 mm by 28 weeks of gestation. Preoperative digital assessments of cervical dilatation before surgery did not correlate with gestational age at birth (r = -0.031, p = 0.36). CONCLUSIONS: In cases of cervical incompetence treated with emergency cerclage, perioperative transvaginal ultrasonographic assessment of the cervix reveals that the procedure results in improved ultrasonographic status of the cervix and that the ultrasonographic cervical findings before and after surgery correlate with pregnancy outcome.

Adolescent↗
PubMed1997

Relaxin and estrogen synergistically accelerate growth and development in the uterine cervix of prepubertal pigs.

UNLABELLED: This study was designed to determine the development and growth-promoting effects of relaxin with or without estrogen on the uterine cervix of prepubertal gilts. Twenty littermate gilts of similar body weight (33 +/- 3 kg; mean +/- SE) at 80 days of age were randomly assigned to four treatments: Vehicle (CONTROL, 1 ml PBS and 1 ml vegetable oil, n = 5); Relaxin (Relaxin, in PBS, 1 ml, 167 micrograms ml-1, n = 5); Estradiol Benzoate (EB, in vegetable oil, 1 ml, 2 mg ml-1, n = 5); and Relaxin plus EB (Relaxin + EB, at the same doses, n = 5), total six intramuscular injections for all treatments. Twenty four hours after the last injection, hysterectomy was performed, and the uterine tissues were immediately frozen at -80 degrees C. Samples were taken from the middle portions of the cervix and the uterine horns and dried to a constant weight to determine the dry weight and water concentration. Homogenates of uterine horns and cervices were analyzed for concentrations and contents of protein, hydroxyproline (collagen index) and DNA. Relaxin alone had no significant effect on any parameters (i.e., wet weight, Relaxin vs. CONTROL: 36 +/- 5 vs. 28 +/- 3 g uterus-1, dry weight 5.6 +/- 0.6 vs. 4.4 +/- 0.4 g uterus-1). EB alone increased significantly (P < 0.05) wet weight of the uterus (EB vs. CONTROL: 85 +/- 23 vs. 28 +/- 3 g uterus-1), dry weight (EB vs. CONTROL: 14.5 +/- 3 vs. 4.4 +/- 0.4 g uterus-1), and hydroxyproline content (EB vs. CONTROL: 47.2 +/- 13 vs. 12.6 +/- 4 mg cervix-1). In the presence of EB, relaxin treatment increased all measurements compared with CONTROL (i.e., wet weight, Relaxin + EB vs. EB: 136 +/- 34 vs. 28 +/- 3 g uterus-1). Compared with EB, Relaxin + EB significantly (P < 0.05) increased the uterine wet weight (Relaxin + EB vs. EB: 136 +/- 34 vs. 85 +/- 23 g uterus-1), the hydroxyproline content (Relaxin + EB vs. EB: 91 +/- 29 vs. 47 +/- 13 mg cervix-1), and DNA content (Relaxin + EB vs. EB: 8.1 +/- 2 vs. 5.4 +/- 1 mg cervix-1). These results indicate that the growth-promoting effects of relaxin on the uterus and cervix may be, at least partly, estrogen-dependent and that the growth and development of the uterus and cervix can be accelerated by a combination of relaxin and estrogen treatment.

Animals↗
PubMed1997

Simultaneous monitoring of head-to-cervix forces, intrauterine pressure and cervical dilatation during labour.

In many westernized countries, the caesarean section role has now reached 15% or more, most commonly because of slow progress in labour. In order for labour to result in a vaginal delivery, the uterine cervix must dilate to allow the foetus to travel through the birth canal. This process is driven by uterine contractions, but the mechanisms by which the contractions result in cervical dilatation are still far from clear. The force exerted by the presenting part (foetal head) on the cervical tissue during contractions (head-to-cervix force, HCF) has been shown to be the variable with the best correlation with cervical dilatation. Unfortunately, the mechanism by which these two variables are related is still poorly understood. In order to investigate the relationship between head-to-cervix force, intrauterine pressure (IUP) and cervical dilatation, we have developed a system for their simultaneous and continuous monitoring during labour. The HCF is measured by using a novel intrauterine probe which is slipped alongside the foetal head so as to lie sandwiched between the latter and the cervix. The probe is fitted with six specially designed miniature force sensors, spaced 1.8 cm apart, which respond linearly and approximate the behaviour of load cells. They are interfaced with a PC by circuitry that allows auto-zeroing and drift compensation. The system enables simultaneous acquisition of intrauterine pressure and foetal heart rate (measured using a Sonicaid Meridian foetal monitor) via a serial link, together with continuous cervical dilatation measured by a caliper-like device applied to the cervix. Some preliminary data are presented, which suggest that the system can be used to investigate the role played by head-to-cervix force and intrauterine pressure in the cervix dilatation process.

Analog-Digital Conversion↗
PubMed1999

Evaluation of the upper uterine cervix by the location of the vesicocervical fold of the urinary bladder to rule out cervical shortening during pregnancy with and without premature contractions.

OBJECTIVES: To measure the length of the upper and lower cervix, as demarcated anatomically by the lowermost edge of the urinary bladder, in second- and third-trimester pregnancies with and without premature contractions. We hypothesized that patients with active premature contractions have a shorter upper cervix, placing them at greater risk of preterm delivery. METHODS: The lengths of the total cervix and of the upper and lower cervix, separately, and funnelling of the internal os, were assessed by endovaginal ultrasonography. In 120 women with normal pregnancy (43 of which with premature contractions), cervical dilatation and effacement were determined by digital examination. The correlation of cervical variables with the course of pregnancy was analyzed by the Wilcoxon test. RESULTS: The mean lengths of the upper and lower cervix were 15.9 +/- 1.7 mm (median 16.0 mm) and 26.4 +/- 3.7 mm (median 27.0 mm), respectively, in patients without premature contractions and 6.9 +/- 3.7 mm (median 6.0 mm) and 24.7 +/- 4.7 mm (median 25.0 mm), respectively, in patients with premature contractions. In the latter subgroup, the upper cervix was significantly shorter (p = 0.0001) but the lower cervix remained almost unchanged. Digital palpation was less accurate than transvaginal sonography for evaluating total cervical length. CONCLUSIONS: Transvaginal sonography is the method of choice for assessing cervical changes during pregnancy. In this prospective study, upper cervical length was the best predictor of preterm labor of all cervical parameters studied. Its length could be accurately determined by the location of the lowermost edge of the urinary bladder (vesicocervical fold of the bladder).

Adult↗
PubMed1992

[Comparative studies of the uterine cervix in pregnancy using palpation and vaginal sonography].

Ultrasonography and manual palpation were used to evaluate the uterine cervix of 71 pregnant women between 14th and 36th week of gestational age. The sonographic length of the uterine cervix was about 4.2 cm according to the relevant cervix palpation (Group I), about 3.2 cm in the moderately shortened cervix (Group II) and about 2.8 cm in the severely shortened cervix (Group III). The distance between the surface of the ectocervix to the urinary bladder corresponded to the cervical palpation showing a constant difference of about 0.5 cm. No difference could be found in the width of the upper cervix. The index was determined as ratio of the sonographically ascertained cervical length and width of the supravaginal cervix. A value of 0.8 or lower describes a cervical incompetence of a higher degree and signifies an unfavourable prognosis. The evaluation of cervical incompetence and the relevance of the sonographically detected opened internal os have not yet been clarified. A hitherto unsolved problem is the dilatation of the cervical canal in case of immature palpatory findings with traumatic anamnesis.

Adult↗