Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition

Shanmugasundaram Nallasamy; Mala Mahendroo

doi:10.1055/s-0037-1599091

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2017; 35(02): 190-200
DOI: 10.1055/s-0037-1599091

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition

Shanmugasundaram Nallasamy

¹Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas

,

Mala Mahendroo

¹Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas

› Author Affiliations

Abstract

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.

Keywords

cervix - preterm birth - epithelial barrier - stroma - extracellular matrix

Full Text

References

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