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Review
. 2017 Dec;41(8):505-510.
doi: 10.1053/j.semperi.2017.08.009. Epub 2017 Oct 5.

Prevention of preterm birth: Novel interventions for the cervix

Bouchra Koullali  1 , Andrea R Westervelt  2 , Kristin M Myers  2 , Michael D House  3
Affiliations
Review

Prevention of preterm birth: Novel interventions for the cervix

Bouchra Koullali et al. Semin Perinatol. 2017 Dec.

Abstract

Preterm birth is the leading cause of neonatal mortality and morbidity worldwide. Spontaneous preterm birth is a complex, multifactorial condition in which cervical dysfunction plays an important role in some women. Current treatment options for cervical dysfunction include cerclage and supplemental progesterone. In addition, cervical pessary is being studied in research protocols. However, cerclage, supplemental progesterone and cervical pessary have well known limitations and there is a strong need for alternate treatment options. In this review, we discuss two novel interventions to treat cervical dysfunction: (1) injectable, silk protein-based biomaterials for cervical tissue augmentation (injectable cerclage) and (2) a patient-specific pessary. Three-dimensional computer simulation of the cervix is performed to provide a biomechanical rationale for the interventions. Further development of these novel interventions could lead to new treatment options for women with cervical dysfunction.

Keywords: Cerclage; Cervix; Pessary; Preterm birth; Remodeling.

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Figures

Figure 1
Figure 1. Computer simulation results of improving cervical stroma material and cervical angle
The increase in stromal material stiffness and the alignment of the cervical canal with the uterine axis reduces the amount of tissue stretching at the internal os. Percentages indicate the volume ratio of the internal os that is above 8% tensile strain under intrauterine pressure of 8.67kPA. Details of the finite element model are found in Westervelt et al., 2017. A soft and stiff cervix are assigned collagen fiber moduli of 1.71kPa and 769kPa, respectively.
Figure 2
Figure 2. Cervical augmentation with silk
(A) Two separate cervices in rabbit before injection; (B) Silk immediately after injection, gestational day 15; (C) Cervical 4-0 Mersilene suture; (D) Injected silk after sacrifice, gestational day 27; (E) Mild foreign body inflammatory response to silk biomaterial; (F) Mild foreign body inflammatory response to 4-0 Mersilene suture.
See this image and copyright information in PMC

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