Connective tissue changes in the cervix during normal pregnancy and pregnancy complicated by cervical incompetence

Abstract

When postpartum cervical biopsy specimens were compared with biopsy specimens from nonpregnant women, they revealed a 12-fold decrease in mechanical strength, a 50% reduction in the concentrations of collagen and sulfated glycosaminoglycans, a 35% reduction in hyaluronic acid, an increase in collagen extractability, and a fivefold increase in collagenolytic activity. Primiparas with relatively high concentrations of collagen and hyaluronic acid had relatively long cervical dilatation times during established labor, suggesting a physiologic importance to these variables. This correlation was not found in multiparas, even though the mean values of the biochemical parameters tested were similar to those in primiparas. Second-trimester biopsy specimens taken from patients with cervical incompetence contained normal collagen concentrations, but relatively high collagen extractabilities and collagenolytic activities, exceeding normal postpartum values. A biopsy specimen that was tested biomechanically had a very low strength and very high extensibility. Most likely, these data reflect a high turnover of collagen in incompetent cervices, resulting in a high proportion of newly synthesized collagen with low biomechanical strength.