1
|
Choi H, Barker E, Abduljabar AA, Anumba D, Porch A. Cervical Tissue Hydration Level Monitoring by a Resonant Microwave Coaxial Probe. Sensors (Basel) 2022; 22:9527. [PMID: 36502229 PMCID: PMC9738423 DOI: 10.3390/s22239527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Cervical tissue hydration level is one of the most important parameters to monitor in the early diagnosis of preterm birth. Electrical-impedance-spectroscopy-based techniques are often used, but they suffer from limited accuracy. Open microwave coaxial probes have been widely used as a broadband dielectric characterization technique for human tissue samples due to their versatility, but with limited accuracy due to their nonresonant nature. In this work, a resonant microwave open coaxial probe with multiple harmonic resonances is proposed as a sensing platform for tissue-hydration-level monitoring. The mechanical design was analyzed and verified by finite-element full 3D electromagnetic simulation and experiments. Dominant sources of errors and the ways to mitigate them were discussed. In vitro experiments were carried out on human cervix samples to verify the precision and accuracy by comparing the results to a commercial skin-hydration sensor. The proposed sensor shows mean fractional frequency shift of (3.3 ± 0.3) × 10-4 per unit % over the entire data. This translates into an absolute frequency shift (ΔfN) of 252 ± 23 kHz/%, 455 ± 41 kHz/%, and 647 ± 57 kHz/% at second, fourth, and sixth harmonic resonance, respectively.
Collapse
Affiliation(s)
- Heungjae Choi
- School of Engineering, Cardiff University, 14-17 The Parade, Cardiff CF24 3AA, UK
| | - Emilia Barker
- School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, UK
| | | | - Dilly Anumba
- Department of Oncology and Metabolism, JW4/40, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Adrian Porch
- School of Engineering, Cardiff University, 14-17 The Parade, Cardiff CF24 3AA, UK
| |
Collapse
|
2
|
Lee HR, Saytashev I, Du Le VN, Mahendroo M, Ramella-Roman J, Novikova T. Mueller matrix imaging for collagen scoring in mice model of pregnancy. Sci Rep 2021; 11:15621. [PMID: 34341418 DOI: 10.1038/s41598-021-95020-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Preterm birth risk is associated with early softening of the uterine cervix in pregnancy due to the accelerated remodeling of collagen extracellular matrix. Studies of mice model of pregnancy were performed with an imaging Mueller polarimeter at different time points of pregnancy to find polarimetric parameters for collagen scoring. Mueller matrix images of the unstained sections of mice uterine cervices were taken at day 6 and day 18 of 19-days gestation period and at different spatial locations through the cervices. The logarithmic decomposition of the recorded Mueller matrices mapped the depolarization, linear retardance, and azimuth of the optical axis of cervical tissue. These images highlighted both the inner structure of cervix and the arrangement of cervical collagen fibers confirmed by the second harmonic generation microscopy. The statistical analysis and two-Gaussians fit of the distributions of linear retardance and linear depolarization in the entire images of cervical tissue (without manual selection of the specific regions of interest) quantified the randomization of collagen fibers alignment with gestation time. At day 18 the remodeling of cervical extracellular matrix of collagen was measurable at the external cervical os that is available for the direct optical observations in vivo. It supports the assumption that imaging Mueller polarimetry holds promise for the fast and accurate collagen scoring in pregnancy and the assessment of the preterm birth risk.
Collapse
|
3
|
Zheng Z, Di X, Wang L, Zhang W, Feng Y, Shi SQ, Garfield RE, Liu H. Evaluation of cervical maturity by cervical collagen measurement using light-induced fluorescence (LIF) during pregnancy. J Int Med Res 2021; 48:300060520964006. [PMID: 33203273 PMCID: PMC7683917 DOI: 10.1177/0300060520964006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective The study aimed to evaluate cervical ripening by measuring cervical collagen levels in non-pregnant women, women with a normal pregnancy, and postpartum women by light-induced fluorescence (LIF). Methods Cervical collagen content in normal pregnant women (n = 165) at various times of gestation was measured by LIF with a collascope, which is specifically designed to measure fluorescence of collagen. Cervical LIF in non-pregnant women (n = 12) and postpartum women (n = 14) was also detected. The demographic characteristics of women at various times were recorded. The Bishop score at 40 to 41 gestational weeks (n = 37) before the onset of labor was analyzed. Results Cervical LIF values progressively declined from the non-pregnant state to late gestation (R = −0.836) and reached their lowest levels during parturition and then increased at postpartum. LIF values and the Bishop score were significantly negatively correlated (R = −0.83). In patients with a Bishop score ≥6, the first stage of labor was shortened with a decrease in LIF values (R = 0.718). Conclusions Cervical collagen levels as measured by LIF could be a useful method for evaluating cervical maturity.
Collapse
Affiliation(s)
- Zheng Zheng
- Department of Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, China; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China.,Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Xiaodan Di
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Lele Wang
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Weijuan Zhang
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Yan Feng
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Shao-Qing Shi
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Robert E Garfield
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| | - Huishu Liu
- Department of Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, China; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China.,Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou, China
| |
Collapse
|
4
|
Helmi H, Siddiqui A, Yan Y, Basij M, Hernandez-Andrade E, Gelovani J, Hsu CD, Hassan SS, Mehrmohammadi M. The role of noninvasive diagnostic imaging in monitoring pregnancy and detecting patients at risk for preterm birth: a review of quantitative approaches. J Matern Fetal Neonatal Med 2020; 35:568-591. [PMID: 32089024 DOI: 10.1080/14767058.2020.1722099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide. The ability to predict patients at risk for preterm birth remains a major health challenge. The currently available clinical diagnostics such as cervical length and fetal fibronectin may detect only up to 30% of patients who eventually experience a spontaneous preterm birth. This paper reviews ongoing efforts to improve the ability to conduct a risk assessment for preterm birth. In particular, this work focuses on quantitative methods of imaging using ultrasound-based techniques, magnetic resonance imaging, and optical imaging modalities. While ultrasound imaging is the major modality for preterm birth risk assessment, a summary of efforts to adopt other imaging modalities is also discussed to identify the technical and diagnostic limits associated with adopting them in clinical settings. We conclude the review by proposing a new approach using combined photoacoustic, ultrasound, and elastography as a potential means to better assess cervical tissue remodeling, and thus improve the detection of patients at-risk of PTB.
Collapse
Affiliation(s)
- Hamid Helmi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Adeel Siddiqui
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI, USA
| | - Juri Gelovani
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.,Office of Women's Health, Wayne State University, Detroit, MI, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.,Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI, USA
| |
Collapse
|
5
|
Yan Y, Gomez-Lopez N, Basij M, Shahvari AV, Vadillo-Ortega F, Hernandez-Andrade E, Hassan SS, Romero R, MehrMohammadi M. Photoacoustic imaging of the uterine cervix to assess collagen and water content changes in murine pregnancy. Biomed Opt Express 2019; 10:4643-4655. [PMID: 31565515 PMCID: PMC6757472 DOI: 10.1364/boe.10.004643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 05/11/2023]
Abstract
The uterine cervix plays a central role in the maintenance of pregnancy and in the process of parturition. Cervical remodeling involves dramatic changes in extracellular matrix composition and, in particular, of collagen and water content during cervical ripening (a term that describes the anatomical, biochemical, and physiologic changes in preparation for labor). Untimely cervical ripening in early gestation predisposes to preterm labor and delivery, the leading cause of infant death worldwide. Inadequate ripening of the cervix is associated with failure of induction or prolonged labor. The current approach to evaluate the state of the cervix relies on digital examination and sonographic examination. Herein, we present a novel imaging method that combines ultrasound (US) and photoacoustic (PA) techniques to evaluate cervical remodeling by assessing the relative collagen and water content of this organ. The method was tested in vitro in extracted collagen phantoms and ex vivo in murine cervical tissues that were collected in mid-pregnancy and at term. We report, for the first time, that our imaging approach provides information about the molecular changes in the cervix at different gestational ages. There was a strong correlation between the results of PA imaging and the histological assessment of the uterine cervix over the course of gestation. These findings suggest that PA imaging is a powerful method to assess the biochemical composition of the cervix and open avenues to non-invasively investigate the composition of this organ, which is essential for reproductive success.
Collapse
Affiliation(s)
- Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Biochemistry, Immunology, and, Microbiology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI 48201, USA
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
| | | | - Felipe Vadillo-Ortega
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Unidad de Vinculación de la Facultad de Medicina,UNAM y Dirección de Investigación, Instituto Nacional de Medicina Genómica, CDMX, Mexico
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
- Detroit Medical Center, Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, FL 33199, USA
| | - Mohammad MehrMohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI 48202, USA
| |
Collapse
|
6
|
Qu Y, Hu P, Shi J, Maslov K, Zhao P, Li C, Ma J, Garcia-Uribe A, Meyers K, Diveley E, Pizzella S, Muench L, Punyamurthy N, Goldstein N, Onwumere O, Alisio M, Meyenburg K, Maynard J, Helm K, Altieri E, Slaughter J, Barber S, Burger T, Kramer C, Chubiz J, Anderson M, McCarthy R, England SK, Macones GA, Stout MJ, Tuuli M, Wang LV. In vivo characterization of connective tissue remodeling using infrared photoacoustic spectra. J Biomed Opt 2018; 23:1-6. [PMID: 30520275 PMCID: PMC6318810 DOI: 10.1117/1.jbo.23.12.121621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
Premature cervical remodeling is a critical precursor of spontaneous preterm birth, and the remodeling process is characterized by an increase in tissue hydration. Nevertheless, current clinical measurements of cervical remodeling are subjective and detect only late events, such as cervical effacement and dilation. Here, we present a photoacoustic endoscope that can quantify tissue hydration by measuring near-infrared cervical spectra. We quantify the water contents of tissue-mimicking hydrogel phantoms as an analog of cervical connective tissue. Applying this method to pregnant women in vivo, we observed an increase in the water content of the cervix throughout pregnancy. The application of this technique in maternal healthcare may advance our understanding of cervical remodeling and provide a sensitive method for predicting preterm birth.
Collapse
Affiliation(s)
- Yuan Qu
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Peng Hu
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Junhui Shi
- California Institute of Technology, Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering and Department of Electrical Engineering, Pasadena, California, United States
| | - Konstantin Maslov
- California Institute of Technology, Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering and Department of Electrical Engineering, Pasadena, California, United States
| | - Peinan Zhao
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Chiye Li
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Jun Ma
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Alejandro Garcia-Uribe
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Karen Meyers
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Emily Diveley
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Stephanie Pizzella
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Lisa Muench
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Nina Punyamurthy
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Naomi Goldstein
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Oji Onwumere
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Mariana Alisio
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Kaytelyn Meyenburg
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Jennifer Maynard
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Kristi Helm
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Emma Altieri
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Janessia Slaughter
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Sabrina Barber
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Tracy Burger
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Christine Kramer
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Jessica Chubiz
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Monica Anderson
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Ronald McCarthy
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Sarah K. England
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - George A. Macones
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Molly J. Stout
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Methodius Tuuli
- Washington University in St. Louis, March of Dimes Prematurity Research Center, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States
| | - Lihong V. Wang
- California Institute of Technology, Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering and Department of Electrical Engineering, Pasadena, California, United States
| |
Collapse
|
7
|
Chue-Sang J, Bai Y, Stoff S, Gonzalez M, Holness N, Gomes J, Jung R, Gandjbakhche A, Chernomordik VV, Ramella-Roman JC. Use of Mueller matrix polarimetry and optical coherence tomography in the characterization of cervical collagen anisotropy. J Biomed Opt 2017; 22:1-9. [PMID: 28853246 PMCID: PMC5997002 DOI: 10.1117/1.jbo.22.8.086010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/24/2017] [Indexed: 05/20/2023]
Abstract
Preterm birth (PTB) presents a serious medical health concern throughout the world. There is a high incidence of PTB in both developed and developing countries ranging from 11% to 15%, respectively. Recent research has shown that cervical collagen orientation and distribution changes during pregnancy may be useful in predicting PTB. Polarization imaging is an effective means to measure optical anisotropy in birefringent materials, such as the cervix's extracellular matrix. Noninvasive, full-field Mueller matrix polarimetry (MMP) imaging methodologies, and optical coherence tomography (OCT) imaging were used to assess cervical collagen content and structure in nonpregnant porcine cervices. We demonstrate that the highly ordered structure of the nonpregnant porcine cervix can be observed with MMP. Furthermore, when utilized ex vivo, OCT and MMP yield very similar results with a mean error of 3.46% between the two modalities.
Collapse
Affiliation(s)
- Joseph Chue-Sang
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Yuqiang Bai
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Susan Stoff
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Mariacarla Gonzalez
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Nola Holness
- Florida International University, Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, United States
| | - Jefferson Gomes
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Ranu Jung
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Amir Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, United States
| | - Viktor V. Chernomordik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, United States
| | - Jessica C. Ramella-Roman
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
- Address all correspondence to: Jessica C. Ramella-Roman, E-mail:
| |
Collapse
|
8
|
Myers KM, Elad D. Biomechanics of the human uterus. Wiley Interdiscip Rev Syst Biol Med 2017; 9. [PMID: 28498625 DOI: 10.1002/wsbm.1388] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/15/2022]
Abstract
The appropriate biomechanical function of the uterus is required for the execution of human reproduction. These functions range from aiding the transport of the embryo to the implantation site, to remodeling its tissue walls to host the placenta, to protecting the fetus during gestation, to contracting forcefully for a safe parturition and postpartum, to remodeling back to its nonpregnant condition to renew the cycle of menstruation. To serve these remarkably diverse functions, the uterus is optimally geared with evolving and contractile muscle and tissue layers that are cued by chemical, hormonal, electrical, and mechanical signals. The relationship between these highly active biological signaling mechanisms and uterine biomechanical function is not completely understood for normal reproductive processes and pathological conditions such as adenomyosis, endometriosis, infertility and preterm labor. Animal studies have illuminated the rich structural function of the uterus, particularly in pregnancy. In humans, medical imaging techniques in ultrasound and magnetic resonance have been combined with computational engineering techniques to characterize the uterus in vivo, and advanced experimental techniques have explored uterine function using ex vivo tissue samples. The collective evidence presented in this review gives an overall perspective on uterine biomechanics related to both its nonpregnant and pregnant function, highlighting open research topics in the field. Additionally, uterine disease and infertility are discussed in the context of tissue injury and repair processes and the role of computational modeling in uncovering etiologies of disease. WIREs Syst Biol Med 2017, 9:e1388. doi: 10.1002/wsbm.1388 For further resources related to this article, please visit the WIREs website.
Collapse
Affiliation(s)
- Kristin M Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - David Elad
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel.,Department of Biomedical Engineering, Columbia University, New York, NY, USA
| |
Collapse
|
9
|
Qian X, Jiang Y, Liu L, Shi SQ, Garfield RE, Liu H. Changes in ectocervical surface area in women throughout pregnancy compared to non-pregnant and postpartum states. J Matern Fetal Neonatal Med 2016; 29:3677-81. [PMID: 26864001 DOI: 10.3109/14767058.2016.1140739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study is to estimate changes in the surface area of the ectocervix (CA) in women during pregnancy and compare this to postpartum and non-pregnant states. METHODS CA was evaluated in 210 normal nulliparous women divided into groups from early to late gestation, 40 postpartum women, and 25 non-pregnant women. CA in cm(2) was estimated from analysis of images taken with an endoscope of the cervical face and an mm scale. An mm scale was also used to determine fornix length and fornix area computed. RESULTS The face, fornix, and total areas of the CA of non-pregnant and postpartum groups are significantly smaller (p < 0.001) than these areas in groups during pregnancy. Generally, the CA of the face, fornix, and total area are also less in early pregnancy compared with late gestation (p < 0.01 to <0.001). Total CA correlates with gestational age (r = 0.196, p < 0.004). CONCLUSIONS (1) During pregnancy, CA slowly and progressively increases to >75% area compared with CA of non-pregnant patients and then reverts back to low CA postpartum. (2) Increases in CA during pregnancy occur in both the face and fornix areas. (3) Increases in CA reflect enlargement in cervical volume and remodeling during pregnancy.
Collapse
Affiliation(s)
- Xueya Qian
- a Preterm Birth Prevention and Treatment Unit, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou , China and.,b Department of Obstetrics , First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Yanmin Jiang
- a Preterm Birth Prevention and Treatment Unit, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou , China and
| | - Lei Liu
- a Preterm Birth Prevention and Treatment Unit, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou , China and
| | - Shao-Qing Shi
- a Preterm Birth Prevention and Treatment Unit, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou , China and
| | - Robert E Garfield
- a Preterm Birth Prevention and Treatment Unit, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou , China and
| | - Huishu Liu
- a Preterm Birth Prevention and Treatment Unit, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou , China and
| |
Collapse
|
10
|
Conde-Agudelo A, Romero R. Vaginal progesterone to prevent preterm birth in pregnant women with a sonographic short cervix: clinical and public health implications. Am J Obstet Gynecol 2016; 214:235-242. [PMID: 26450404 PMCID: PMC5703061 DOI: 10.1016/j.ajog.2015.09.102] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 12/20/2022]
Abstract
Vaginal progesterone administration to women with a sonographic short cervix is an efficacious and safe intervention used to prevent preterm birth and neonatal morbidity and mortality. The clinical and public health implications of this approach in the United States have been critically appraised and compared to other therapeutic interventions in obstetrics. Vaginal progesterone administration to women with a transvaginal sonographic cervical length (CL) ≤25 mm before 25 weeks of gestation is associated with a significant and substantial reduction of the risk for preterm birth from <28 to <35 weeks of gestation, respiratory distress syndrome, composite neonatal morbidity and mortality, admission to the neonatal intensive care unit, and mechanical ventilation. These beneficial effects have been achieved in women with a singleton gestation, with or without a history of spontaneous preterm birth, and did not differ significantly as a function of CL (<10 mm, 10-20 mm, or 21-25 mm). The number of patients required for treatment to prevent 1 case of preterm birth or adverse neonatal outcomes ranges from 10-19 women. The number needed to screen for the prevention of 1 case of preterm birth before 34 weeks of gestation is 125 women, and 225 for the prevention of 1 case of major neonatal morbidity or neonatal mortality. Several cost-effectiveness and decision analyses have shown that the combination of universal transvaginal CL screening and vaginal progesterone administration to women with a short cervix is a cost-effective intervention that prevents preterm birth and associated perinatal morbidity and mortality. Universal assessment of CL and treatment with vaginal progesterone for singleton gestations in the United States would result in an annual reduction of approximately 30,000 preterm births before 34 weeks of gestation and of 17,500 cases of major neonatal morbidity or neonatal mortality. In summary, there is compelling evidence to recommend universal transvaginal CL screening at 18-24 weeks of gestation in women with a singleton gestation and to offer vaginal progesterone to those with a CL ≤25 mm, regardless of the history of spontaneous preterm birth, with the goal of preventing preterm birth and neonatal morbidity and mortality.
Collapse
Affiliation(s)
- Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| |
Collapse
|
11
|
Hernandez-Andrade E, Romero R, Korzeniewski SJ, Ahn H, Aurioles-Garibay A, Garcia M, Schwartz AG, Yeo L, Chaiworapongsa T, Hassan SS. Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery. J Perinat Med 2014; 42:159-69. [PMID: 24356388 PMCID: PMC4183449 DOI: 10.1515/jpm-2013-0277] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/25/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine if there is an association between cervical strain, evaluated using ultrasound elastography, and spontaneous preterm delivery (sPTD) <37 weeks of gestation. METHODS One hundred and eighty nine (189) women at 16-24 weeks of gestation were evaluated. Ultrasound elastography was used to estimate cervical strain in three anatomical planes: one mid-sagittal in the same plane used for cervical length measurement, and two cross sectional images: one at the level of the internal cervical os, and the other at the level of the external cervical os. In each plane, two regions of interest (endocervix and entire cervix) were examined; a total of six regions of interest were evaluated. RESULTS The prevalence of sPTD was 11% (21/189). Strain values from each of the six cervical regions correlated weakly with cervical length (from r=-0.24, P<0.001 to r=-0.03, P=0.69). Strain measurements obtained in a cross sectional view of the internal cervical os were significantly associated with sPTD. Women with strain values ≤25th centile in the endocervical canal (0.19) and in the entire cervix (0.14) were 80% less likely to have a sPTD than women with strain values >25th centile [endocervical: odds ratio (OR) 0.2; 95% confidence interval (CI), 0.03-0.96; entire cervix: OR 0.17; 95% CI, 0.03-0.9]. Additional adjustment for gestational age, race, smoking status, parity, maternal age, pre-pregnancy body mass index, and previous preterm delivery did not appreciably alter the magnitude or statistical significance of these associations. Strain values obtained from the external cervical os and from the sagittal view were not associated with sPTD. CONCLUSION Low strain values in the internal cervical os were associated with a significantly lower risk of spontaneous preterm delivery <37 weeks of gestation.
Collapse
Affiliation(s)
- Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Hyunyoung Ahn
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alma Aurioles-Garibay
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Maynor Garcia
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alyse G. Schwartz
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
12
|
Feltovich H, Hall TJ, Berghella V. Beyond cervical length: emerging technologies for assessing the pregnant cervix. Am J Obstet Gynecol 2012; 207:345-54. [PMID: 22717270 DOI: 10.1016/j.ajog.2012.05.015] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/02/2012] [Accepted: 05/21/2012] [Indexed: 12/12/2022]
Abstract
Spontaneous preterm birth is a heterogeneous phenotype. A multitude of pathophysiologic pathways culminate in the final common denominator of cervical softening, shortening, and dilation that leads to preterm birth. A precise description of specific microstructural changes to the cervix is imperative if we are to identify the causative upstream molecular processes and resultant biomechanical events that are associated with each unique pathway. Currently, however, we have no reliable clinical tools for quantitative and objective evaluation, which likely contributes to the reason the singleton spontaneous preterm birth rate has not changed appreciably in >100 years. Fortunately, promising techniques to evaluate tissue hydration, collagen structure, and/or tissue elasticity are emerging. These will add to the body of knowledge about the cervix and facilitate the coordination of molecular studies and ultimately lead to novel approaches to preterm birth prediction and, finally, prevention.
Collapse
|
13
|
Vargis E, Brown N, Williams K, Al-Hendy A, Paria BC, Reese J, Mahadevan-Jansen A. Detecting biochemical changes in the rodent cervix during pregnancy using Raman spectroscopy. Ann Biomed Eng 2012; 40:1814-24. [PMID: 22411265 DOI: 10.1007/s10439-012-0541-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
Abstract
The goal of this research is to determine whether Raman spectroscopy (RS), an optical method that probes the vibrational modes of tissue components, can be used in vivo to study changes in the mouse cervix during pregnancy. If successful, such a tool could be used to detect cervical changes due to pregnancy, both normal and abnormal, in animal models and humans. For this study, Raman spectra were acquired before, during and after a 19-day mouse gestational period. In some cases, after Raman data was obtained, cervices were excised for structural testing and histological staining for collagen and smooth muscle. Various peaks of the Raman spectra, such as the areas corresponding to fatty acid content and collagen organization, changed as the cervix became softer in preparation for labor and delivery. These findings correspond to the increase in compliance of the tissue and the collagen disorganization visualized with the histological staining. The results of this study suggest that non-invasive RS can be used to study cervical changes during pregnancy, labor and delivery and can possibly predict preterm delivery before overt clinical manifestations, potentially lead to more effective preventive and therapeutic interventions.
Collapse
|
14
|
Moro CF, Consonni SR, Rosa RG, Nascimento MAC, Joazeiro PP. High iNOS mRNA and protein localization during late pregnancy suggest a role for nitric oxide in mouse pubic symphysis relaxation. Mol Reprod Dev 2012; 79:272-82. [PMID: 22223460 DOI: 10.1002/mrd.22020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 12/13/2011] [Indexed: 11/10/2022]
Abstract
Remodeling and relaxation of the mouse pubic symphysis (PS) are central events in parturition. The mouse PS remodels in a hormone-controlled process that involves the modification of the fibrocartilage into an interpubic ligament (IpL), followed by its relaxation prior to parturition. It is recognized that nitric oxide synthase (NOS) and consequently nitric oxide (NO) generation play important roles in extracellular matrix modification, and may promote cytoskeleton changes that contribute to the remodeling of connective tissue, which precedes the onset of labor. To our knowledge, no studies thus far have investigated inducible nitric oxide synthase (iNOS) expression, protein localization, and NO generation in the mouse PS during pregnancy. In this work, we used a combination of the immunolocalization of iNOS, its relative mRNA expression, and NO production to examine the possible involvement of iNOS in remodeling and relaxation of the mouse IpL during late pregnancy. The presence of iNOS was observed in chondrocytes and fibroblast-like cells in the interpubic tissues. In addition, iNOS mRNA and NO production were higher during preterm labor on Day 19 of pregnancy (D19) than NO production on D18 or in virgin groups. The significant increase in iNOS mRNA expression and NO generation from the partially relaxed IpL at D18 to the completely relaxed IpL at D19 may indicate that NO plays an important role in late pregnancy during relaxation of the mouse IpL.
Collapse
Affiliation(s)
- Camila Fernandes Moro
- Department of Histology and Embryology, State University of Campinas (Unicamp), Campinas, SP, Brazil
| | | | | | | | | |
Collapse
|
15
|
Garfield R, Shi L, Shi SQ. Use of progesterone and progestin analogs for inhibition of preterm birth and other uterine contractility disorders. Facts Views Vis Obgyn 2012; 4:237-44. [PMID: 24753915 PMCID: PMC3987481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this paper we focus on preterm birth as a uterine contractility disorder caused by hypercontractility of the -myometrium. We describe changes in uterine function during term and preterm labor and delivery. We also examine the usefulness of measurement of uterine electromyographic (EMG) activity, noninvasively monitored from the -abdominal surface of pregnant patients. The use of progesterone treatment for preterm birth is discussed and we conclude that present therapies with progesterone could be improved by changing the route of administration. -Finally we show the results of recent studies that show that progesterone injections completely inhibit uterine EMG activity when given several days to hours before normal delivery. These studies illustrate how progesterone suppresses labor at term or preterm, probably through repression of genes which control excitability and conduction of electrical activity. However, direct profusion of soluble progesterone into the uterine cavity has little immediate inhibitory action and this may demonstrate that progesterone has no direct, nongenomic effects, at least in the rat model used. Further studies are required to determine the effects of progesterone on human uterine EMG activity and whether progesterone treatments will prevent preterm birth.
Collapse
|
16
|
Kuon RJ, Garfield R. Actions of progestins for the inhibition of cervical ripening and uterine contractions to prevent preterm birth. Facts Views Vis Obgyn 2012; 4:110-9. [PMID: 24753898 PMCID: PMC3987504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The importance of progesterone (P4) for maintenance of pregnancy, its role in cervical ripening and uterine contractions is at least partly established and therefore, not surprisingly, the basis for the concept to use P4 as a treatment for preterm birth. Due to the complexity of the condition of preterm birth there are still questions concerning the optimal population that might benefit, timing of treatment, dosage, vehicle and route of administration. Recently vaginal P4 and intramuscular 17-alpha-hydroxyprogesterone caproate (17P) have been used to prevent preterm birth in patients with a high risk for early delivery. The aim of this study was to assess cervical changes throughout pregnancy in rats and the timing of term and preterm delivery after various progestin treatments given by different routes and vehicles in hope of identifying better treatment regimens. This paper presents results that suggest that there are better routes of treatment than the vaginal route (e.g. topical), that the vehicle used in many of the clinical studies (Replens®) is not appropriate due to a low release of the steroid and consequently low uptake of P4, and that inhibition of birth is primarily due to inhibition of uterine contractility that can be achieved by supplementation of P4 but not with 17P.
Collapse
Affiliation(s)
- R.-J. Kuon
- Department of Obstetrics and Gynecology, University of Heidelberg, 69115 Heidelberg, Germany
| | - R.E. Garfield
- Department of Obstetrics and Gynecology, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona 85013, USA.
| |
Collapse
|