Preterm birth is the primary contributor to perinatal morbidity and mortality, with those born prior to 32 weeks disproportionately contributing compared to those born at 32–37 weeks. Outcomes for babies born prematurely can be devastating. Parturition is recognized as a mechanical process that involves the two processes that are required to initiate labor: rhythmic myometrial contractions and cervical remodeling with subsequent dilation. Studies of parturition tend to separate these two processes rather than evaluate them as a unified system. The mechanical property characterization of the cervix has been primarily performed on isolated cervical tissue, with an implied understanding of the contribution from the uterine corpus. Few studies have evaluated the function of the uterine corpus in the absence of myometrial contractions or in relationship to retaining the fetus. Therefore, the cervical-uterine interaction has largely been neglected in the literature. We suggest that a system-level biomechanical approach is needed to understand pregnancy maintenance. To that end, this paper has two main goals. One goal is to highlight the gaps in current knowledge that need to be addressed in order to develop any comprehensive and clinically relevant models of the system. The second goal is to illustrate the utility of finite element models in understanding pregnancy maintenance of the cervical-uterine system. The paper targets an audience that includes the reproductive biologist/clinician and the engineer/physical scientist interested in biomechanics and the system level behavior of tissues.
System-Level Biomechanical Approach for the Evaluation of Term and Preterm Pregnancy Maintenance
Fort Collins, CO 80523
Women and Infants Hospital of Rhode Island,
Providence RI 02905
Urbana, IL 61801
Chicago, IL 60612
Contributed by the Bioengineering Division of ASME for publication in the Journal of Biomechanical Engineering. Manuscript received October 1, 2012; final manuscript received January 20, 2013; accepted manuscript posted January 28, 2013; published online February 8, 2013. Editor: Victor H. Barocas.
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Mahmoud, H., Wagoner Johnson, A., Chien, E. K., Poellmann, M. J., and McFarlin, B. (February 8, 2013). "System-Level Biomechanical Approach for the Evaluation of Term and Preterm Pregnancy Maintenance." ASME. J Biomech Eng. February 2013; 135(2): 021009. https://doi.org/10.1115/1.4023486
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