Cervical Softening in Early Pregnancy

  • A. Rådestad

Abstract

The concept of cervical “maturation”, “ripening” or “priming” refers to the events leading to a soft, effaced and dilated uterine cervix in the third trimester of pregnancy, whereas cervical “preparation” or “softening” often refers to methods used to change the cervix from a stiff to a soft structure in the first and second trimesters.

Keywords

Prostaglandin Progesterone Sponge Oestradiol PGE2 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cates W, Schulz KF, Grimes DA, Tyler CW. Short-term complications of uterine evacuation techniques for abortion at 12 weeks’ gestation or earlier. In: Zatuchni GI, Speidel SJJ, eds, Pregnancy termination procedures, safety and new developments. Hagerstown: Harper and Row, 1979; 127–35.Google Scholar
  2. 2.
    Merik O. Preterm birth and low birth weight related to complications in previous vacuum aspiration abortion. A case-control study within a cohort. Thesis, Acta Universitas Uppsala no. 422, 1982.Google Scholar
  3. 3.
    Wiqvist N, Beguin F, Bygdeman M, Fernström I, Toppozada M. Induction of abortion by extra-amniotic prostaglandin administration. Prostaglandins 1972; 1:34–53.CrossRefGoogle Scholar
  4. 4.
    Calder AA, Embrey MP, Tait T. Ripening of the cervix with extra-amniotic prostaglandin E2 in viscous gel before induction of labor. Br J Obstet Gynaecol 1977; 84:264–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Danforth DN. The fibrous nature of the human cervix, and its relation to the isthmic segment in gravid and nongravid uteri. Am J Obstet Gynecol 1947; 53:541–60.PubMedGoogle Scholar
  6. 6.
    Danforth DN. The distribution and functional activity of the cervical musculature. Am J Obstet Gynecol 1954; 68:1261–71.PubMedGoogle Scholar
  7. 7.
    Danforth DN. Early studies of the anatomy and physiology of the human cervix — implications for the future. In: Naftolin F, Stubblefield PG, eds, Dilatation of the uterine cervix — connective tissue biology and clinical management. New York: Raven Press, 1980; 3–15.Google Scholar
  8. 8.
    Schild HO, Fitzpatric RJ, Nixon WCW. Activity of the human cervix and corpus uteri. Lancet 1951;i:250–3.CrossRefGoogle Scholar
  9. 9.
    Conrad JT, Ueland K. Physical characteristics of the cervix. Clin Obstet Gynecol 1983; 26:27–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Junqueira LCU, Zugaib M, Montes GS, Toledo OMS, Krisztán RM, Shigihara KM. Morphologic and histochemical evidence for the occurrence of collagenolysis and the role of neutrophilic polymorphonuclear leukocytes during cervical dilation. Am J Obstet Gynecol 1980; 138:273–81.PubMedGoogle Scholar
  11. 11.
    Uldbjerg N, Ekman G, Malmström A, Olsson K, Ulmsten U. Ripening of the human uterine cervix related to changes in collagen, glycosaminoglycans and collagenolytic activity. Am J Obstet Gynecol 1983; 147:662–6.PubMedGoogle Scholar
  12. 12.
    Tokarz RD, Williford JF, Söderström RM. Mobility of fluid as a factor in acute therapeutic dilation of the human cervix. Adv Planned Parenthood 1981; 16:22–9.Google Scholar
  13. 13.
    Rådestad A, Christensen NJ. Magnesium sulphate and cervical ripening. A biomechanical double-blind, randomized comparison between a synthetic polyvinyl sponge with and without magnesium sulphate25O-3. Contraception 1989; 39:253–63.PubMedCrossRefGoogle Scholar
  14. 14.
    Karube H, Kanke Y, Mori Y. Increase of structural glycoprotein during dilatation of human cervix in pregnancy at term. Endocrinol Jpn 1975; 22:445–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Shimizu T, Endo M, Yosizawa Z. Glycoconjugates (glycosaminoglycans and glycoproteins) and glycogen in the human cervix uteri. Tohoku J Exp Med 1980; 131:289–99.PubMedCrossRefGoogle Scholar
  16. 16.
    Theobald PW, Rath W, Kühnle H, Kuhn W. Histological and electron-microscopic examinations of collagenous connective tissue of the non-pregnant cervix, the pregnant cervix, and the pregnant prostaglandin-treated cervix. Arch Gynecol 1982; 231:241–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Minamoto T, Arai K, Hirakawa S, Nagai Y. Immunohistochemical studies on collagen types in the uterine cervix in pregnant and nonpregnant states. Am J Obstet Gynecol 1987; 156:138–44.PubMedGoogle Scholar
  18. 18.
    Rath W, Adelmann-Grill BC, Schauer A, Kuhn W. Morphologische und Biochemische Aspekte der Prostaglandininduzierten Zervixreifung. Z Geburtshilfe Perinatol 1987; 191:21–8.PubMedGoogle Scholar
  19. 19.
    Di Lieto A, Catalano D, Campanile M et al. The morphological characteristics and ultrastructural aspects of cervical ripening induced by sulprostone. Acta Eur Fertil 1988; 19:33–6.Google Scholar
  20. 20.
    Owman C, Rosengren E, Sjöberg N-O. Adrenergic innervation of the human female reproductive organs: a histochemical and chemical investigation. Obstet Gynecol 1967; 30:763–73.PubMedGoogle Scholar
  21. 21.
    Fried G, Meister B, Rådestad A. Peptide-containing nerves in the human pregnant uterine cervix: an immunohistochemical study exploring the effect of RU 486 (mifepristone). Hum Reprod 1990; 5:870–6.PubMedGoogle Scholar
  22. 22.
    Bryman I, Sahni S, Norström A, Lindblom B. Influence of prostaglandins on contractility of the isolated human cervical muscle. Obstet Gynecol 1984; 63:280–4.PubMedGoogle Scholar
  23. 23.
    Conrad JT, Ueland K. Reduction of the stretch modulus of human cervical tissue by prostaglandin E2. Am J Obstet Gynecol 1976; 15:218–23.Google Scholar
  24. 24.
    Bakke T. Cervical consistency in women of fertile age measured with a new mechanical instrument. Acta Obstet Gynecol Scand 1974; 53:293–302.PubMedCrossRefGoogle Scholar
  25. 25.
    Soden PD, Kershaw I. Tensile testing of connective tissues. Med Biol Eng 1974; 7:510–18.CrossRefGoogle Scholar
  26. 26.
    Hulka JF, Lefler HT, Anglone A, Lachenbruch PA. A new electronic force monitor to measure factors influencing cervical dilatation for vacuum curettage. Am J Obstet Gynecol 1974; 120:166–73.PubMedGoogle Scholar
  27. 27.
    Liu DTY, Black MM, Melcher DH, Melville HAH, Cameron S, Morgon J. Dilatation of the parous non-pregnant cervix. Br J Obstet Gynaecol 1975; 82:246–51.PubMedCrossRefGoogle Scholar
  28. 28.
    Fisher J, Anthony GS, McManus TJ, Coutts JRT, Calder A. Use of a force measuring instrument during cervical dilatation. J Med Eng Technol 1981; 5:194–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Rath W, Kühnle H, Theobald P, Kuhn W. Objective demonstration of cervical softening with a prostaglandin F gel during first trimester abortion. Int J Gynaecol Obstet 1982; 20:195–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Richardson W, Smith DC, Evans AL, Anthony GS. A novel cervical dilator force measurement instrument. J Med Eng Techn 1989; 13:220–1.CrossRefGoogle Scholar
  31. 31.
    Cabrol D, Jannet D, Le Houezec R, Dudzik W, Bonoris E, Cedard L. Mechanical properties of the pregnant human uterine cervix. Use of an instrument to measure the index of cervical distensibility. Gynecol Obstet Invest 1990; 29:32–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Hulka JF, Higgins G. Tears of the internal cervical os during dilation for routine curettage. Am J Obstet Gynecol 1961; 82:913–19.PubMedGoogle Scholar
  33. 33.
    Hulka JF. Pratt dilators: resistance at 9 mm is an instrumentation artifact. Am J Obstet Gynecol 1988; 159:871–3.PubMedGoogle Scholar
  34. 34.
    Kiwi R, Neuman MR, Merkatz IR, Selim MA, Lysikiewicz A. Determination of the elastic properties of the cervix. Obstet Gynecol 1988; 71:568–74.PubMedGoogle Scholar
  35. 35.
    Anthony GS, Fisher J, Coutts JRT, Calder AA. The effect of exogenous hormones on the resistance of the early pregnant human cervix. Br J Obstet Gynaecol 1984; 91:1249–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Ott ER. Pregnancy termination: cervical dilatation — a review. Popul Rep 1977; 6:85–103.Google Scholar
  37. 37.
    Johnson N. Intracervical tents: usage and mode of action. Obstet Gynecol Surv 1989; 44: 410–20.PubMedCrossRefGoogle Scholar
  38. 38.
    Jonasson A, Larsson B. Biochemical changes in human cervical connective tissue during pretreatment with Laminaria tents in legal first trimester abortions. Int J Gynaecol Obstet 1989; 28:361–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Grimes DA, Ray IG, Middleton CJ. Lamicel versus laminaria for cervical dilatation before early second-trimester abortion: a randomized clinical trial. Obstet Gynecol 1987; 69:887–90.PubMedGoogle Scholar
  40. 40.
    Atienza MF, Burkman RT, King TM. Use of osmotic dilators to facilitate induced midtrimester abortion: clinical evaluations. Contraception 1984; 30:215–23.PubMedCrossRefGoogle Scholar
  41. 41.
    Hillier K, Coad N. Synthesis of prostaglandins by the human uterine cervix in vitro during passive mechanical stretch. J Pharm Pharmacol 1982; 34:262–3.PubMedCrossRefGoogle Scholar
  42. 42.
    Norström A, Bergman I, Hansson HA. Cervical dilatation by Lamicel before first trimester abortion: a clinical and experimental study. Br J Obstet Gynaecol 1988; 95:372–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Crankshaw DJ, Crankshaw J, Branda LA, Daniel EE. Receptors for E type prostaglandins in the plasma membrane of non-pregnant myometrium. Arch Biochem Biophys 1979; 198:70–7.PubMedCrossRefGoogle Scholar
  44. 44.
    WHO Prostaglandin Task Force. Randomized comparison of different prostaglandin analogues and laminaria tent for preoperative cervical dilatation. Contraception 1986; 34:237–51.Google Scholar
  45. 45.
    Green K, Christensen NJ, Bygdeman M. The chemistry and pharmacology of prostaglandins, with reference to human reproduction. J Reprod Fertil 1981; 62:269–81.PubMedCrossRefGoogle Scholar
  46. 46.
    Uldbjerg N, Ekman G, Malmström A, Sporrong B, Ulmsten U, Wingerup L. Biochemical and morphological changes of human cervix after local application of prostaglandin E2 in pregnancy. Lancet 1981; ii:267–8.CrossRefGoogle Scholar
  47. 47.
    Uldbjerg N, Ekman G, Herltoft P, Malmström A, Ulmsten U, Wingerup L. Human cervical connective tissue and its reaction to prostaglandin E2. Acta Obstet Gynecol Scand [Suppl] 1983; 113:163–6.CrossRefGoogle Scholar
  48. 48.
    Philibert D, Moguilewsky M, Mary I, Lecaque D, Tournemine C, Secchi J, Deraedt R. Pharmacological profile of RU 486 in animals. In: Segal SJ, Baulien EE, eds., The antiprogestin steroid RU 486 and human fertility control. New York: Plenum Press, 1985; 49–68.Google Scholar
  49. 49.
    Moguilewsky M, Philibert D. RU 38486: potent antiglucocorticoid activity correlated with strong binding to the cytosolic glucocorticoid receptor followed by an impaired activation. J Steroid Biochem 1984; 20:271–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Heikinheimo O. Summary of a doctoral thesis: Antiprogesterone steroid RU 486. Pharmacokine-tics and receptor binding in humans. Acta Obstet Gynecol Scand 1990; 69:357–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Philibert D, Hardy M, Gaillard-Moguilewsky M, Nique F, Tournemine C, Nédélec L. New analogues of mifepristone with more dissociated antiprogesterone activities. J Steroid Biochem 1989; 34:413–17.PubMedCrossRefGoogle Scholar
  52. 52.
    Bygdeman M, Swahn ML. Progesterone receptor blockage. Effect on uterine contractility and early pregnancy. Contraception 1985; 32:45–51.PubMedCrossRefGoogle Scholar
  53. 53.
    Couzinet B, Le Strat N, Ulmann A, Baulieu EE, Schaison G. Termination of early pregnancy by the progesterone antagonist RU 486 (mifepristone). N Engl J Med 1986; 315:1565–70.PubMedCrossRefGoogle Scholar
  54. 54.
    Mishell DRJ, Shoupe D, Brenner PF et al. Termination of early gestation with the anti-protestin steroid RU 486: medium versus low dose. Contraception 1987; 35:307–21.PubMedCrossRefGoogle Scholar
  55. 55.
    Birgerson L, Odlind V. The antiprogestational agent RU 486 as an abortifacient in early human pregnancy: a comparison of three dose regimens. Contraception 1988; 38:391–400.PubMedCrossRefGoogle Scholar
  56. 56.
    Swahn ML, Bygdeman M. The effect of antiprogestin RU 586 on uterine contractility and sensitivity to prostaglandin and oxytocin. Br J Obstet Gynaecol 1988; 95:126–34.PubMedCrossRefGoogle Scholar
  57. 57.
    Silvestre L, Dubois C, Renault M, Rezvani Y, Baulieu EE, Ulmann A. Voluntary interruption of pregnancy with mifepristone (RU 486) and a prostaglandin analogue. N Engl J Med 1990; 322:645–8.PubMedCrossRefGoogle Scholar
  58. 58.
    UK Multicentre Trial. The efficacy and tolerance of mifepristone and prostaglandin in first trimester termination of pregnancy. Br J Obstet Gynaecol 1990; 97:480–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Rådestad A, Christensen NJ, Strömberg L. Induced cervical ripening with mifepristone in first trimester abortion. A double-blind randomized biomechanical study. Contraception 1988; 38:301–12.PubMedCrossRefGoogle Scholar
  60. 60.
    Durlot F, Dubois C, Brunerie J, Frydman R. Efficacy of progesterone antagonist RU 486 (mifepristone) for pre-operative cervical dilatation during first trimester abortion. Hum Reprod 1988; 3:583–4.PubMedGoogle Scholar
  61. 61.
    De Grandi P, Giudici G. Administration orale d’un antiprogesterone (Mifepristone, RU 486) pour la préparation du col utérin à l’interruption de grossesse au cours du premier trimestre. J Gynecol Obstet Biol Reprod 1989;18:801–8.Google Scholar
  62. 62.
    Lefebvre Y, Proulx L, Elie R, Poulin O, Lanza E. The effects of RU-38486 on cervical ripening. Am J Obstet Gynecol 1990; 162:61–5.PubMedGoogle Scholar
  63. 63.
    Gupta JK, Johnson N. Effect of mifepristone on dilatation of the pregnant and non-pregnant cervix. Lancet 1990; 335:1238–40.PubMedCrossRefGoogle Scholar
  64. 64.
    Johnson N, Bryce FC. Could antiprogesterones be used as alternative cervical ripening agents? Am J Obstet Gynecol 1990; 162:688–90.PubMedGoogle Scholar
  65. 65.
    WHO Task Force on Post-ovulatory Methods for Fertility Regulation. The use of mifepristone (RU 486) for cervical preparation in first trimester pregnancy termination by vacuum aspiration. Br J Obstet Gynaecol 1990; 97:260–6.Google Scholar
  66. 66.
    Rådestad A, Bygdeman M, Green K. Induced cervical ripening with mifepristone (RU 486) and bioconversion of arachidonic acid in human pregnant uterine cervix in the first trimester. A double-blind randomized biomechanical and biochemical study. Contraception 1990; 41:283–92.PubMedCrossRefGoogle Scholar
  67. 67.
    Abel MH, Baird DT. The effect of beta-estradiol and progesterone on prostaglandin production by human endometrium maintained in organ culture. Endocrinology 1980; 106:1599–606.PubMedCrossRefGoogle Scholar
  68. 68.
    Kelly RW, Healy DL, Cameron MJ, Cameron IT, Baird DT. The stimulation of prostaglandin production by two antiprogesterone steroids in human endometrial cells. J Clin Endocrinol Metab 1986; 62:1117–23.CrossRefGoogle Scholar
  69. 69.
    Jeremy JY, Dandona P. RU 486 antagonises the inhibitory action of progesterone on prostacyclin and thromboxane A2 synthesis in cultured rat myometrial expiants. J Endocrinol 1986; 19:655–60.Google Scholar
  70. 70.
    Norman JE, Wu WX, Kelly RW, Glasier AF, McNeilly AS, Baird DT. Effects of mifepristone in vivo on decidual prostaglandin synthesis and metabolism. Contraception 1991; 44:89–98.PubMedCrossRefGoogle Scholar
  71. 71.
    Cabrol D, Carbonne B, Bienkiewicz A, Dallot E, Alj AE, Cedard L. Induction of labor and cervical maturation using mifepristone (RU 486) in the late pregnant rat. Influence of a cyclooxygenase inhibitor (Diclofenac). Prostaglandins 1991; 42:71–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Stiemer B, Elger W. Cervical ripening of the rat in dependence on endocrine milieu; effects of antigestagens. J Perinatol Med 1990; 18:419–29.CrossRefGoogle Scholar
  73. 73.
    Hegele-Hartung C, Chwalisz K, Beier HM, Elger W. Ripening of the uterine cervix of the guinea-pig after treatment with the progesterone antagonist onapristone (ZK 98,299): an electron microscopic study. Hum Reprod 1989; 4:369–77.PubMedGoogle Scholar
  74. 74.
    Uldbjerg N, Ulmsten U. The physiology of cervical ripening and cervical dilatation and the effect of abortifacient drugs. Baillère Tindall, Clin Obstet Gynaecol, 1990; 4:263–82.CrossRefGoogle Scholar

Copyright information

© Royal College of Obstetricians and Gynaecologists 1992

Authors and Affiliations

  • A. Rådestad

There are no affiliations available

Personalised recommendations