Biomechanisms of cervical remodeling and current approaches to maturity assessment

The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, repair to the original state, which a dense long tubular structure. In this review, problem impaired discussed in both preterm birth delayed transformation, leads unpreparedness cervix for childbirth prolongation pregnancy. Histological, immunological structural dynamic changes begin before delivery are noted as early first trimester gestation. There few ways assess maturity cervix. second third trimester, order predict these ultrasound cervicometry phosphorylated insulin-like growth factor binding protein-1 test. At full term, determine its readiness delivery, palpation assessment. Inadequate assessment characteristics one factors untimely prevention term inappropriate choice method preparation labor. It necessary develop new approaches comprehensive cervix, using existing methods, discover maturity.
 maturation diagnosis considered based on literature data from such databases PubMed, ResearchGate, Google Scholar, well electronic resources M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes molecular, biochemical histophysiological processes occurring during all stages gestation.
 generally accepted that main role gestation played by: collagen fiber restructuring / desorganization, decreased concentrations elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level tissue hydrophilicity, vascularization, glycosaminoglycan matrix metalloproteinase content. Palpatory technique most common methods determining length, have insufficient sensitivity, probably because they do not cover pathogenetic pathways cannot characteristics. Improvement efficiency possible through introduction combined techniques use promising elastography, with Doppler vessels, determination disintegrin metalloprotease thrombospondin-like repeats-1 placental 1-microglobulin secretion, relaxin maternal blood.
 Understanding occur crucial predicting diagnosing isthmic-cervical insufficiency, understanding lack timely readiness, choosing tactics preinduction induction labor if necessary. clinical their objectivity require approach search prognostic markers maturation.