The Biomechanics of High-Risk Pregnancies – Evaluating Cervical Funneling

The reproductive soft tissues that support the fetus undergo some of the most dramatic and unique growth and remodeling events in the human body. During pregnancy, the uterus and fetal membrane must grow and stretch to accommodate the fetus. Simultaneously, the cervix must remodel and be a mechanical barrier to keep the fetus within the uterus. All three tissues must withstand mechanical forces to protect, support, and maintain an optimal growth environment for the developing baby. Then, in a reversal of roles, ideally nearing term, the uterus begins to contract and the cervix deforms to allow for a safe delivery. The magnitude of biomechanical stress and stretch of these soft tissues supporting the fetus are thought to control physiologic processes that regulate tissue growth, remodeling, contractility, and rupture, and it is generally hypothesized that these mechanical signals are clinical cues for normal labor and preterm birth, a major long-lasting public health problem with heavy emotional and financial consequences. In this talk I will reveal what we know about the soft tissue mechanics of pregnancy. I will present computational models of pregnancy based on ultrasonic anatomical measurements and cervical stiffness measurements from a novel aspirator clinical tool. I will examine the mechanical environment of pregnancy by comparing biomechanical models of patients clinically considered at low- and high-risk of preterm birth. The high-risk cohort is a subset of patients participating in the TOPS clinical trial at Columbia University Irving Medical Center, an NIH-funded clinical trial to examine the efficacy of the pessary in reducing preterm birth in singleton pregnancies. Through this experimental and modeling effort I aim to hypothesize which factor or combination of factors may be responsible for clinically-observed mechanical dysfunction in pregnancy.