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Midtrimester pregnancy loss and cervical incompetence—Is there an association with connective tissue laxity?

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DOI: 10.4236/ojog.2014.41006    4,127 Downloads   5,899 Views   Citations

ABSTRACT

Objectives: The basic mechanisms of cervical incompetence remain unknown although preliminary histological, biochemical and DNA studies suggest connective tissue pathology may be a contributing factor. Certain connective tissue disorders are known to be associated with obstetric complications. Utilising a standardised established scoring system for connective tissue laxity, this study aimed to test the relationship between clinical evidence of connective tissue laxity and cervical incompetence. Methods: This case-control study involved pregnant and non-pregnant women with a history of mid-trimester pregnancy loss in the absence of major bleeding, infection and uterine abnormalities and a control group of women with uncomplicated obstetric histories. Relevant medical details were obtained. Connective tissue laxity was assessed utilizing the Beighton scoring system. Potential confounding factors, including age, pregnancy and gestation were explored. Results: The frequency of connective tissue laxity between the cases [n = 29] was not statistically different from the controls [n = 58] [p = 0.391] suggesting a lack of association between cervical incompetence and clinical evidence of connective tissue laxity. Conclusion: Although no clear evidence of connective tissue laxity was demonstrated, it is possible that cervical incompetence is associated with abnormal connective tissue. But this abnormality is different from the defect that underlies joint hypermobility and skin elasticity.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Au, S. , Cullinane, F. , Savarirayan, R. and Grover, S. (2014) Midtrimester pregnancy loss and cervical incompetence—Is there an association with connective tissue laxity?. Open Journal of Obstetrics and Gynecology, 4, 28-32. doi: 10.4236/ojog.2014.41006.

References

[1] Shennan A. and Jones, B. (2004) The cervix and prematurity: Aetiology, prediction, and prevention. Seminars in Fetal & Neonatal Medicine, 9, 471-479. http://dx.doi.org/10.1016/j.siny.2004.09.001
[2] Harger, J.H. (2002) Cerclage and cervical insufficiency: An evidence-based analysis. Obstetrics & Gynecology, 100, 1313-1327.
[3] Jorgensen, A.L., Alfirevic, Z., Tudur Smith, C. and Williamson, P.R. (2007) Cervical stitch (cerclage) for preventing pregnancy loss: Individual patient data meta-analysis. BJOG, 114, 1460-1476.
[4] Warren, J.E., Silver, R.M., Dalton, J., Nelson, L.T., Branch, D.W. and Porter, T.F. (2007) Collagen 1Alpha1 and transforming growth factor-beta polymorphisms in women with cervical insufficiency. Obstetrics & Gynecology, 110, 619-624.
[5] Kaufman, R.H., Adam, E., Hatch, E.E., Noller, K., Herbst, A.L., Palmer, J.R., et al. (2000) Continued follow-up of pregnancy outcomes in diethylstilbestrol-exposed offspring. Obstetrics & Gynecology, 96, 483-489.
[6] Rackow, B. and Arici, A. (2007) Reproductive performance of women with müllerian anomalies. Current Opinion in Obstetrics and Gynecology, 19, 229-237. http://dx.doi.org/10.1097/GCO.0b013 e32814b0649
[7] Vyas, N.A., Vink, J.S., Ghidini, A., Pezzullo, J.C., Korker, V., Landy, H.J., et al. (2006) Risk factors for cervical insufficiency after term delivery. American Journal of Obstetrics & Gynecology, 195, 787-791.
[8] Lind, J. and Wallenburg, H.C. (2002) Pregnancy and the Ehlers-Danlos syndrome: A retrospective study in a Dutch population. Acta Obstetricia et Gynecologica Scandinavica, 81, 293-300.
[9] Anum, E.A., Hill, L.D., Pandya, A. and Strauss, J.F. (2009) Connective tissue and related disorders and preterm birth: Clues to genes contributing to prematurity. Placenta, 30, 207-215.
[10] Rechberger, T., Uldbjerg, N. and Oxlund, H. (1988) Connective tissue changes in the cervix during normal pregnancy and pregnancy complicated by cervical incompetence. Obstetrics & Gynecology, 71, 563-567.
[11] Iwahashi, M., Muragaki, Y., Ooshima, A. and Umesaki, N. (2003) Decreased type I collagen expression in human uterine cervix during pregnancy. The Journal of Clinical Endocrinology and Metabolism, 88, 2231-2235.
[12] Schlembach, D., Mackay, L., Shi, L., Maner, W.L., Garfield, R.E. and Maul, H. (2009) Cervical ripening and insufficiency: From biochemical and molecular studies to in vivo clinical examination. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 144, S70-S76.
[13] Larsson, L.G., Baum, J., Mudholkar, G.S. and Srivastava, D.K. (1993) Hypermobility: Prevalence and features in a Swedish population. British Journal of Rheumatology, 32, 116-119.
[14] Beighton, P., De Paepe, A., Steinmann, B., Tsipouras, P. and Wenstrup, R.J. (1998) Ehlers-Danlos syndromes: Revised nosology, Villefranche, 1997. Ehlers-Danlos National Foundation (USA) and Ehlers-Danlos Support Group (UK). American Journal of Medical Genetics, 77, 31-37.
[15] Remvig, L., Jensen, D.V. and Ward, R.C. (2007) Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: Review of the literature. Journal of Rheumatology, 34, 804-809.
[16] Hermanns-Le, T., Pierard, G. and Quatresooz, P. (2005) Ehlers-Danlos-like dermal abnormalities in women with recurrent preterm premature rupture of fetal membranes. American Journal of Dermatopathology, 27, 407-410.
[17] Hypermobility Syndrome Association (2010) Beighton score. http://www.hypermobility.org/ beighton.php
[18] MRC/RCOG WPoCC (1993) Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage. British Journal of Obstetrics and Gynaecology, 100, 516-523.
[19] To, M.S., Alfirevic, Z., Heath, V.C., Cicero, S., Cacho, A.M., Williamson, P.R., et al. (2004) Cervical cerclage for prevention of preterm delivery in women with short cervix: Randomised controlled trial. Lancet, 363, 1849-1853.
[20] Grahame, R. (1999) Joint hypermobility and genetic collagen disorders: Are they related? Archives of Disorder Child, 80, 188-191.

  
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